Table 1.

Common Features of Schizophrenia and Potential Negative Consequences for Genetic Counseling Provided by a Medical Genetics and/or Mental Health Care Professional

Common Features of Schizophrenia	Potential Consequences for Genetic Counseling
Individual patient characteristics	• Rapport building is challenging
“Positive” symptoms	• Patient is unwilling to believe information provided
Fixed false beliefs (delusions), false perceptions like hearing voices (hallucinations), suspiciousness, unusual thought form and content	• Patient gives false impression of disinterest during counseling
“Negative” symptoms	• Patient displays poor retention of information provided
Lack of drive or motivation (avolition), flat affect, lack of spontaneous speech (alogia), loss of interest in pleasurable activities (anhedonia), social withdrawal	• Patient is an unreliable historian
Cognitive impairments	• Patient is less likely to actively seek out a referral
Attention and/or memory problems
Poor insight
Limited awareness that they have a mental illness
External factor	• False belief on the part of counselor and/or patient that etiology is entirely uncertain
Clinical and genetic heterogeneity	• False belief on the part of counselor and/or patient that diagnosis is entirely uncertain
Clinical diagnosis only, variable signs and symptoms, lack of universal genetic testing, no common genetic variants or environmental factors of notable effect size, limited opportunity to individualize recurrence risk statistics	• Diagnostic uncertainty in family history taking
Stigma	• Counselor and patient frustration with perceived lack of knowledge and relatively fewer opportunities for personalized information
Stereotypes, myths about etiology and risk factors, belief that schizophrenia is somehow fundamentally different from other diseases, desire for social distance	• Provision of misinformation by counselor
Knowledge gaps of key professionals	• Patient is less likely to be referred or offered counseling
Limited training of medical genetics professionals in psychiatric illness and of mental health care professionals in genetics