Optional Rotation: Child and Adolescent Bipolar Spectrum Services

The field of genetics/genomics is currently one of the fastest growing in science.  Every day, new variations in the human genome are discovered and their potential effects on the body are delineated.  Some mutations and changes have easily understood effects that accompany them, while others are do not have such clear cut answers.  One area that has been captivating scientists for years is the genetics of mental health.  There has been significant research conducted concerning this field of study, and while some results have been promising, such as that of a recent team that discovered singlenucleotide polymorphisms (SNP) more common among individuals with schizophrenia , scientists have largely not found any consistent clinically significant genetic changes that contribute to an individual’s mental health.


Last fall, we had the pleasure of having Dr. Jehannine Austin, president of the National Society of Genetic Counselors (NSGC), talk about her experiences running the first ever genetic counseling clinic specifically targeting patients with psychiatric disorders.  Although genetic testing is not available for these patients, Jehannine and her colleagues were able to speak to them about the multifactorial nature of their disorders, how both genetic and environmental factors were tied to their presentation.  Listening to Jehannine talk about how these services she and her team provided peaked my interest in potentially being a future resource and a genetic counselor who would value the opportunity to counsel patients on mental health disorders.  This was one of the reasons why I chose to pursue an optional rotation at the Child and Adolescent Bipolar Spectrum Services (or CABS clinic.)  The clinic services youths with bipolar disorder, following their treatment, providing therapy services, coordinating other aspects of care such as school services, following up with inpatient treatments, and offering clinical research opportunities for those who qualify.  I went in with the hope that I would leave the rotation with a better understanding of pediatric psychiatric disorders, as well as the treatment and management options that follow after diagnosis.

The CABS clinic was gracious enough to allow Brooke Hornak, Michelle Morrow (who also share the same interest as I do) and me to join their team for a month.  The experience I had there was absolutely incredible, and although I was only there for a small portion of time, I feel that through my observations I was able to learn much about the intricacies of medical psychiatric care. During my rotation, I was able to observe intake sessions and medication and treatment follow-ups.  During intake sessions, new patients were seen during two different appointments.  During the first session, patients were asked a series of very detailed interview questions by a therapist or social worker that helped to determine the child’s experience with mood changes and overall mental health.  Questions were also asked regarding past medical, developmental, educational, and social history, and any reports of trauma or abuse.  The second session involves a review of the information, and is followed by a discussion with one of the psychiatrists about whether or not the individual meets any mental health diagnosis criteria.  If the psychiatrist believes that they do have bipolar disorder, the patient then has the opportunity to continue care through the CABS clinic or through another psychiatric care facility.  These intake sessions were extremely interesting to observe.  The questions often resulted in very difficult answers.  Many children as young as 3 or 4 presented with a past history of trauma, and had significant psychiatric symptoms as well.  However, all of the clinicians were extremely kind, patient, and thorough with the patients and families, and by watching them I truly feel that I learned important skills in terms of counseling individuals with seriously negative psychosocial events in their pasts.

I also had the opportunity to observe the psychiatrists as they followed up with their patients about treatment and their progress.  During these sessions, it was very apparent how much the child’s bipolar disorder could affect the entire family.  Many parents and siblings became visibly emotional, and felt tired and even helpless.  However, once again, the clinicians at the CABS clinic expertly addressed these concerns and worries head on, which was inspiring to watch.  As a genetic counseling student, one of our roles that we consistently learn about, is that our field has a focus on tending to the whole patient, not simply addressing only their medical diagnosis and treatment, but the psychosocial issues that may come with it.  Being able to observe these sessions showed to me how truly important it is to care for the mental health of the entire family as well, so that the family could function well for the good of the patient.

My time at the CABS clinic was exciting and inspiring to me.  Watching and learning from individuals who have mastered a plethora of psychosocial skills was incredibly valuable to me during my clinical rotations.  Seeing children and families affected by bipolar disorder, and the strength and resilience they showed during treatment, pushed me further to pursue a genetic counseling position that would directly help individuals with a history of bipolar disorder or other mental health disorders.  I know that my fellow students and I greatly enjoyed our learning experience, and I can only hope that future genetic counseling students can utilize the CABS optional rotation and learn from the wonderful team and families there.

 - Emily Massiello, Class of 2017