Committee updates guidelines for genetic testing in psychiatric care

A committee of psychiatrists and geneticists from the International Society of Psychiatric Genetics has issued an update to their recommendations for the use of genetic testing in psychiatric care.

The revised guidelines address using genetic testing to guide treatment, diagnose mental disorders with molecular technologies, and related clinical and ethical challenges, according to a statement from the society.

The expert committee reviewed the available evidence to provide guidance for mental health clinicians as well as health care providers in general medical communities.

“As the major scientific society focused on the genetics of psychiatric disorders, the International Society of Psychiatric Genetics recognizes the growing attention given to clinical genetic testing and the questions raised about the value of such testing in psychiatry,” according to the statement. “This statement is based on the best available published evidence to date and will be reviewed periodically to keep pace with this rapidly changing field.”

Recommendations/statements included:

promoting educational programs that improve knowledge of genetic medicine among trainees and mental health professionals, increase public awareness and decrease stigma;
identifying known pathogenic variants could help diagnose rare conditions and inform family counseling;
detecting de novo mutations and copy number variants (CNVs) could help manage serious psychiatric disorders;
conducting CNV testing for familial risk counseling;
diagnostic or genome-wide genetic testing should include counseling by a professional with expertise in mental health and interpreting genetic tests;
if possible, consultation with a medical geneticist when a patient has a recognized genetic disorder or when broad health implications are identified;
respecting the autonomy of patients regarding preferences for notification of any incidental findings whenever genome-wide testing is performed;
genetic test results remain private; and
conducting HLA-A and HLA-B testing before carbamazepine and oxcarbazepine use.

The committee explained that common genetic variants alone are not enough to cause psychiatric disorders (ie, depression, bipolar disorder, substance dependence or schizophrenia), but the clinical value of combining genotypes from large numbers of common variants — which can produce an overall genetic risk score — is still unclear.

However, the committee could not agree on widespread use of genetic testing for CNVs in adult-onset mental illness, even though they agreed it has utility for children with autism and other neurodevelopmental disorders, according to a press release.

In addition, they could not agree on pharmacogenetic tests that clinicians should use when debating whether to prescribe drugs like carbamazepine. They recommended using pharmacogenetic testing “as a decision-support tool to assist in thoughtful implementation of good clinical care.”

More research is needed to identify relevant genes and understand the correct role of genetic testing and its clinical utility in psychiatric care, according to the committee. – by Savannah Demko

Reference:

International Society of Psychiatric Genetics. Genetic Testing Statement. https://ispg.net/genetic-testing-statement/. Accessed on Mar. 13, 2019.

Disclosure: Healio Psychiatry was unable to confirm any relevant financial disclosures at the time of publication.