J Genet Counsel (2012) 21:355–356 DOI 10.1007/s10897-011-9463-9

BOOK REVIEW

How to Talk with Families About Genetics and Psychiatric Illness By Holly Peay and Jehannine Austin. W.W. Norton & Company, New York, 2011, 280 pp., $24.95. Dee Quinn

Received: 9 November 2011 / Accepted: 16 November 2011 / Published online: 9 December 2011 # National Society of Genetic Counselors, Inc. 2011

How to Talk with Families About Genetics and Psychiatric Illness is a guide to providing information and counseling to families concerning the genetic aspects of psychiatric disorders. As such, it will be very useful to a variety of health care practitioners. According to the authors, the purpose of this book is to “provide mental health clinicians with tools to address…questions about why or how the illness developed and about risks of other family members.” Congratulations to the authors for writing a much needed reference on a difficult, often convoluted and evolving topic. The authors are clearly knowledgeable about the subject and they share many of their experiences in the provision of this information to families. The case studies in the middle chapters are extremely helpful in that they clearly define questions clients ask, and they also define questions clients may be afraid to ask. Specifically, the authors cite excellent examples of addressing client needs and how to elicit unstated concerns. The authors’ responses are sensitive and insightful, as well as clearly and simply stated. The chapters on contracting and taking a family history, both of which are essential to the provision of genetic counseling for psychiatric disorders, provided an outstanding template for mental health clinicians to use. In particular, the case examples at the end of each chapter are enlightening. The first chapter, “Genetics 101” is an excellent overview of methodologies used in this field. This section provides useful suggestions on communicating difficult issues such as genetic heterogeneity and susceptibility. Overall, however, I would have preferred to see a more in-depth literature review of the genetics of mental illness; that is, more specific D. Quinn (*) Colleges of Medicine and Pharmacy, The University of Arizona, Tucson, AZ 85724, USA e-mail: [email protected]

descriptions of the available studies (e.g., sample sizes, statistical analyses, and magnitude of risks) would make the book more broadly applicable, especially to academic professionals. There also seems to be an over emphasis on long term cognitive effects of cannabis and methamphetamine, excluding other drugs with known long-term cognitive effects such as alcohol. Chapter 4, “Explaining How Psychiatric Illness Happens,” contains a wonderful tool for explaining the interaction of genetic and environmental influences in the occurrence of psychiatric disorders. The “jar” model provides clinicians with a visual instrument to clarify the interaction of genetic predisposition and environmental influences. As a teratology counselor, I have already used this tool in my practice to describe this interaction for families considering adopting a child with a family history of mental illness. Teratology counseling is generally done by telephone, and this tool has worked exceptionally well in that regard. Chapter 6, “Explaining Risk,” provides good background on risk communication, as well as tips for incorporating risk assessment into clinical practice. The last chapters, “Talking to Specific Populations,” cite numerous illustrations of clients’ concerns that the provider may encounter in each population. The sections addressing apprehensions of parents with children at-risk for or affected by a psychiatric illness contain outstanding examples of approaches to anticipatory guidance for these families and their children. The discussion with parents concerning the importance of their ability to control environmental aspects is a useful guide for parenting all children. However, the section on pregnant women who have a psychiatric disorder could have been more expanded. In my experience as a prenatal counselor, concerns about a personal or family history of psychiatric disorder and/or the use of medications are increasingly frequent.

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While Reprotox and TERIS are superb resources, they are fee-for-service and are not likely to be available to mental health practitioners. OTIS, the Organization of Teratology Information Specialists, provides toll-free telephone access to health care providers and the public for teratology risk assessments and counseling – as such, it should have been highlighted in the text of this chapter. An overview of the effects of prenatal exposures to common substances, such as alcohol and psychotropic medications, would have been helpful.

Quinn

Overall, this book provides excellent suggestions on approaches to counseling individuals and families who have concerns about the occurrence of psychiatric disorders. Mental health professionals will find the information and suggested approaches instrumental for incorporating this much needed aspect of mental health care. As genetic counselors, our experiences working with families with specific health care needs are an invaluable resource for all health care providers. Thanks again to the authors for producing a much needed reference in this area.