by Ananya Sundaram
In recent years, there has been considerable progress in the research of psychiatric genetics, providing invaluable insights into the genetic aetiology of mental disorders. Rather than being based solely on environmental risk factors, evidence from past decades shows that several conditions, including bipolar disorder, schizophrenia and autism, are highly heritable. More recently, this growing field of research has also found that certain gene variations can be linked with these disorders, which could prove useful in clinical settings. Possible clinical applications have not yet been put into practice, but as research continues and our understanding of psychiatric genetics advances, mechanisms may be established to predict an individual’s risk of developing a mental illness.
This development poses many ethical questions and concerns, due to the possible misuse of these tools. Among these are questions about how policies should differ by age of the patient (i.e prenatal, child and adult); who should be able to request or access tests and results; and concerns about reactions of patients to their results, particularly if they are found to be at high risk of developing a psychiatric disorder. A 2009 study documented that 62% of unaffected individuals expressed concern that positive tests results could lead to negative feelings of stress, vulnerability or even depression, and 61% of patients and family members worried that it could increase suicide rates. There were also common concerns about employment discrimination.
Some participants noted that a positive test result for risk of psychiatric disorder may encourage them to adjust their lifestyle choices. For example, those at risk of depression may limit drug and alcohol intake, reduce stress, and exercise more. Some reported that it may even factor into their decisions about marriage and childbearing.
Prenatal screening is a particularly divisive topic, as the only available intervention would be termination of the pregnancy. Factors such as personal opposition to abortion and faith in the development of new treatments led to varied responses to this proposition. The least controversial form of genetic screening for risk of mental illness is for symptomatic patients. When surveyed, psychiatrists and patients alike agreed that this could prove very useful.
In conclusion, attitudes towards genetic testing for psychiatric disorders are complex and varied. While there are many concerns with the use of this tool, there seems to be a general consensus that it could be extremely beneficial in clinical practice.
Citations:
[1] Lawrence, Ryan E, and Paul S Appelbaum. “Genetic Testing in Psychiatry: A Review of Attitudes and Beliefs .” Psychiatry, 2011. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3285424/#R48.
[2] Andreassen, Ole A, Guy F L Hindley, Oleksandr Frei, and Olav B Smeland. “New Insights from the Last Decade of Research in Psychiatric Genetics: Discoveries, Challenges and Clinical Implications.” World psychiatry : official journal of the World Psychiatric Association (WPA), February 2023. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9840515/.
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