title: Evaluating genetic counseling for individuals with schizophrenia in the molecular age.
abstract: BACKGROUND
  Recent advances in schizophrenia genetics are shedding new light on etiopathogenesis, but issues germane to translation of findings into clinical practice are relatively understudied. We assessed the need for, and efficacy of, a contemporary genetic counseling protocol for individuals with schizophrenia.
  
  
  METHODS
  After characterizing rare copy number variation in a cohort of adults with schizophrenia, we recruited subjects from the majority of individuals who had no clinically relevant structural genetic variant. We used a pre-post study design with longitudinal follow-up to assess both the profile of need and the impact of general genetic counseling on key knowledge-based and psychological factors.
  
  
  RESULTS
  Thirty-nine (60.0%) of 65 patients approached actively expressed an interest in the study. At baseline, participants (n = 25) tended to overestimate the risk of familial recurrence of schizophrenia, express considerable concern related to this perceived risk, endorse myths about schizophrenia etiology, and blame themselves for their illness. Postcounseling, there was a significant improvement in understanding of the empiric recurrence risk (P = .0090), accompanied by a decrease in associated concern (P = .0020). There were also significant gains in subjective (P = .0007) and objective (P = .0103) knowledge, and reductions in internalized stigma (P = .0111) and self-blame (P = .0401). Satisfaction with genetic counseling, including endorsement of the need for such counseling (86.4%), was high.
  
  
  CONCLUSIONS
  These results provide initial evidence of need for, and efficacy of, genetic counseling for individuals with schizophrenia. The findings may help facilitate development of a contemporary genetic counseling process that could optimize outcomes in the nascent field of evidence-based psychiatric genetic counseling.
authors.affiliation: To whom correspondence should be addressed; 33 Russell Street, Room 1100, Toronto, Ontario, Canada M5S 2S1; tel: (416) 535-8501 x2731, fax: (416) 535-7199, e-mail: anne.bassett@utoronto.ca.
authors.forename: Gregory
authors.initials: G
authors.lastname: Costain
authors.forename: Mary Jane
authors.initials: MJ
authors.lastname: Esplen
authors.forename: Brenda
authors.initials: B
authors.lastname: Toner
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Scherer
authors.forename: Wendy S
authors.initials: WS
authors.lastname: Meschino
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Hodgkinson
authors.forename: Anne S
authors.initials: AS
authors.lastname: Bassett
mesh_terms: D000328:Adult; D002985:Clinical Protocols / Q000592:standards*; D003258:Consumer Behavior; D005260:Female; D005500:Follow-Up Studies; D005817:Genetic Counseling / Q000523:psychology / Q000592:standards*; D005820:Genetic Testing / Q000592:standards; D006167:Guilt; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012559:Schizophrenia / Q000235:genetics*; D057545:Social Stigma