Table I.

Suggestions for how clinicians might approach various aspects of the prenatal psychiatric genetic counseling session.

Issue	Suggested wording
Broad screening questions for eliciting a psychiatric family history (suggestions from the FIGS)27	“Has anyone ever been hospitalized for a “nervous breakdown?” “Has anyone in the family attempted suicide?” “Has anyone received electroconvulsive therapy or ECT?” “Is there anyone in the family who has had noticeable symptoms of: paranoia/hearing or seeing things that are not there/depression/anxiety/checking/hoarding?” “Has anyone in the family taken medications for their “nerves” or medicines like lithium or Prozac?”
Exploring a patient’s interest in discussing implications of their psychiatric family history	“Thank you for sharing the information about the family history of psychiatric illness. Would you be interested in having a conversation with me about what we know from research about the things that can contribute to the development of these conditions, chances for children to develop a psychiatric problem, and what sorts of things might be done to protect mental health?”
Contracting: situations when a patient expresses interest in discussing chance for illness recurrence only	“I hear that what you really want to know about is the chance for your future child to develop schizophrenia. We can certainly talk about that. What I propose to do first, is to provide you with some context for the numbers. We can talk a bit about what we know from research about the causes of psychiatric illness and how this relates to your/your family members experiences. We can also talk about how this relates to how people recover, and what we can do to protect mental health. Would that be alright? I find that having this context tends to really help people to get the most out of the conversation about the numbers.”
Contracting: Opening emotional issues as a topic for discussion	“Sometimes people have feelings of guilt around their personal experience with/family history of psychiatric illness, and/or they can sometimes feel judged for wanting to be a parent despite having a history of psychiatric problems, and these can be helpful things to talk about - have you experienced anything like this?”
Contracting: Explicit statement of clinician’s goals for the session	“I want to thoroughly addresses the needs and questions that you have, so that you leave feeling that you got something meaningful and important from our conversation today. To make this session as helpful for you as it can be, I’d like to invite you to share your thoughts and questions with me as we go – does that sound ok?”
Exploring patient’s existing explanation for cause of illness	“Can you tell me what you think contributed to the development of your own illness? “What was going on for you around the time you experienced your first episode?”
Discussing probability for illness recurrence in children: explaining ranges	“I am basing this range on the family history information that you provided for me. Studies have shown that if someone has a single first degree relative (like a parent) with schizophrenia, then their chance to develop the same condition themselves is around 15%. But, in this situation, in addition to having a parent who has experienced schizophrenia, your future child also has an uncle, a grandparent, and a great grandparent all on the same side of the family, and all with (what sounds like) schizophrenia. A greater the number of affected relatives suggests a greater chance of recurrence in the family. If we assume that your own parent and grandparent did indeed have schizophrenia or something like it, then the upper end of the range of chance is likely to be around 50%. So in this situation the chance for your child is somewhere between 15 and 50%”