Abstract
Purpose of Review
Genetic testing for mental illness is likely to become increasingly prevalent as the science behind it is refined. This article identifies anticipated ethical challenges for patients, psychiatrists, and genetic counselors and makes recommendations for addressing them.
Recent Findings
Many of the ethical challenges of psychiatric genetic testing are likely to stem from failures to comprehend the nature and implications of test results. Recent studies have identified gaps in the knowledge base of psychiatrists and genetic counselors, which limit their abilities to provide patients with appropriate education. A small number of studies have demonstrated the value of counseling in empowering patients to deal with relevant genetic information.
Summary
Psychiatrists and other health professionals must be able to assist patients and families in making informed decisions about genetic testing and interpreting test results. Filling their knowledge gaps on these issues will be a critical step towards meeting these responsibilities.
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References
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Couzin J. Gene tests for psychiatric risk polarize researchers. Science. 2008;319:274–7.
Austin J. Genetic testing for psychiatric disorders: its role in clinical psychiatric practice. Psychiatr Times. 2013:15–7.
Mitchell PB, Meiser B, Wilde A, Fullerton J, Donald J, Wilhelm K, et al. Predictive and diagnostic genetic testing in psychiatry. Psychiatr Genet. 2010;33:225–43.
Samson JN, Wong AHC. 2015 The genetics of schizophrenia. In: Lipina TV, Roder JC, editors. Drug Discovery in Schizophrenia. Royal Society of Chemistry.
Schizophrenia Working Group of the Psychiatric Genomics Consortium. Biological insights from 108 schizophrenia-associated genetic loci. Nature. 2014;511:421–7.
Hyde CL, Nagle MW, Tian C, Chen X, Paciga SA, Wendland JR, et al. Identification of 15 genetic loci associated with risk of major depression in individuals of European descent. Nat Genet. 2016;48:1031–6.
Uher R. Gene–environment interactions in common mental disorders: an update and strategy for a genome-wide search. Soc Psychiatry Psychiatr Epidemiol. 2014;49:3–14.
•• Dubovsky SL. The limitations of genetic testing in psychiatry. Psychother Psychosom. 2016;85:129–35. Thorough evaluation of the challenges and limitations of genetic testing for psychiatric disorders, including an excellent review of relevant genetic testing and treatment studies
Zandi PP, Judy JT. The promise and reality of pharmacogenetics in psychiatry. Psychiatr Clin North Am. 2010;33:181–224.
•• Salm M, Abbate K, Appelbaum P, Ottman R, Chung W, Marder K, et al. Use of genetic tests among neurologists and psychiatrists: knowledge, attitudes, behaviors, and needs for training. J Genet Couns. 2014;23:156–63. Important study of neurologists’ and psychiatrists’ opinions and practices concerning genetic tests, finding that most believed such tests important but were concerned about possible psychological harm to patients, and that almost half of respondents lacked a genetics professional for patient referrals
Lawrence RE, Appelbaum PS. Genetic testing in psychiatry: a review of attitudes and beliefs. Psychiatry. 2011;74:315–31.
Lebowitz MS, Ahn W, Nolen-Hoeksema S. Fixable or fate? Perceptions of the biology of depression. J Consult Clin Psychol. 2013;81:518–27.
Lebowitz MS, Ahn W. Effects of biological explanations for mental disorders on clinicians’ empathy. Proc Natl Acad Sci. 2014;111:17786–90.
Austin JC, Smith GN, Honer WG. The genomic era and perceptions of psychotic disorders: genetic risk estimation, associations with reproductive decisions and views about predictive testing. Am J Med Genet B Neuropsychiatr Genet 2006;141B:926–928.
DeLisi LE, Bertisch H. A preliminary comparison of the hopes of researchers, clinicians, and families for the future ethical use of genetic findings on schizophrenia. Am J Med Genet B Neuropsychiatr Genet. 2006;141B:110–5.
Laegsgaard MM, Kristensen AS, Mors O. Potential consumers’ attitudes toward psychiatric genetic research and testing and factors influencing their intentions to test. Genet Test Mol Biomark. 2009;13:57–65.
Meiser B, Mitchell PB, Kasparian NA, Strong K, Simpson JM, Mireskandari S, et al. Attitudes towards childbearing, causal attributions for bipolar disorder and psychological distress: a study of families with multiple cases of bipolar disorder. Psychol Med. 2007;37:1601–11.
Meiser B, Kasparian NA, Mitchell PB, Strong K, Simpson JM, Tabassum L, et al. Attitudes to genetic testing in families with multiple cases of bipolar disorder. Genet Test. 2008;12:233–43.
Friedman Ross L, Saal HM, David KL, Anderson RR. American Academy of Pediatrics, American College of Medical Genetics and Genomics. Technical report: ethical and policy issues in genetic testing and screening of children. Genet Med. 2013;15:234–45.
Appelbaum PS. Who’s afraid of psychiatric genomics? Am J Bioeth. 2017;17(4):15–7.
Lawrence RE, Friesen P, Brucato G, Girgis RR, Dixon L. Concerns about genetic testing for schizophrenia among young adults at clinical high risk for psychosis. AJOB Empir Bioeth. 2016;7:193–8.
Egalite N, Groisman IJ, Godard B. Genetic counseling practice in next generation sequencing research: implications for the ethical oversight of the informed consent process. J Genet Couns. 2014;23:661–70.
Shirts BH, Parker LS. Changing interpretations, stable genes: responsibilities of patients, professionals, and policy makers in the clinical interpretation of complex genetic information. Genet Med. 2008;10:778–83.
Roche MI, Berg JS. Incidental findings with genomic testing: implications for genetic counseling practice. Curr Genet Med Rep. 2015;3:166–76.
Appelbaum PS, Fyer A, Klitzman RL, Martinez J, Parens E, Zhang Y, et al. Researchers’ views on informed consent for return of secondary results in genomic research. Genet Med. 2015;17:644–50.
Aziz N, Zhao Q, Bry L, Driscoll DK, Funke B, Gibson JS, et al. College of American Pathologists’ laboratory standards for next-generation sequencing clinical tests. Arch Pathol Lab Med. 2015;139:481–93.
Dar-Nimrod I, Heine SJ. Genetic essentialism: on the deceptive determinism of DNA. Psychol Bull. 2011;137:800–18.
• Friesen P, Lawrence RE, Brucato G, Girgis RR, Dixon L. Hopes and expectations regarding genetic testing for schizophrenia among young adults at clinical high-risk for psychosis. J Psychiatr Pract. 2016;22:442–9. Qualitative study of 15 young adults at clinical high-risk for psychosis to evaluate understanding of and hopes regarding genetic testing for schizophrenia; this article includes a recommendation for incorporation of genetic counseling to help counteract genetic optimism and educate young adults about the limitations of genetic testing
Appelbaum PS. Genetic discrimination in mental disorders: the impact of the Genetic Information Nondiscrimination Act. Psychiatr Serv. 2010;61:338–40.
Sankar P, Cho MK, Wolpe PR, Schairer C. What is in a cause? Exploring the relationship between genetic cause and felt stigma. Genet Med. 2006;8:33–42.
Phelan JC, Bromet EJ, Link BG. Psychiatric illness and family stigma. Schizophr Bull. 1998;24:115–26.
Hinshaw SP. The stigmatization of mental illness in children and parents: developmental issues, family concerns, and research needs. J Child Psychol Psychiatry. 2005;46:714–34.
Angermeyer MC, Schulze B, Dietrich S. Courtesy stigma: a focus group study of relatives of schizophrenia patients. Soc Psychiatry Psychiatr Epidemiol. 2003;38:593–602.
Chapple A, May C, Campion P. Parental guilt: the part played by the clinical geneticist. J Genet Couns. 1995;4:179–91.
Trippitelli CL, Jamison KR, Folstein MF, Bartko JJ, DePaulo JR. Pilot study on patients’ and spouses’ attitudes toward potential genetic testing for bipolar disorder. Am J Psychiatry. 1998;155:899–904.
Gershon ES, Alliey-Rodriguez N. New ethical issues for genetic counseling in common mental disorders. Am J Psychiatry. 2013;170:968–76.
Suther S, Kiros G-E. Barriers to the use of genetic testing: a study of racial and ethnic disparities. Genet Med. 2009;11:655–62.
Jenkins S, Arribas-Ayllon M. Genetic counselling for psychiatric disorders: accounts of psychiatric health professionals in the United Kingdom. J Genet Couns. 2016;25:1243–55.
Hoop JG, Roberts LW, Hammond KAG, Cox NJ. Psychiatrists’ attitudes, knowledge, and experience regarding genetics: a preliminary study. Genet Med. 2008;10:439–49.
Finn CT, Smoller JW. Genetic counseling in psychiatry. Harv Rev Psychiatry. 2006;14:109–21.
Tsuang DW, Faraone SV, Tsuang MT. Genetic counseling for psychiatric disorders. Curr Psychiatry Rep. 2001;3:138–43.
•• Inglis A, Koehn D, McGillivray B, Stewart SE, Austin J. Evaluating a unique, specialist psychiatric genetic counseling clinic: uptake and impact. Clin Genet. 2015;87:218–24. Important study of individuals with non-syndromic psychiatric disorders and their families, assessing the impact of genetic counseling and finding it to increase empowerment
• Hippman C, Ringrose A, Inglis A, Cheek J, Albert AYK, Remick R, et al. A pilot randomized clinical trial evaluating the impact of genetic counseling for serious mental illnesses. J Clin Psychiatry. 2016;77(2):e190–8. doi:10.4088/JCP.14m09710. This controlled trial studied participants’ understanding and perception of their illness, and assessed the impact of genetic counseling. The authors recommend that genetic counseling should be considered for patients with serious mental illnesses
National Society of Genetic Counselors: who are genetic counselors? [Internet]. [cited 2017 Mar 9]. Available from: http://www.nsgc.org/page/whoaregcs
Peay H, McInerney J. A pilot study on psychiatric genetic counseling: counselors’ needs. J Genet Couns. 2002;11:485. [abstract]
Monaco LC, Conway L, Valverde K, Austin JC. Exploring genetic counselors’ perceptions of and attitudes towards schizophrenia. Public Health Genomics. 2010;13:21–6.
Hunter MJ, Hippman C, Honer WG, Austin JC. Genetic counseling for schizophrenia: a review of referrals to a provincial medical genetics program from 1968–2007. Am J Med Genet A. 2010;152A:147–52.
Maintenance of certification: continuing medical education [Internet]. Am Board Psychiatry Neurol. [cited 2017 Mar 9]. Available from: https://www.abpn.com/maintain-certification/moc-activity-requirements/continuing-medical-education-cme/
PA State Board of Medicine. CE requirements for genetic counselors [Internet]. Jan 1, 2015. Available from: http://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/Medicine/Documents/Board%20Documents/MedM%20-%20CME%20Genetic%20Counselors.pdf
National Society of Genetic Counselors: states issuing licenses for genetic counselors [Internet]. [cited 2017 Mar 9]. Available from: http://www.nsgc.org/p/cm/ld/fid=19
Acknowledgements
This work was supported by grants from the National Human Genome Research Institute (P50HG007257 and U01HG008680).
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Paul S. Appelbaum and Shawna Benston report a grant from the National Human Genome Research Institute.
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This article does not contain any studies with human or animal subjects performed by any of the authors.
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This article is part of the Topical Collection on Genetic Disorders
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Appelbaum, P.S., Benston, S. Anticipating the Ethical Challenges of Psychiatric Genetic Testing. Curr Psychiatry Rep 19, 39 (2017). https://doi.org/10.1007/s11920-017-0790-x
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DOI: https://doi.org/10.1007/s11920-017-0790-x