How to Talk with Families About Genetics and Psychiatric Illness
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Addressing clients’ questions and concerns about the role of genetics in mental illness.
As we learn more about how our biology and genes can play into the development of a mental health disorder, patients and their families are increasingly seeking answers to tough questions about common risk factors, the likelihood of recurrence, the need for genetic testing, and implications for future generations.
A practical, go-to resource for all mental health clinicians, this guide explains just how to address these questions and concerns in a way that’s comprehensible and compassionate. Filled with case studies, sample dialogues, and question-and-answer examples, it is an essential roadmap for practitioners, helping them to demystify a complex issue for their clients and equip them with the accurate, reassuring information they need.
disorders (Cardno et al., 1999; Smoller & Finn, 2003). Adoption Studies Adoption studies investigate the rates of psychiatric illnesses in adopted children in relation to the rates found in their biological and adoptive parents. These kinds of studies can contribute substantially to the endeavor of disentangling the relative contributions of genes and environment to the development of a psychiatric illness. A limitation is that they can obviously occur only in a naturalistic setting (i.e., the
confirmed clinical validity and utility in predicting onset of psychiatric illness, diagnosing psychiatric illness, or determining best treatment for psychiatric illness (see Chapter 11 for full discussion). We anticipate that this will change, at least for a subset of families, in the near future. What You Can Say to Clients and Family Members about Genetics and Psychiatric Illness “Genes are the instructions that tell the body how to grow, develop, and function.” Starting with a brief
keep in mind that clues may be found in unexpected places. Anticipate that clients will know less about relatives as they become more distantly related. If clients do have information about more distant relatives, be aware that diagnoses may be less reliable and that histories of “institutionalizations” and “nervous breakdowns” must be interpreted in light of the social context of the time. Collect family history from both the maternal and paternal sides of the family. This is important for two
Complications Complications of both pregnancy (e.g., preeclampsia, diabetes, rhesus incompatibility) and delivery (e.g., lack of oxygen during delivery and emergency caesarian section) are associated with increased risk for a newborn to develop schizophrenia in later life. Individuals whose perinatal period was complicated are two to four times more likely to develop schizophrenia than those whose perinatal period was not complicated (Cannon et al., 2002). The evidence regarding risk for mood
Susceptibility Testing Chapter 12. How to Talk About Genetic Testing to Inform Medication Strategy: Personalized Medicine Chapter 13. Looking Forward: How You and Your Client Might Benefit from a More Complete Understanding of Etiology Appendix: Further Reading and Resources References Acknowledgments During the writing of this book, I was supported by the Canadian Institutes of Health Research, the Michael Smith Foundation for Health Research, and the Provincial Health Services Authority