Genetics education a necessity now, for the future of psychiatric care

Genetics education should no longer be considered optional in psychiatric training as it is currently critical to patient care, according to experts in the field.

However, knowledge of psychiatric genetics — and how to incorporate this knowledge into clinical practice — are not at the forefront of current residency training programs, members of the Residency Education Committee of the International Society of Psychiatric Genetics wrote in a viewpoint published in JAMA Psychiatry and a companion article published in the Journal of Clinical Psychiatry.

“Most psychiatry residencies included very limited education in genetics,” John Nurnberger Jr, MD, PhD, of Indiana University School of Medicine, told Healio Psychiatry, speaking on behalf of the other viewpoint authors, Aaron Besterman, MD, and Daniel Moreno-De-Luca, MD, as well as the Residency Education Committee of the International Society of Psychiatric Genetics.

“Reasons for this include limited familiarity with genetics among faculty members and a prevailing opinion that genetic principles and genetic testing are not currently useful or needed in clinical practice. Our paper challenges that idea,” he continued.

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The importance of genetic testing

Clinical evidence has shown that different types of genetic variations can increase a person’s risk for psychiatric disorders, Nurnberger and colleagues wrote in the viewpoint. Although genetic testing is now recommended for all patients with autism spectrum disorder, intellectual disabilities and developmental delay, only a minority of these patients receive testing.

“We believe there are multiple reasons that the recommendations are not followed,” Nurnberger said. “Some of them include the following: not all clinicians are aware of the recommendations; patients and families may not agree to have testing done; clinicians may be under the impression that the yield from testing is too small; there may be reimbursement issues; and clinicians may not be comfortable ordering or interpreting genetic tests.”

In their Journal of Clinical Psychiatry article, the Committee advised that psychiatric residents consider genetic testing a standard part of the diagnostic workup for patients with autism disorders or intellectual disabilities.

There are many clinical benefits of genetic testing in psychiatry, Nurnberger and colleagues wrote, including having a better etiologic understanding of a patient’s specific disorder, the ability to provide support and counseling for the patient and family, watching for any known comorbidities and reducing the risk for medication adverse effects.

Therapeutic response and pharmacologic treatment-related adverse effects are modulated by genetic factors, the Committee explained. Pharmacogenomic tests may be helpful in certain situations. The Committee encourages caution in the use of currently available commercial screening tests since their efficacy is not yet firmly established in controlled clinical trials. Psychiatrists in training will need to know how to consider whether these products, or more specialized tests, can help guide the management of patients; for example, when certain patients are taking carbamazepine or citalopram.

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In training and practice

The Committee has collaborated with the National Neuroscience Curriculum Initiative and the Inter-Society Coordinating Committee for Practitioner Education in Genomics to provide online learning activities and resources on multiple neuroscience topics to boost genetics training (http://www.nncionline.org). Nurnberger recommended residency programs emphasize these experiential problem-solving exercises but practicing clinicians can use these resources as well.

Nurnberger and colleagues also recommended using informal seminars and journal clubs to talk about genetic topics in a setting that allows for more questions and discussion. In addition, residents should be encouraged to go to meetings presenting high-level genetic data.

“It’s time for psychiatrists to consider familiarity with genetic principles and findings as a necessary part of our expertise,” Nurnberger told Healio Psychiatry. “Increasingly, our patient care will require this, not least because patients will bring us questions and test results that require a knowledgeable response. Proper treatment will also require that psychiatrists are familiar with the situations in which they should order genetic tests.”

Spreading the word that genetics education should be featured in psychiatric training presents an ongoing challenge. Nurnberger said the Committee plans to continue highlighting the importance of implementing these principles in education and practice and internalizing this message to include countries in the developing world in the future. – by Savannah Demko

References:

Besterman AD, et al. JAMA Psychiatry. 2019;doi:10.1001/jamapsychiatry.2018.3872.

Nurnberger Jr. JI, et al. J Clin Psychiatry. 2019;doi:10.4088/JCP.17nr12046.

Disclosure: Nurnberger reports serving as an investigator for Assurex and for Janssen.