Child and adolescent psychiatrists’ use, attitudes, and understanding of genetic testing and pharmacogenetics in clinical practice

• Published in: Psychiatry research Vol. 325; p. 115246
• Main Authors: Soda, Takahiro, Merner, Amanda R., Small, Brent J., Torgerson, Laura N., Muñoz, Katrina, Austin, Jehannine, Storch, Eric A., Pereira, Stacey, Lázaro-Muñoz, Gabriel
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.07.2023
• Subjects: Adolescent; Adolescent Psychiatry; Child; Child and adolescent psychiatry; Ethics; Genetic Testing; Genetics; Health Knowledge, Attitudes, Practice; Humans; Pharmacogenetics; Practice patterns; Psychiatry - education; Psychopharmacology; Survey; Ethics; Survey; Practice patterns; Psychopharmacology; Genetics; Child and adolescent psychiatry; Genetic testing
• ISSN: 0165-1781; 1872-7123; 1872-7123
• DOI: 10.1016/j.psychres.2023.115246

•Majority of child and adolescent psychiatrists reported ordering genetic testing in the past year.•Pharmacogenetic testing was the most common genetic test ordered among clinicians.•Patient/family request for pharmacogenetic testing was among the top reasons given for ordering.•Some notable differences between ordering patterns of clinicians in different practice settings.•A minority indicated they would change effective medication regimen based on test results alone. The purpose of this study was to report current practices and attitudes of child and adolescent psychiatrists (CAP) regarding diagnostic genetic and pharmacogenetic (PGx) testing. We surveyed 958 US-based practicing CAP. 54.9% of respondents indicated that they had ordered/referred for a genetic test in the past 12 months. 87% of respondents agreed that it is their role to discuss genetic information regarding psychiatric conditions with their patients; however, 45% rated their knowledge of genetic testing practice guidelines as poor/very poor. The most ordered test was PGx (32.2%), followed by chromosomal microarray (23.0%). 73.4% reported that PGx is at least slightly useful in child and adolescent psychiatry. Most (62.8%) were asked by a patient/family to order PGx in the past 12 months and 41.7% reported they would order PGx in response to a family request. Those who ordered a PGx test were more likely to have been asked by a patient/family and to work in private practice. 13.8% of respondents agreed/strongly agreed that a PGx test can predict the effectiveness of specific antidepressants. Some respondents also indicated they would make clinical changes based on PGx information even if a medication was currently effective and there were no side effects. Genetic testing has become routine clinical care in child and adolescent psychiatry. Despite this, many providers rate their associated knowledge as poor/very poor. Patient requests were associated with ordering practices and providers misinterpretation of PGx may be leading to unnecessary changes in clinical management. There is need for further education and support for clinicians.