Growing consumer awareness and the increasing availability of genetic tests for many conditions is likely increasing the number of questions your patients are asking about their risk of disease, the risk to their offspring and whether genetic testing is right for them. Genetic counselors can help you address your patients’ needs and incorporate genetics and genomics into your practice.
1. What is the Psychiatric SIG?
The Psychiatric SIG is a group of genetic counselors who work together to develop and advance the field of psychiatric genetic counseling by:
- Promoting awareness within the NSGC and outside the NSGC,
- Providing education to NSGC members as well as all healthcare professionals and the general public, and
- Encouraging dialogue between SIG members and other groups such as researchers, patient advocacy groups, other healthcare provider groups, and affected individuals and families.
2. What information can genetic counselors provide about psychiatric illnesses?
Major psychiatric illnesses are common – approximately 3% of the population are affected by schizophrenia, bipolar disorder or schizoaffective disorder - complex disorders, for which no genetic testing is currently clinically available. In spite of the lack of genetic testing, there is general recognition that these illnesses typically arise as a result of the combined effects of several genetic and environmental contributions. In addition, some of the specific potential contributors to risk have been identified; these are thought to include cannabis use, methamphetamine use, immigration, obstetric complications, and a number of specific genes. Thus, although not all of the potential contributors have yet been identified, genetic counselors can present what is currently known in an accessible manner. Further, for most mental illnesses, high quality empiric risk data are available, so even in the absence of genetic testing, risks for family members to become affected can be calculated by individualizing empiric risks based on unique characteristics of the family in question (e.g. age at illness onset, age of individual for whom risk is calculated, etc.). Further, genetic counseling is well suited to address some of the misconceptions that many people have regarding mental illnesses, e.g. fatalistic beliefs, or theories about “schizophrenogenic” mothers, and can be used to frame information about genetic and environmental contributors to mental illness pathogenesis in such a way that affected individuals are not thought of as genetically “different”. For example, it appears likely that everyone has genetic vulnerability to psychiatric illness; the amount will simply vary between individuals. Thus, genetic counseling may be ideally placed to address disease-associated stigma.
3. What has the Psychiatric SIG accomplished (including references and resources we would recommend)?
Since the Psychiatric Special Interest Group’s inception in 1996, we have concentrated on providing education about the current state of psychiatric genetics to fellow genetic counselors at the NSGC AEC and through publications in the Journal of Genetic Counseling (see below), as well as to other health care providers, such as psychiatrists at the Annual Psychiatric Association (APA) conference in 2009.
- Peay, H. L., McCarthy Veach, P., Palmer, C. G. S., Rosen-Sheidley, B., Gettig, E., & Austin, J. C. 2008. Psychiatric disorders in clinical genetics I: Addressing family histories of psychiatric illness. Journal of Genetic Counseling, 17 (1), 6-17.
- Austin, J. C., Palmer, C. G. S., Rosen-Sheidley, B., McCarthy Veach, P., Gettig, E., & Peay, H. L. 2008. Psychiatric disorders in clinical genetics II: Individualizing recurrence risks. Journal of Genetic Counseling, 17 (1), 18-29.
Before we can embark on writing Practice Guidelines for Psychiatric Genetic Counseling, there needs to be a sufficient evidence base to support recommendations. Therefore, members of the Psychiatric SIG have been working tirelessly to generate such evidence. Here is a list of journal articles that have been published on the path towards evidence-based psychiatric genetic counseling:
- Austin, J.C., Smith, G.N., & Honer, W.G. 2006. The genomic era and perceptions of psychotic disorders: Genetic risk estimation, associations with reproductive decisions, and views about predictive testing. American Journal of Medical Genetics. Part B., 141B, 926-928.
- Lyus, V.L. 2007. The importance of genetic counseling for individuals with schizophrenia and their relatives: Potential clients' opinions and experiences. American Journal of Medical Genetics; 144B(8): 1014-1021.
- Austin, J.C. & Honer, W.G. 2008. Psychiatric genetic counseling for parents of individuals with psychotic disorders: A pilot study. Early Intervention in Psychiatry, 2, 80-89.
- Peay, H.L., Hooker, G.W., Kassem, L., & Biesecker, B.B. 2009. Family risk and related education and counseling needs: Perceptions of adults with bipolar disorder and siblings of adults with bipolar disorder. American Journal of Medical Genetics. Part A., 149A(3), 364-371.
- Hunter, M.J., Hippman, C., Honer, W.G., & Austin, J.C. 2010. Genetic counseling for schizophrenia: A review of referrals to a provincial medical genetics program from 1968 to 2007. American Journal of Medical Genetics. Part A., 152A(1), 147-152.
While you’re waiting for the Practice Guidelines, we suggest checking out a book recently published by two of our members: “How to Talk with Families About Genetics and Psychiatric Illness”, by Dr. Jehannine Austin and Holly Peay.
4. What are we working on now?
- We have many current studies that are ongoing in the area of genetics and psychiatric illness, including the first randomized controlled trial investigating the efficacy of genetic counseling for psychiatric illness. Stay tuned for results from current studies as well as our next big project: a multi-site randomized controlled trial evaluating the efficacy of psychiatric genetic counseling.
- The Psychiatric SIG offers a grant award every year to support student projects that focus on psychiatric illnesses.
- We are always trying to disseminate information about genetics and psychiatric illness, including keeping an up-to-date list of empiric recurrence risks on the Psychiatric SIG webpage.
5. Why do genetic counselors join the Psychiatric SIG?
- To learn more about psychiatric illnesses
- To stay on top of current research into the genetics of psychiatric illnesses
- To participate in educational efforts on the topic of psychiatric illnesses
- To join forces with like-minded individuals
You do not have to practice in the area or already have expertise in the area to join the SIG and make a valuable contribution to our activities!
6. Want more information?
Please contact either of the Psychiatric SIG co-chairs