Anxiety Disorders: Harvard University

Kessler RC, Amminger GP, Aguilar-Gaxiola S, Alonso J, Lee S, Ustün TB. · Department of Healthcare Policy, Harvard Medical School, Boston, MA 02115, USA. · Curr Opin Psychiatry. · Pubmed #17551351 links to  free full text

Abstract: PURPOSE OF REVIEW: The aim of this article is to review recent epidemiological research on age-of-onset of mental disorders, focusing on the WHO World Mental Health surveys. RECENT FINDINGS: Median and inter-quartile range (IQR; 25th-75th percentiles) of age-of-onset is much earlier for phobias (7-14, IQR 4-20) and impulse-control disorders (7-15; IQR 4-35) than other anxiety disorders (25-53, IQR 15-75), mood disorders (25-45, IQR 17-65), and substance disorders (18-29, IQR 16-43). Although less data exist for nonaffective psychosis, available evidence suggests that median age-of-onset is in the range late teens through early 20s. Roughly half of all lifetime mental disorders in most studies start by the mid-teens and three quarters by the mid-20s. Later onsets are mostly secondary conditions. Severe disorders are typically preceded by less severe disorders that are seldom brought to clinical attention. SUMMARY: First onset of mental disorders usually occur in childhood or adolescence, although treatment typically does not occur until a number of years later. Although interventions with early incipient disorders might help reduce severity-persistence of primary disorders and prevent secondary disorders, additional research is needed on appropriate treatments for early incipient cases and on long-term evaluation of the effects of early intervention on secondary prevention.

Huffman JC, Stern TA. · Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA. · Dialogues Clin Neurosci. · Pubmed #17506224 No free full text.

Abstract: The use of cardiovascular medications can have a variety of neuropsychiatric consequences. Many cardiovascular agents cause higher rates of fatigue and sedation than placebo, and case reports of medication-induced mood syndromes, psychosis, and cognitive disturbances exist for many cardiovascular drugs. Depression has been associated with P3-blockers, methyldopa, and reserpine, but more recent syntheses of the data have suggested that these associations are much weaker than originally believed. Though low cholesterol levels have been associated with depression and suicide, lipid-lowering agents have not been associated with these adverse effects. Finally, cardiovascular medications may have beneficial neuropsychiatric consequences; for example, the use of clonidine in patients with attention deficit-hyperactivity disorder, the use of prazosin for patients with post-traumatic stress disorder; and the use of propranolol for performance anxiety and akathisia.

Kubzansky LD. · Department of Society, Human Development, and Health, Harvard School of Public Health Boston, MA 02115, USA. · Cleve Clin J Med. · Pubmed #17455549 links to  free full text

This publication has no abstract.

McNally RJ. · Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, MA 02138 USA. · Clin Psychol Rev. · Pubmed #17292521 No free full text.

Abstract: Exposure therapy for anxiety disorders has been one of success stories of clinical psychology and psychiatry. Nevertheless, a significant minority of patients fail to benefit from extant treatments. This clinical impasse is prompting renewed attempts to understand fear and its reduction at neural, cellular, and molecular as well as behavioral levels of analysis. The purpose of this article is to provide a review of theories of exposure therapy, including recent developments in emotional processing theory, and to discuss insights from neuroscience that promise to improve psychological treatments for reducing pathological fears.

Kessler RC. · Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA. · J Clin Psychiatry. · Pubmed #17288502 links to  free full text

Abstract: This article compares the preliminary, descriptive European Study of The Epidemiology of Mental Disorders (ESEMeD) findings reported in this supplement with 8 broad patterns of results found in previous psychiatric epidemiologic surveys. It is a systematic review of the literature on community epidemiologic surveys of anxiety and mood disorders. It concludes that the ESEMeD findings are broadly consistent with the patterns found in previous surveys but faults the preliminary ESEMeD analyses for failing to distinguish cases by severity and to consider the effects of severity on need for treatment. The fact that the ESEMeD surveys collected much richer data than previous psychiatric epidemiologic surveys on role impairment, symptom severity, and episode duration makes it possible to develop more useful classifications of clinical severity in future analyses. Elaborations that feature such distinctions have the potential to substantially increase the relevance of the ESEMeD findings for European health care policy.

Huffman JC, Smith FA, Quinn DK, Fricchione GL. · Harvard Medical School and Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA. · Harv Rev Psychiatry. · Pubmed #17162654 No free full text.

Abstract: Depression, anxiety, and other psychological variables following acute myocardial infarction (MI) have been the subject of intense study over the last two decades. Through selective literature review and editorial commentary, we address six vital, unanswered questions concerning these psychological variables and their impact on coronary outcome. The picture that emerges is complex. Despite all that has been learned about the nature, consequences, and management of post-MI depression and related disorders, there remain many open issues. First, the prevalence, phenomenology, medical impact, and method of diagnosis of post-MI depression and other psychiatric syndromes remain unclear. In addition, at least four pathophysiologic mechanisms have been proposed to explain the link between depression and cardiac disease, but evidence of causation remains elusive. There have been increasingly well-designed treatment studies of post-MI depression, but the optimal agents and timing of treatment have yet to be defined. Finally, few recent studies of post-MI anxiety have been conducted. To make further progress, large, multicenter trials that use optimized screening tools, obtain data at several time points, consider multiple psychosocial variables, and correct carefully for medical/cardiac severity are required.

Hertz JA, Knight JR. · Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA. · Adolesc Med Clin. · Pubmed #17030290 No free full text.

Abstract: Misuse of prescription drugs has been a growing problem in the United States affecting all age groups, including adolescents. Recent years have produced many advances in medical management of chronic pain, depression and anxiety, and attention-deficit/hyperactivity disorder. Many of the medications used to treat these disorders, such as the opioids, benzodiazepines, and psychostimulants, also have potential for abuse and dependence. The challenge for the clinician today is to maximize safe and effective treatment with available medication, while preventing the diversion of prescribed medication or the development of substance-related disorders in patients receiving these medications.

Spencer TJ. · Pediatric Psychopharmacology Unit, Psychiatry Service, Massachusetts General Hospital, and the Department of Psychiatry, Harvard Medical School, Boston, Mass. 02114, USA. · J Clin Psychiatry. · Pubmed #16961427 No free full text.

Abstract: In recent years, evidence has been accumulating regarding high levels of comorbidity between attention-deficit/hyperactivity disorder (ADHD) and a number of disorders, including mood and anxiety disorders and conduct disorder. Thus, ADHD is most likely a group of conditions, rather than a single homogeneous clinical entity, with potentially different etiologic and modifying risk factors and different outcomes. Follow-up studies of children with ADHD indicate that subgroups of subjects with ADHD and comorbid disorders have a poorer outcome as evidenced by significantly greater social, emotional, and psychological difficulties. Investigation of these issues should help to clarify the etiology, course, and outcome of ADHD.

Romanoff MR. · Massachusetts General Hospital, Boston, USA. · J Am Acad Nurse Pract. · Pubmed #16958771 No free full text.

Abstract: PURPOSE: To educate primary care providers on the physical effects of posttraumatic stress disorder (PTSD), explain why military veterans are at great risk, and describe how to identify PTSD in primary care clients. DATA SOURCES: Current scientific and psychiatric literature on PTSD. CONCLUSIONS: PTSD is prevalent in the military community because of the frequency and type of trauma seen in the combat zone. With the ongoing military deployments, assessment for the presence of PTSD is increasingly important for comprehensive and high-quality primary care. Clients with trauma histories, such as veterans, are at increased risk for physical disorders such as heart disease and psychological disorders such as anxiety, depression, and PTSD. IMPLICATIONS FOR PRACTICE: Primary care clinicians, including those outside the military health system, are essential in identifying trauma histories and directing clients to appropriate care.

Ceranoglu TA, Stern TA. · Massachusetts General Hospital, Child and Adolescent Psychiatry Service, Charlestown, MA 02129, USA. · J Intensive Care Med. · Pubmed #16946447 No free full text.

Abstract: Adults with a myriad of medical and surgical conditions are at risk for pain, delirium, and disfigurement. Needless to say, these critical illnesses are profoundly stressful for patients and their caregivers. However, physicians rarely consider the reactions of children to their parents' illnesses. The article presents the case of a 15-year-old girl who developed posttraumatic stress disorder following her mother's severe burn and complicated course in a critical care unit; the case is used to discuss strategies for the detection of psychological vulnerability and for the implementation of care. By learning more about the children of adult patients, by screening for interpersonal dysfunction, and by maximizing support systems, clinicians can improve function and minimize distress.

Rauch SL, Shin LM, Phelps EA. · Psychiatric Neuroscience Division, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts, USA. · Biol Psychiatry. · Pubmed #16919525 No free full text.

Abstract: The prevailing neurocircuitry models of anxiety disorders have been amygdalocentric in form. The bases for such models have progressed from theoretical considerations, extrapolated from research in animals, to in vivo human imaging data. For example, one current model of posttraumatic stress disorder (PTSD) has been highly influenced by knowledge from rodent fear conditioning research. Given the phenomenological parallels between fear conditioning and the pathogenesis of PTSD, we have proposed that PTSD is characterized by exaggerated amygdala responses (subserving exaggerated acquisition of fear associations and expression of fear responses) and deficient frontal cortical function (mediating deficits in extinction and the capacity to suppress attention/response to trauma-related stimuli), as well as deficient hippocampal function (mediating deficits in appreciation of safe contexts and explicit learning/memory). Neuroimaging studies have yielded convergent findings in support of this model. However, to date, neuroimaging investigations of PTSD have not principally employed conditioning and extinction paradigms per se. The recent development of such imaging probes now sets the stage for directly testing hypotheses regarding the neural substrates of fear conditioning and extinction abnormalities in PTSD.

Hewlett J, Waisbren SE. · Division of Genetics, Children's Hospital Boston, Massachusetts, USA. · J Inherit Metab Dis. · Pubmed #16917730 No free full text.

Abstract: As more states adopt expanded newborn screening for metabolic disorders, the overall number of false positives increases. False-positive screening results have been associated with increased anxiety and stress in parents of infants who require follow-up testing, even after the infant's good health is confirmed. This article reviews the literature on the negative impact of false-positive newborn screening results on parents, along with a review of current communication practices for follow-up screening. The results of this review suggest that parental stress and anxiety can be reduced with improved education and communication to parents, specifically at the time of follow-up screening. Communication strategies with sample materials are proposed.

Hoge EA, Austin ED, Pollack MH. · Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. · Depress Anxiety. · Pubmed #16892420 No free full text.

Abstract: The growing recognition and occurrence of traumatic exposure in the general population has given increased salience to the need to understand the concept of resilience. More than just the "flip side" of a risk factor, the notion of resilience encompasses psychological and biological characteristics, intrinsic to an individual, that might be modifiable and that confer protection against the development of psychopathology in the face of stress. In this review, we provide some perspective on the concept of "resilience" by examining early use of the term in research on "children at risk" and discuss the relationship between risk and resilience factors. We then review psychological and biological factors that may confer resilience to the development of posttraumatic stress disorder (PTSD) following trauma, examine how resilience has been assessed and measured, and discuss issues to be addressed in furthering our understanding of this critical concept going forward.

McNally RJ. · Department of Psychology, Harvard University, 1230 William James Hall, 33 Kirkland Street, Cambridge, MA 02138, USA. · Ann N Y Acad Sci. · Pubmed #16891577 No free full text.

Abstract: Of the biological measures in the field of traumatic stress studies, the script-driven imagery paradigm has yielded the most consistent data. Approximately, two-thirds of individuals with a diagnosis of posttraumatic stress disorder (PTSD) exhibit heightened psychophysiologic reactivity while listening to audiotaped descriptions of their traumatic autobiographical memories. Nevertheless, these findings do not necessarily indicate the presence of PTSD or even that the memories are genuine. For example, people reporting (presumably) false memories of having been abducted by space aliens similarly exhibit heightened reactivity, even though they do not suffer from PTSD. To enhance the validity of diagnostic decision making in the forensic and policy arenas, we can use the methods of historians, specifically, consulting archival records to verify trauma histories and supplement biological data.

Koenen KC. · Harvard School of Public Health, Department of Society, Human Development and Health, 677 Huntington Avenue, Kresge 613, Boston, MA 02115, USA. · Ann N Y Acad Sci. · Pubmed #16891576 No free full text.

Abstract: Epidemiologic and meta-analytic studies point to consistent effects of pretrauma factors on risk for posttraumatic stress disorder (PTSD). However, our understanding of why only some individuals are vulnerable to the adverse effects of traumatic events remains limited. This article argues that a developmentally informed approach to the epidemiology of PTSD is needed to move this understanding forward. However, there are many challenges to such an approach including the historic conceptualization of PTSD as a normative response to traumatic events, the almost exclusive reliance on retrospective self-report of PTSD risk factors, and the lack of attention to current knowledge of human development in selecting risk factors for epidemiologic studies. The developmental construct of self-regulation may provide a key mechanism for understanding the effects of pretrauma factors on the vulnerability to PTSD. Pretrauma factors shown to have consistent effect on risk for PTSD in meta-analytic studies include familial psychopathology, child abuse, and preexisting psychopathology. A preliminary framework integrating these pretrauma factors with self-regulation as a central mechanism in the etiology of PTSD is presented. The implications of a developmentally informed epidemiologic approach to PTSD for theory, research, and practice are discussed.

Gorman JM. · Harvard Medical School, McLean Hospital, Belmont, Massachusetts 02478, USA. · Gend Med. · Pubmed #16860269 No free full text.

Abstract: BACKGROUND: In the United States, depression is approximately twice as common among women as among men, across all age groups. OBJECTIVE: This review examines gender differences in the epidemiology and clinical presentation of depression, and explores whether women respond differently than men to antidepressant medications. METHODS: This is a selective review focusing on current issues in the management of depression, with particular attention to gender differences in the epidemiology, diagnosis, and treatment of the disease. RESULTS: Women are more likely than men to have atypical symptoms of depression (eg, hypersomnia, hyperphagia), to have comorbid anxiety disorders, and to attempt suicide. Women are also more likely to have seasonal affective disorder. Mood and anxiety symptoms that seem to be related to the menstrual cycle do not often represent genuine premenstrual dysphoria, but when premenstrual dysphoric disorder does occur, its impact on quality of life is similar to that of major depressive disorder. There is ongoing controversy about whether men and women respond equally well to antidepressant medications, and preliminary evidence suggests that selective serotonin reuptake inhibitors (SSRIs) are more effective in the presence of estrogen. Depression affects about 10% of pregnant women. Antidepressant medication should be considered during pregnancy if depression is moderate or severe, or if withdrawal of maintenance medication is likely to result in recurrent depression. The potential benefits of using antidepressant medications in a pregnant or breastfeeding woman should be balanced against the potential risks to the newborn. Because of the risk of neonatal withdrawal syndrome, SSRIs should be used at the lowest effective dose during the third trimester of pregnancy and should be tapered before delivery. CONCLUSIONS: Continuing research is needed to determine how gender influences the risk, clinical presentation, and response to treatment of depression. Exploration of sex differences in animals and humans should aid in efforts to treat depression as an organic disorder rather than a psychological maladaptation.

Stoddard FJ, Usher CT, Abrams AN. · Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA. · Child Adolesc Psychiatr Clin N Am. · Pubmed #16797442 No free full text.

Abstract: Psychopharmacologic treatment in pediatric critical care requires a careful child or adolescent psychiatric evaluation, including a thorough review of the history of present illness or injury, any current or pre-existing psychiatric disorder, past history, and laboratory studies. Although there is limited evidence to guide psychopharmacologic practice in this setting, psychopharmacologic treatment is increasing in critical care, with known indications for treatment, benefits, and risks; initial dosing guidelines; and best practices.Treatment is guided by the knowledge bases in pediatric physiology, psycho-pharmacology, and treatment of critically ill adults. Pharmacologic considerations include pharmacokinetic and pharmcodynamic aspects of specific drugs and drug classes, in particular elimination half-life, developmental considerations, drug interactions, and adverse effects. Evaluation and management of pain is a key initial step, as pain may mimic psychiatric symptoms and its effective treatment can ameliorate them. Patient comfort and safety are primary objectives for children who are acutely ill and who will survive and for those who will not. Judicious use of psychopharmacolgic agents in pediatric critical care using the limited but growing evidence base and a clinical best practices collaborative approach can reduce anxiety,sadness, disorientation, and agitation; improve analgesia; and save lives of children who are suicidal or delirious. In addition to pain, other disorders or indications for psychopharmacologic treatment are affective disorders;PTSD; post-suicide attempt patients; disruptive behavior disorders (especially ADHD); and adjustment, developmental, and substance use disorders. Treating children who are critically ill with psychotropic drugs is an integral component of comprehensive pediatric critical care in relieving pain and delirium; reducing inattention or agitation or aggressive behavior;relieving acute stress, anxiety, or depression; and improving sleep and nutrition. In palliative care, psychopharmacology is integrated with psychologicapproaches to enhance children's comfort at the end of life. Defining how best to prevent the adverse consequences of suffering and stress in pediatric critical care is a goal for protocols and for new psychopharmacologic research [23,153].

Sudarsky L. · Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. · Semin Neurol. · Pubmed #16791781 No free full text.

Abstract: Psychogenic disorders of posture and gait are common and are the major manifestation in 8 to 10% of patients with psychogenic movement disorders. The colorful history of these disorders is reviewed. Anxiety and depression are the commonest psychological accompaniments of functional gait disorder in contemporary practice. The particular case of the cautious gait and its flip side, "fear of falling," are considered in more detail. Common presentations for somatoform disorders and malingering are also described. It is often possible to make this diagnosis based on recognition features and gait observation. Incongruous neurologic signs are commonly found, and several features are so typical as to be nearly diagnostic. Caveats and pitfalls in diagnosis based on observational features are noted. In particular, the cautious gait is often the presenting feature of an older patient with an organic balance impairment. An approach to the patient with psychogenic gait disorder is described. Although the nature of the problem is often quickly apparent in such patients, the optimal management is a challenge. Dramatic cures still occur, and some patients respond quickly to psychological management and rehabilitation therapies, but persistence for more than 6 to 12 months is frequently associated with an unfavorable prognosis and long-term disability. The outcome studies are reviewed.

Block SD. · Division of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute and Brigham and Women's Hospital and Harvard Medical School Center for Palliative Care, Boston, Massachusetts 02115, USA. · J Palliat Med. · Pubmed #16752981 No free full text.

Abstract: This paper provides a systematic, evidence-based review of the psychological issues confronted by patients at the end of life, drawing on recent literature. The epidemiology, approach to clinical assessment, clinical presentation, and therapeutic options related to common psychological issues that arise in end-stage illness are described. The spectrum of normal and dysfunctional reactions are identified, and approaches to enhancing coping and quality of life are emphasized. The learner will be able to describe: (1) normal coping responses of patients at the end of life; (2) epidemiology of common psychiatric disorders at the end of life; (3) the approach to clinical assessment of psychological distress at the end of life; and (4) therapeutic approaches to common psychological problems at the end of life.

McNally RJ. · Department of Psychology, Harvard University, 1230 William James Hall, 33 Kirkland Street, Cambridge, MA 02138, USA. · Trends Cogn Sci. · Pubmed #16697695 No free full text.

Abstract: Characteristically arising in response to overwhelmingly terrifying events, post-traumatic stress disorder (PTSD) is a disorder of memory: sufferers seemingly relive their trauma in the form of involuntary recollection. Prominent cognitive abnormalities, especially in memory functioning, have motivated research designed to elucidate the mediating mechanisms that produce PTSD symptoms, especially those involving involuntary recollection. Recent developments suggest a pathophysiological model of PTSD which includes hyporesponsive prefrontal cortical regions and/or a hyper-responsive amygdala. Other work has also identified above-average cognitive ability as a protective factor and below-average hippocampal volume as a vulnerability factor for PTSD among the trauma-exposed. These attempts to elucidate the mediating mechanisms of PTSD have been both cognitive and, more recently, cognitive-neuroscientific in emphasis.

Dahlin C. · Palliative Care Service, Massachusetts General Hospital, Boston, MA 02115, USA. · Home Healthc Nurse. · Pubmed #16680051 No free full text.

This publication has no abstract.

Geller DA. · Pediatric Obsessive Compulsive Disorder Program, Division of Pediatric Psychopharmacology, Massachusetts General Hospital, YAW 6A, Fruit Street, Boston, MA 02114, USA. · Psychiatr Clin North Am. · Pubmed #16650713 No free full text.

Abstract: The available literature indicates that OCD affecting children and adolescents is highly prevalent. Pediatric-onset OCD seems to share important similarities with the adult disorder but also shows important differences.For example, the clinical phenotype of OCD is remarkably consistent at all ages with some allowances for developmental expression. Pediatric patients frequently demonstrate poor insight into the nature of their obsessions, which in association with their limited verbal expression may make the diagnosis more difficult. Obsessions involving fear of harm and separation, compulsions without obsessions, and rituals involving family members are more common in younger patients. Treatment response,including serotonergic specificity and the need for robust dosing, is another feature shared by early- and adult-onset OCD. Imporfant differences across the life span can also be identified. Perhaps the clearest difference pertains to age of onset. Age-at-onset data have shown a bimodal distribution of age of onset of OCD, with one peak in preadolescent childhood and another peak in adulthood. Another distinction between child and adult OCD is gender representation. Whereas adult studies report equal gender representation or a slight female preponderance, pediatric clinical samples are clearly male predominant. Patterns of psychiatric comorbidity in pediatric OCD show high rates of tic and mood and anxiety disorders, similar to the patterns in adults, but also show a distinct association with disruptive behavior disorders (ADHD and oppositional defiant disorder) and other specific and pervasive developmental disorders. Family studies indicate that the disorder is highly familial and that a childhood onset of the disorder seems to be associated with a markedly increased risk for familial transmission of OCD, tic disorders, and ADHD.Both scientifically and clinically, the recognition of developmentally specific OCD phenotypes may be valuable. For example, research efforts aimed at identifying OCD-associated genes are likely to be more successful if developmentally homogeneous samples are studied instead of combining data from children, adolescents, and adults, as has been common in OCD studies.Clinical management is also informed by an appreciation of the unique cor-relates of OCD affecting youth, especially comorbidity with chronic tic dis-orders and ADHD and their impact on treatment.The so-called "spectrum disorders" related to OCD are less prominent in children and adolescents than in adults. Although sharing some features with typical OCD, these symptoms are less clearly ego-dystonic and less anxiety producing, frequently provide a measure of gratification, and are less responsive in general to SSRIs. Often cognitive antecedents to these behaviors are less well developed than in more typical OCD, and behavioral interventions are the mainstay of treatment but with more variable success.

Fava M. · Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA 02114, USA. · J Psychopharmacol. · Pubmed #16644769 No free full text.

Abstract: Despite the efficacy of currently available antidepressant treatment, residual symptoms are common among individuals treated for major depressive disorder and are associated with an increased risk of relapse and poor psychosocial functioning. However, distinguishing treatment-emergent side effects from residual symptoms can be challenging for clinicians. Anxiety, sleep disturbance, somnolence/fatigue, apathy and cognitive dysfunction are among the more frequent residual symptoms. Approaches to the management of residual symptoms include addressing treatment-emergent side effects and co-morbid conditions, optimizing antidepressant dosing and using augmentation therapy. Clinicians are often guided in their decisions by anecdotal impressions. Studies assessing the evaluation and treatment of residual symptoms and side effects will contribute importantly to the optimal acute and long-term management of depression.

Kawachi I, Subramanian SV. · Harvard School of Public Health, MA 02115, USA. · J Trauma Stress. · Pubmed #16612828 No free full text.

Abstract: Increasingly it is recognized that health and illness are products of individual level risk and protective factors, as well as forces operating at contextual levels. In this article, we present the motivation and rationale for understanding trauma within its context. We use the example of the concept of social capital to illustrate the relevance of the contextual approach for trauma research and outline a multilevel modeling approach to examining contextual influences on trauma outcomes.

Finn CT, Smoller JW. · Harvard Medical School, Department of Psychiatry and Psychiatric Genetics Program in Mood and Anxiety Disorders, Massachusetts General Hospital, Boston, MA, USA. · Harv Rev Psychiatry. · Pubmed #16603476 No free full text.

Abstract: While psychiatrists may commonly discuss family history in clinical practice, there has been little systematic research documenting the role and effectiveness of genetic counseling for psychiatric disorders. In the coming years, the expected identification of susceptibility genes for psychiatric disorders may bring new opportunities and expectations from patients and families for the clinical translation of research findings in psychiatric genetics. We review evidence for possible increasing demand for genetic counseling, particularly if specific genes related to psychiatric disorders are identified. We then explore both the potential role of genetic counseling for psychiatric disorders and the issues involved in conveying genetic information in the clinical setting. Further research regarding the effectiveness of counseling interventions, as well as additional efforts directed at genetics education for clinicians, will be needed if emerging advances in genetic research are to be incorporated into clinical practice.