The highly anxious individual presenting for Huntington disease-predictive genetic testing: the psychiatrist's role in assessment and counseling.

Guidelines in the Huntington disease genetic counseling community have set a standard for the process of at-risk counseling, recommending the involvement of a multidisciplinary team, which includes a psychiatrist or psychologist. Though most studies have been largely reassuring regarding the psychologic consequences of predictive testing, there are individuals presenting to testing who really want something else other than the test results, who are being pressured by others to obtain results, or who remain deeply ambivalent about testing. Particularly concerning are those testing candidates who are highly anxious or depressed at the time of presentation. Balancing the ethical principles of autonomy with beneficence and nonmaleficence requires careful exploration of the motivations behind testing to ensure that all are fully informed of alternatives, and opportunities for further support are offered when needed. This chapter illustrates 13 areas of focus and inquiry in the psychiatric interview and gives some case examples to illustrate an approach to the psychiatric assessment and counseling of highly anxious individuals seeking genetic testing.