Psych CASC / OSCE · Foundations — psychiatric genetics and epigenetics
Family genetics counselling after first-episode psychosis — CASC/communication station
Communication station: accurate heritability language, non-directive counselling, PRS limits, anti-stigma, and support without false reassurance or fatalism.
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Study tools
Target exams
FRANZCPMRCPsychABPNMD-DNB
Prompt
You are the psychiatry registrar. A 20-year-old man is recovering from first-episode schizophrenia on the early psychosis unit. His parents request a 10-minute meeting: they feel guilty ('we passed on bad genes'), ask whether their 16-year-old daughter should have a commercial online 'mental illness DNA test', and whether treatment is futile because 'schizophrenia is 80% genetic'. There is no known chromosomal syndrome in the index patient.
Station brief
Format. Communication / psychoeducation station, approximately 8–10 minutes. Shared understanding; not a genetics lecture. [1]
Candidate instructions. Address guilt without false reassurance; explain multifactorial risk and what "80% genetic" does and does not mean; advise against commercial DTC psychiatric PRS as diagnosis; outline sensible support for the sister; affirm evidence-based treatment. [1][5]
References8ShowHide
- [1]Sullivan PF, Kendler KS, Neale MC Schizophrenia as a complex trait: evidence from a meta-analysis of twin studies Arch Gen Psychiatry, 2003.PMID 14662550
- [2]Hilker R, Helenius D, Fagerlund B, et al. Heritability of Schizophrenia and Schizophrenia Spectrum Based on the Nationwide Danish Twin Register Biol Psychiatry, 2018.PMID 28987712
- [3]Purcell SM, Wray NR, Stone JL, et al. Common polygenic variation contributes to risk of schizophrenia and bipolar disorder Nature, 2009.PMID 19571811
- [4]Schizophrenia Working Group of the Psychiatric Genomics Consortium Biological insights from 108 schizophrenia-associated genetic loci Nature, 2014.PMID 25056061
- [5]Lewis CM, Vassos E Polygenic risk scores: from research tools to clinical instruments Genome Med, 2020.PMID 32423490
- [6]Sullivan PF, Neale MC, Kendler KS Genetic epidemiology of major depression: review and meta-analysis Am J Psychiatry, 2000.PMID 11007705
- [7]Cross-Disorder Group of the Psychiatric Genomics Consortium Genomic Relationships, Novel Loci, and Pleiotropic Mechanisms across Eight Psychiatric Disorders Cell, 2019.PMID 31835028
- [8]Weaver ICG, Cervoni N, Champagne FA, et al. Epigenetic programming by maternal behavior Nat Neurosci, 2004.PMID 15220929