Genetic Counselling for Psychiatric Disorders: Accounts of Psychiatric Health Professionals in the United Kingdom

Genetic counselling is not routinely offered for psychiatric disorders in the United Kingdom through NHS regional clinical genetics departments. However, recent genomic advances, confirming a genetic contribution to mental illness, are anticipated to increase demand for psychiatric genetic counselling. This is the first study of its kind to employ qualitative methods of research to explore accounts of psychiatric health professionals regarding the prospects for genetic counselling services within clinical psychiatry in the UK. Data were collected from 32 questionnaire participants, and 9 subsequent interviewees. Data analysis revealed that although participants had not encountered patients explicitly demanding psychiatric genetic counselling, psychiatric health professionals believe that such a service would be useful and desirable. Genomic advances may have significant implications for genetic counselling in clinical psychiatry even if these discoveries do not lead to genetic testing. Psychiatric health professionals describe clinical genetics as a skilled profession capable of combining complex risk communication with much needed psychosocial support. However, participants noted barriers to the implementation of psychiatric genetic counselling services including, but not limited to, the complexities of uncertainty in psychiatric diagnoses, patient engagement and ethical concerns regarding limited capacity.     

Complex Genetic Disorders: Evaluating When Genetic Research Findings Are Applicable for Genetic Counseling Practice

Traditional genetic counseling processes and principles will be extended to a new realm—complex disorders. Although it may seem like a daunting task, understanding the methodologies used to study complex genetic disorders will enable genetic counselors to critically analyze research studies involving complex disorders. In this article, we explain newly evolving methodologies for genetic research, including case-control studies and transmission disequilibrium testing (TDT). Additionally, a framework is provided for evaluating original research findings and replication studies.     

Billing for Medical Genetics and Genetic Counseling Services: A National Survey

In January 2007 the American Medical Association added a new Current Procedural Terminology® (CPT) code, 96040, for “Medical Genetics and Genetic Counseling Services.” In order to identify the impact of having this new code and to identify issues with implementation of the code, the National Society of Genetic Counselors (NSGC) CPT® Working Group surveyed NSGC members using an internet-based survey tool. The majority of respondents (94%) reported being aware of the new code and over half of the respondents (69%) said they were billing for genetic counseling. Approximately 24% of those billing reported using 96040. Many facilities are not using this code and the reported success of billing using 96040 is highly varied. Continued education may be beneficial to encourage reimbursement for 96040 and follow up is needed to assess the ongoing implementation and impact of the new CPT® code.     

Reading Disability: A Model for the Genetic Analysis of Complex Behavioral Disorders

Family, linkage, and twin studies of reading disability are briefly reviewed, and evidence is presented from the twin component of the Colorado Reading Project that implicates genetic factors in the expression of reading disability. Recently developed behavioral genetic methodology is outlined, which provides an estimate of the magnitude of these genetic effects. The present report details the application of this methodology to reading performance data obtained from 96 identical twin pairs and 72 fraternal twin pairs in which at least one member of each pair was identified as reading disabled. Results indicate that approximately 50% of the reading deficit observed in the probands may be attributed to genetic factors. Although such an analysis assumes that reading disability is a homogeneous disorder, there may exist alternative forms with differing genetic etiologies. To test this hypothesis, the methodology can be extended to assess differential genetic etiology in alternative subgroups of disabled readers.     

Affirming the Existential within Medicine: Medical Humanities, Governance, and Imaginative Understanding

This paper first distinguishes governance (collective, autonomous self-regulatory processes) from government (externally-imposed mandatory regulation); it proposes that the second of these is essentially incompatible with a conception of the medical humanities that involves imagination and vision on the part of medical practitioners. It next develops that conception of the medical humanities, as having three distinguishable aspects (all of them distinct from the separate phenomena popularly known as "arts-in-health"): first, an intellectual enquiry into the nature of clinical medicine; second, an important dimension of medical education; third, a resource for moral and aesthetic influences upon clinical practice, supporting "humane health care" as the moral inspirations behind organised medicine. Medical humanities sustains these three aspects through paying proper attention to the existential and subjective aspects of medicine. By encouraging authentic imagination among health care practitioners, medical humanities aligns well with both humane health care and governance in the sense of self-regulation. However, it can neither be achieved mechanistically nor well-measured through proxies such as patient satisfaction. Above all, it should not be allowed to supply, through inappropriate qualitative "targets," new forms of management tyranny.     

Personal Constructs of Students with Eating Disorders: Implications for Counselling

Members of two self-help groupsfor university andpolytechnic students with eating disorders were asked to generale personal constructs. The analysis of the subsequent grids showed that the students were concerned with similar emotional issues. Il also produceda significant difference between ratings of'self and 'ideal self, butfailed to produce evidence of' tight' construing. Discussion ofthe grids made a positive contribution to the self-help process.     

University Counselling Services in Australia and New Zealand: Activities,Changes, and Challenges

The high prevalence of stress and psychological distress in university students highlights the need for adequate support services to enable students to achieve their goals. This study aimed to describe counselling services available to university students in Australia and New Zealand and to benchmark them against international services. Participants were five Australian and three New Zealand Counselling Services. Results showed that counselling services are using a variety of formats and e‐technologies to deliver services to students, but are hampered by limited resources compared with their international counterparts. These include very high counsellor student ratios, lower average number of consultations per student, and lower mental health qualifications of counsellors. This has even greater implications in the context of higher education reform in Australia that may further widen the gap between needs of students and available counselling services. Inadequate counselling support can negatively impact on students, universities, and the community through lost potential.     

Risk Perception and Psychological Distress in Genetic Counselling for Hereditary Breast and/or Ovarian Cancer

Oncological Genetic Counselling (CGO) allows the identification of a genetic component that increases the risk of developing a cancer. Individuals’ psychological reactions are influenced by both the content of the received information and the subjective perception of their own risk of becoming ill or being a carrier of a genetic mutation. This study included 120 participants who underwent genetic counselling for breast and/or ovarian cancer. The aim of the study was to examine the relation between their cancer risk perception and the genetic risk during CGO before receiving genetic test results, considering the influence of some psychological variables, in particular distress, anxiety and depression. Participants completed the following tools during a psychological interview: a socio-demographic form, Cancer Risk Perception (CRP) and Genetic Risk Perception (GRP), Hospital Anxiety and Depression Scale (HADS) and Distress Thermometer (DT). The data seem to confirm our hypothesis. Positive and significant correlations were found between the observed variables. Moreover, genetic risk perception determined an increase in depressive symptomatology and cancer risk perception led to an increase in anxious symptomatology, specifically in participants during cancer treatment. The present results suggest the importance of assessing genetic and cancer risk perception in individuals who undergo CGO, to identify those who are at risk of a decrease in psychological well-being and of developing greater psychological distress.     

The Interface Between the Practice of Medical Genetics and Human Genetic Research: What Every Genetic Counselor Needs to Know

Genetic counselors have historically used human genetic research as an advanced information resource for their patients. Most commonly, this has been via access to information provided by gene identification studies in advance of commercial testing. More recently genetic counselors have been participating in human genetic research studies as part of the investigative team. This review provides a framework to help genetic counselors in research and clinical practice understand the historical perspectives, ethical principles, and federal regulations that govern the current practice of human subject research. Special consideration is given to the IRB process and unique issues in human genetic research. This overview is intended to help improve the ability of genetic counselors to act as advocates for their patients.     

Causal Impotence and Evolutionary Influence: Epistemological Challenges for Non-Naturalism

Two epistemological critiques of non-naturalism are not always carefully distinguished. According to the Causal Objection, the fact that moral properties cannot cause our moral beliefs implies that it would be a coincidence if many of them were true. According to the Evolutionary Objection, the fact that evolutionary pressures have influenced our moral beliefs implies a similar coincidence. After distinguishing these epistemological critiques, I provide an extensive defense of the Causal Objection that also strengthens the Evolutionary Objection. In particular, I formulate a “Master Causal Objection” featuring the controversial premise that non-naturalism can provide no adequate explanation for moral knowledge. I defend this premise by first narrowing down the range of candidate explanations to conceptual, constitutive, and evolutionary explanations, and then considering and eliminating each of these in turn.  My discussion of evolutionary explanations suggests that non-naturalists must refute the Causal Objection in order to refute the Evolutionary Objection.     

循证医学与医学教育改革

循证医学这一新的医疗模式反映了世界医学的发展趋势,代表了现代医学的前进方向。医学教育必须应这一趋势,按照循证医学的基本精神促进观念更新,推进医疗模式、教学内容、教学方法和继续教育等方面的改革,全面提高医学教育质量。     

Reprogenetics,Genetic Tools and Reproductive Risk: Attitudes and Understanding Among Ethnic Groups in Israel

The present study investigated a possible relationship between the attitudes toward genetic technologies and the understanding of genetics, reproduction, and reproductive risk among Israeli Arabs and Israeli Jews. The study included 203 respondents, who answered a structured self-report questionnaire. They were recruited using a snowball method, which increased the participation of Israeli Arabs in the sample, although the sample was not representative of the Israeli population as a whole (there were more Arabs and fewer men). The respondents in this study expressed a positive attitude toward genetic technologies, but were less in favor of using genetic tools for non-medical purposes. Respondents of both groups were not knowledgeable of genetics; however, they scored higher on the items related to reproductive risk, which suggests that some awareness about genetic risk exists in both sectors of the Israeli population. Nevertheless, Israeli Arabs were less positive than Israeli Jews regarding the application of genetic tools. Moreover, although an understanding of genetics correlated positively with the attitude among Arabs, it did not affect the attitude of Jews, who remained very positive, regardless of their level of understanding. This result suggests that other social and cultural factors, besides understanding, might be at work among these two major ethnic sectors. Further studies that integrate educational, social, and cultural aspects among ethnic sectors of the population are required to improve health services and genetic counselling in Israel and in other countries.     

医学、医学教育的本质与医学人文精神的培养

医学的本质属性是社会性和人文性.医学的终极价值是医学人文价值,医学教育的本质要求必须做好医学生人文精神的培养.医学教育改革的重点是如何加强和改进医学人文教育.医学人才培养的重点是增强医学人文精神的培育与养成.从新的视角加强医学人文教育是当代医学教育工作者的历史使命和重要责任.     

Attitudes and Beliefs of African-Americans Toward Genetics,Genetic Testing,and Sickle Cell Disease Education and Awareness

Research among African-Americans indicates this population perceives sickle cell (SCD) to be a serious disease and sickle cell trait (SCT) screening an important intervention. However, studies have consistently demonstrated a lower than desired uptake of SCD education, inadequate knowledge regarding personal and family trait status, and a low perceived susceptibility of giving birth to a child with the disease. We examined general attitudes and beliefs regarding genetics and genetic testing including prenatal testing and newborn screening; we used this information as the foundation to more specifically assess attitudes and beliefs regarding SCD and perceived barriers to SCD education and awareness. Thirty-five African-American adult men and women participated in one of four focus groups. Thematic analysis identified that both prenatal testing and newborn screening are acceptable forms of genetic testing. Based largely on their personal experiences, participants possessed an understanding of the natural progression of SCD but had a limited understanding of the inheritance and probable risk of giving birth to a child with the disease. Barriers to education and greater awareness of SCD were classified as personal, familial, and societal. Community based interventions focused on sharing the stories of individuals with first-hand experiences with SCD should be considered.     

Counselling, support and advice: The adolescent viewpoint

Few discussions on counselling pay more than lip service to what adolescents actually want. Data presented on the preferences of adolescents with regard to helping services show that no one method of providing help would be adequate. An indication of the number of relatively Isolated and unsupported adolescents is given, suggesting that 20-40% of young people lack a regular source of advice or understanding. Professional and official sources of advice are rarely used, and are not likely to be until they improve both their accessibility and image in the eyes of youth.     

医学整合:公共卫生教育发展的方向

医学整合是我国公共卫生发展的战略方向,也是公共卫生教育发展的方向.我国公共卫生教育在医学整合存在诸多不利因素,需要与基础医学和临床医学教育整合,与健康教育和健康促进整合,与公共卫生实践整合,培养具有整合医学知识、素质和能力的公共卫生人才.     

Eating Disorders: A Bond between Medicine,Culture and Psychoanalysis

Action in connection with the therapeutic process is often equated with acting out. The subtle behaviour that belongs to ?the complicated system of transmitting and receiving unconscious signals? (Sandler), with which the patient attempts to make the analyst behave as the object of transference or to fulfill an unconscious desire, is also described as acting out or micro-acting out (Treurniet). This fine-grained action, however, means nothing; it is not symbolic or communicative action. Its intention is, rather, to trigger effects and induce interactions. It occurs not only on the side of the analysand but also on that of the analyst, and is part of the unconscious communication in the therapeutic process. Presented here are some of the various interactive ways and means with which the analyst is prompted into unconscious action and certain, unnoticed, ways in that he turn ?treats? the patient. The analyst's action responses can bear the character of interpretations with which he may unintentionally reveal how he regards the behaviour of the patient.