Intrauterine diagnosis and genetic counseling in psychiatry

Abstract

Genetic counseling has an important place in the care and follow‐up of patients and families with disorders of mental development and of mental function. Amniocentesis, obtaining a small amount of amniotic fluid with fetal cells for biochemical and chromosomal tests, has greatly advanced the precision of genetic counseling for a growing list of testable conditions. Currently, the major indications are the Down syndrome (trisomy 21), numerous rare inborn errors of metabolism, and neural tube closure defects in “high‐risk” families. In the future, additional behavioral syndromes associated with abnormal chromosomes or biochemical markers may be suitable for such very early detection. The social and psychological problems arising in testing and counseling for genetic and chromosomal diseases require wider recognition.     

The decision to terminate childbearing: Differences in preoperative ambivalence between tubal ligation women and vasectomy wives

Abstract

This paper examines the degree of preoperative ambivalence expressed by 255 currently married tubal ligation patients compared to 167 wives of vasectomy patients regarding the decision to terminate childbearing and aspects of the decision‐making process which account for differences between groups. Data indicate that tubal ligation women are significantly more certain and comfortable with their decision than are vasectomy wives. In order to explain this finding, analysis focused on sociodemographic factors; time factors related to the decision; variables related to communication with spouse and others; factors internal to the individual, including interest in another child and motivation for the decision; external constraints on the decision; and couple dynamics in the decision‐making process. Results indicate that group differences in ambivalence are primarily due to the effects of strong male control over the termination decision, as perceived by the wife, and a disproportionate prevalence of this pattern among vasectomy couples. An interaction effect between male dominance and group membership was also found. Implications of study results for preoperative counseling, including likely sources of future regret, are considered.     

Genetic counseling as an occupational specialty: A sociological perspective

Abstract

Observations of client‐counselor interaction during genetic counseling sessions at a metropolitan hospital on the West Coast identified five major problems with which genetic counselors had to deal. Their clients needed: (1) a diagnosis of the disease condition; (2) an evaluation of the genetic nature of the condition; (3) to be taught biomedical information; (4) assistance in coping with psychological stress; and (5) information on available community resources and social service support. The genetic counselors under observation tended to satisfy the clients’ first two needs, the need for a diagnosis and for a genetic evaluation, but they tended not to satisfy the clients’ needs in the areas of education and psychosocial counseling. Genetic counseling appears to demand a synthesis of five different professional skills, those of the medical doctor, the geneticist, the educator, the psychotherapist, and the social worker. These findings are discussed in terms of their relevance for creating programs for training genetic counselors.     

Sickle cell trait counseling-evaluation of counselors and counselees.

In this study, information about both counselee and counselor performance was obtained from taped recordings of 193 structured counseling sessions with persons diagnosed as having sickle cell trait. The data provide evidence that: (1) lay persons can understand essential sickle cell information; (2) trained lay persons using a structured format can transmit successfully sickle cell information; (3) only education and age, among counselee characteristics studies, were related to successful learning; (4) the evaluation of information transfer in counseling programs cannot be limited to counselees' comprehension but must also consider other variables such as counselor performance and curriculum content; (5) a reduction in negative feelings associated with a diagnosis of sickle cell trait is an immediate effect of counseling; and (6) audio-taping of counseling sessions is client acceptable and useful for evaluation, quality control, and counselor training.     

Utility and efficiency of linked marker genes for genetic counseling. II. Identification of linkage phase by offspring phenotypes

For a linked marker locus to be useful for genetic counseling, the counselee must be heterozygous for both disease and marker loci and his or her linkage phase must be known. It is shown that when the phenotypes of the counselee's previous children for the disease and marker loci are known, the linkage phase can often be inferred with a high probability, and thus it is possible to conduct genetic counseling. To evaluate the utility of linked marker genes for genetic counseling, the accuracy of prediction of the risk for a prospective child with a given marker gene to develop the genetic disease and the proportion of families in which a particular marker locus can be used for genetic counseling are studied for X-linked recessive, autosomal dominant, and autosomal recessive diseases. In the case of X-linked genetic diseases, information from children is very useful for determining the linkage phase of the counselee and predicting the genetic disease. In the case of autosomal dominant diseases, not all children are informative, but if the number of children is large, the phenotypes of children are often more informative than the information from grandparents. In the case of autosomal recessive diseases, information from grandparents is usually useless, since they show a normal phenotype for the disease locus. If we use information on the phenotypes of children, however, the linkage phase of the counselee and the risk of a prospective child can be inferred with a high probability. The proportion of informative families depends on the dominance relationship and frequencies of marker alleles, and the number of children. In general, codominant markers are more useful than are dominant markers, and a locus with high heterozygosity is more useful than is a locus with low heterozygosity.     

Utility and efficiency of linked marker genes for genetic counseling. III. Proportion of informative families under linkage disequilibrium.

A marker locus closely linked to a disease locus is often useful for genetic counseling provided that a counselee is heterozygous at both disease and marker loci. Furthermore, the linkage phase of these genes in the counselee must be known. When the linkage between the disease and marker loci is very close, one often finds linkage disequilibrium between the loci. To evaluate the effect of such nonrandom associations on the utility of linked marker genes for genetic counseling, the proportion of informative families is studied for X-linked recessive and autosomal dominant diseases. This proportion is higher for X-linked genes than for autosomal genes, if other factors are the same. In general, codominant markers are more useful than dominant markers. Also, under appropriate conditions, the proportion of informative families is higher when linkage disequilibrium is present. The results obtained in this paper are useful for evaluating the utility of polymorphic restriction endonuclease cleavage sites as markers in genetic counseling.     

Factors influencing genetic counseling attendance rate: A geographically based study

Abstract

A study of factors influencing genetic counseling attendance rate has been conducted in the Bouches‐du‐Rhône area, in the south of France. In this area, a birth defects monitoring system (Eurocat n°22) annually covers 23,000 births. All the genetic services are delivered by only one genetic center located in Marseilles, and the data collected are computerized. The comparison of these two data bases gives an opportunity to estimate the rate of genetic counseling attendance after the occurrence of an affected stillbirth or live birth. Among the parents of 358 infants born in 1983–84 in this area with a pathology requiring genetic counseling, 226 (63 per cent) attended the Genetic Center within the first year after birth. The rate of attendance is statistically higher (p < 0.01) for the parents who had a stillbirth (78 per cent) than for those who had a live birth (57 per cent). It is also higher (p < 0.01) for the Marseilles maternities group (68 per cent) than for the group outside Marseilles (50 per cent). The referral delays are also analyzed according to malformation etiology and to viability of the child by the eighth day of lue. Besides evaluating a particular genetic center's effectiveness in diffusing information to the public concerned, this work shows that couples’ request is strongly dependent on a psychological need.     

Prenatal screening for hemoglobinopathies. II. Evaluation of counseling.

Learning during genetic counseling is often below expectations, especially in the context of genetic screening. In this report we describe learning as a result of genetic counseling of 298 pregnant women identified as hemoglobinopathy carriers, 234 with sickle cell trait and 64 with beta-thalassemia trait. Counseling was designed to provide the information needed in a simple, clear, and nondirective manner. A special videotape produced for this purpose provided dramatization and a role model illustrating an appropriate response. After viewing the videotape the counselee had an opportunity to question the counselor and to have any misconceptions corrected. Questionnaires revealed significantly increased knowledge as a result of counseling in each of the three hemoglobinopathy subject areas tested-namely, clinical manifestations, genetics, and prenatal diagnosis. Five factors correlated with higher knowledge scores after counseling-namely, a younger patient age, more years of education, knowledge of having trait before this identification, knowledge of the baby's father having trait before counseling, and having no prior children.     

Periodical abstracts

Abstract

This research analyzed physicians’ attitudes toward and use of genetic counseling. Data were obtained through mailed questionnaires sent to all 445 general and family practitioners, pediatricians, and obstetrician‐gynecologists in private practice and involved in direct patient care in Maricopa and Pima Counties, Arizona. Results indicated strong attitudinal support for genetic counseling. Almost all respondents felt that it was a useful and necessary medical service, and most felt that it resulted in more responsible patient decisions. Actual genetic counseling by physicians was comparatively rare, however. The data suggested that the paucity of counseling may have derived from a lack of training in genetics, scarcity of patient requests, and legal naïveté. Genetic counseling, amniocentesis, and abortion received the most support from younger physicians, obstetrician‐gynecologists, and those who were Jewish, less religious, and had few or no children.     

Regulation of offspring and the Roman Catholic Church

Abstract

The 1976 enactment of the National Sickle Cell Anemia, Cooley's Anemia, Tay‐Sachs, and Genetic Disease Act may mark the emergence of a national policy on mass genetic screening. The law includes provisions intended to protect persons who are tested for genetic traits in screening programs operated with government funds. Two key features are (1) guaranteed access to competent genetic counseling and (2) strict confidentiality of test results. Because genetic screening will be conducted through state public health departments, I surveyed the states to determine how they were currently providing access to genetic counseling and protection of genetic data. The responses indicated that (1) there is an extreme heterogeneity of counseling services, and (2) that most states have not developed programs to safeguard genetic data.     

Personality effects on spatial learning: Comparisons between visual conditions in a weakly electric fish

Recent research has explored links between cognition and personality, with prominent hypotheses proposing that personality drives consistent individual differences in cognitive function. These hypotheses particularly expect bolder individuals to be faster, but less accurate, as a trade‐off in cognitive function. However, cognitive processes are typically interconnected and defined in more complex terms than simply speed and accuracy. Here, we present evidence that personality‐based differences in learning rates are a result of differences in decision‐making during training in a two‐alternative forced‐choice spatial memory task. This was examined in the mormyrid fish Gnathonemus petersii in the presence of light, where both vision and the electric sense are available, and in the dark, where visibility is limited and fish rely mostly on electrosensing. The species is adapted for the dark to avoid visual predators; thus, the presence of light can induce high‐risk and the dark low‐risk. We show that light conditions had little effect on learning, with bolder fish learning faster both in the light and in the dark conditions. Yet the relationship between learning rates and error rates indicates that the effect on learning is indirectly influenced by accuracy during training. Speed‐accuracy trade‐offs were not found in decision‐making, with bolder individuals deciding faster and more accurately both in the light and in the dark. Only learning strategy was affected by light conditions, with significantly more fish preferring response to place learning in the dark than in the light, where distal cues were not visible. We conclude that other than effects from the integration of visual information, bolder individuals show a consistently greater tendency to explore and find food rewards during training. This affects their decision‐making and in turn their learning performance. We highlight the complexity by which personality‐based effects are exhibited in spatial associative learning.     

临床医生在基因检测咨询中面对伦理两难问题态度与选择 ——基于情景案例分析

目的 通过情景案例分析,聚焦基因检测咨询中的伦理两难事件,探究临床医生的伦理道德抉择及可能的影响因素。 方法 采用分层随机抽样方法,对624名临床医生进行了匿名问卷调查。 结果 对于XY染色体女性案件,88%的应答者选择告知敏感性信息;对于父系信息的披露,近60%的应答者选择单独告诉母亲;对于是否告知患儿其他亲属相关遗传病信息的案件,应答者的意见则相对分散。 结论 针对三个典型的基因检测咨询中的伦理两难问题,应结合国际相关指南的要求,进一步加大相关的法律与伦理理念、知识的教育与普及。     

Genetic counseling and the presenile dementias

Abstract

The clinical application of genetic counseling techniques to the presenile dementing illnesses is discussed, using examples. The problems encountered in adult‐onset illness are very different from those seen in illnesses affecting children. Some general guidelines and some specific ones are presented.     

Predicting species distributions for conservation decisions

Species distribution models (SDMs) are increasingly proposed to support conservation decision making. However, evidence of SDMs supporting solutions for on‐ground conservation problems is still scarce in the scientific literature. Here, we show that successful examples exist but are still largely hidden in the grey literature, and thus less accessible for analysis and learning. Furthermore, the decision framework within which SDMs are used is rarely made explicit. Using case studies from biological invasions, identification of critical habitats, reserve selection and translocation of endangered species, we propose that SDMs may be tailored to suit a range of decision‐making contexts when used within a structured and transparent decision‐making process. To construct appropriate SDMs to more effectively guide conservation actions, modellers need to better understand the decision process, and decision makers need to provide feedback to modellers regarding the actual use of SDMs to support conservation decisions. This could be facilitated by individuals or institutions playing the role of ‘translators’ between modellers and decision makers. We encourage species distribution modellers to get involved in real decision‐making processes that will benefit from their technical input; this strategy has the potential to better bridge theory and practice, and contribute to improve both scientific knowledge and conservation outcomes.     

Artificial intelligence in differentiating tropical infections: A step ahead

Background and objectiveDifferentiating tropical infections are difficult due to its homogenous nature of clinical and laboratorial presentations among them. Sophisticated differential tests and prediction tools are better ways to tackle this issue. Here, we aimed to develop a clinician assisted decision making tool to differentiate the common tropical infections.MethodologyA cross sectional study through 9 item self-administered questionnaire were performed to understand the need of developing a decision making tool and its parameters. The most significant differential parameters among the identified infections were measured through a retrospective study and decision tree was developed. Based on the parameters identified, a multinomial logistic regression model and a machine learning model were developed which could better differentiate the infection.ResultsA total of 40 physicians involved in the management of tropical infections were included for need analysis. Dengue, malaria, leptospirosis and scrub typhus were the common tropical infections in our settings. Sodium, total bilirubin, albumin, lymphocytes and platelets were the laboratory parameters; and abdominal pain, arthralgia, myalgia and urine output were the clinical presentation identified as better predictors. In multinomial logistic regression analysis with dengue as a reference revealed a predictability of 60.7%, 62.5% and 66% for dengue, malaria and leptospirosis, respectively, whereas, scrub typhus showed only 38% of predictability. The multi classification machine learning model observed to have an overall predictability of 55–60%, whereas a binary classification machine learning algorithms showed an average of 79–84% for one vs other and 69–88% for one vs one disease category.ConclusionThis is a first of its kind study where both statistical and machine learning approaches were explored simultaneously for differentiating tropical infections. Machine learning techniques in healthcare sectors will aid in early detection and better patient care.     

Mate selection in man: Evidence,theory, and outcome

Abstract

This review presents a comprehensive survey of the literature on mate selection and non‐random mating in man. The topics discussed include: (1) genetic aspects of non‐random mating for complex traits; (2) evidence on resemblance between spouses on a large variety of traits such as intelligence, personality, physical characteristics, and sociocultural traits; (3) a critical review of sociological and psychological theories offered to account for assortative mating, and (4) implications of assortative mating for marital satisfaction. It is suggested that the factors leading to choice of marriage partners need to be studied from the point of view of multivariate profiles rather than single traits. Such studies will require sophisticated methodologies of research design and data analysis.     

News notes

Abstract

This paper is concerned with the efficacy of genetic counseling with respect to schizophrenia. Evidence for the genetic basis of schizophrenia is reviewed, as are data demonstrating increases in the marital and reproductive rates of schizophrenic patients. The dilemmas of genetic counseling are discussed, and a strategy for early identification of individuals with a predisposition to schizophrenia is described.     

The combined effects of the 5‐ HTTLPR and HTR1A rs6295 polymorphisms modulate decision making in schizophrenia patients

Decision making ability has been reported to be impaired in schizophrenia patients, but no research has examined the genetic bases of this impairment. This study investigated how decision making was affected by the genetic variants in the serotonin transporter gene (triallelic 5‐ HTTLPR) and serotonin receptor 1A gene (rs6295) and their interaction in 465 schizophrenia patients and 448 healthy controls. The Iowa Gambling Task (IGT) was used to evaluate decision making under ambiguity (the first 40 trials) and decision making under risk (the last 60 trials). Results showed that, among the patients, the main effects of 5‐ HTTLPR (F_2,16 = 6.54, P = 0.002) and HTR1A rs6295 (F_2,16 = 3.87, P = 0.021) polymorphisms and their interaction effect (F_4,16 = 3.32, P = 0.005) were significant for the first 40 trials, with the GG genotype of HTR1A rs6295, the L′L′ genotype of 5‐ HTTLPR and the GG‐L′L′ combination showing poorer IGT performance than their counterparts. Results for the healthy controls showed a similar pattern but did not reach statistical significance. No significant effects were found for the last 60 trials. These results are discussed in terms of their implications for our understanding of the genetic mechanisms of decision making in schizophrenia patients as well as healthy adults.     

Contraceptive use and efficacy in a genetically counseled population

Abstract

This paper reports contraceptive use and efficacy rates among 648 married women aged 15 to 44 who had received genetic counseling six months previously. Over half (53.5 per cent) of the counseled population were using non‐surgical contraception; 20 per cent were pregnant or postpartum; 10 per cent were seeking to become pregnant; 11 per cent were sterilized. Only 4.5 per cent were neither using contraceptives nor seeking to become pregnant. Women who were certain about their reproductive intentions after counseling utilized contraceptives effectively, with only two pregnancies at six months among those seeking to delay wanted pregnancies and only one pregnancy among those seeking to prevent pregnancy. This represents six‐month contraceptive failure rates of 4.3 and 2.1 per cent respectively for the two groups, rates similar to those with comparable intentions in the U. S. population at large. A distinguishing characteristic of the genetically counseled group was that 32 per cent of contraceptive users reported that their reproductive intentions were uncertain after counseling. The six‐month pregnancy rate in this uncertain group was 10 per cent.     

医疗机构合理用药评价模型的构建研究

目的 针对医疗机构的合理用药水平进行评价研究。方法 根据医疗机构合理用药的具体要求,构建医疗机构合理用药评价指标体系,采用基于模糊群决策的方法和多指标评价分析法构建医疗机构合理用药评价模型。结果 构建了基于模糊群决策的医疗机构合理用药评价模型,并通过实例分析证明了评价模型的可行性。结论 建立的基于模糊群决策的医疗机构合理用药评价模型能够对医疗机构的合理用药水平进行科学评价,为提高医疗机构合理用药水平奠定基础。