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Integrating Genomics into Psychiatric Practice

Ethical and Legal Challenges for Clinicians

Ward, Eric T., MD; Kostick, Kristin M., PhD, MA; Lázaro-Muñoz, Gabriel, PhD, JD, MBE

doi: 10.1097/HRP.0000000000000203
Perspectives

Psychiatric genomics is a rapidly growing field that holds much promise for improving risk prediction, prevention, diagnosis, treatment selection, and understanding of the pathogenesis of patients’ symptoms. The field of psychiatry (i.e., professional organizations, mental health clinicians, educational institutions), however, needs to address numerous challenges to promote the responsible translation of genomic technologies and knowledge into psychiatric practice. The goal of this article is to review how clinicians currently encounter and use genomics in the clinic, to summarize the existing literature on how clinicians feel about the use of genomics in psychiatry, and to analyze foreseeable ethical and legal challenges for the responsible integration of genomics into psychiatric care at the structural and clinic levels. Structural challenges are defined as aspects of the larger system of psychiatric practice that constitute potential barriers to the responsible integration of genomics for the purposes of psychiatric care and prevention. These structural challenges exist at a level where professional groups can intervene to set standards and regulate the practice of psychiatry and genomics. Clinic-level challenges are day-to-day issues clinicians face when managing genomic tests in the clinic. We discuss the need for action to mitigate these challenges and maximize the clinical and social utility of psychiatric genomics, including the following: expanding genomics training among mental health clinicians; establishing practice guidelines that consider potential clinical, psychological, and social implications of psychiatric genomics; promoting an integrated care model for managing genomics in psychiatry; emphasizing patient engagement and informed consent when managing genomic testing in psychiatric care.

From the University of North Carolina School of Medicine (Dr. Ward); Center for Medical Ethics and Health Policy, Baylor College of Medicine (Drs. Kostick and Lázaro-Muñoz).

Funded, in part, by the National Human Genome Research Institute of the National Institutes of Health grant no. R00HG008689 (Dr. Lázaro-Muñoz).

Original manuscript received 8 December 2017; revised manuscript received 16 March 2018, accepted for publication subject to revision 24 April 2018; revised manuscript received 4 May 2018.

Correspondence: Gabriel Lázaro-Muñoz, Baylor College of Medicine, 1 Baylor Plaza, Suite 326DB, Houston, TX 77030. Email: glazaro@bcm.edu

© 2019 President and Fellows of Harvard College
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