PSYCHIATRIC GENOMICS IN CLINICAL PRACTICE IN THE UK: THE ALL WALES PSYCHIATRIC GENOMICS SERVICE

Background In the UK, individuals with physical health conditions, intellectual disabilities, or syndromic presentations have been able to access genetic counselling and testing within the National Health Service (NHS) for a significant period. However, despite major advances in our understanding of the genetic basis of psychiatric conditions such as schizophrenia, people with these and related conditions have not been able to routinely access the same level of healthcare. The All Wales Psychiatric Genomics Service (AWPGS), the UK’s first dedicated psychiatric genomic clinical service, was established to address this inequality. Methods The AWPGS is a national, multidisciplinary collaboration between psychiatry and clinical genetics. We provide specialist assessment, genetic counselling, and, where appropriate, genetic testing for i) individuals with psychiatric conditions and their families, and ii) individuals in whom a highly penetrant psychiatric genetic variant has been identified by other services. We accept referrals from healthcare professionals across Wales. We assess patients in our joint psychiatry-clinical genetics clinic, delivered in person, virtually, through domiciliary visits, or via ward visits where appropriate. Our work is supported by a monthly multidisciplinary team meeting involving colleagues from psychiatry, clinical and laboratory genetics, pharmacy, and genetic counselling, which facilitates case discussions and the interpretation of genomic findings. Results Since its launch in 2022, the AWPGS has assessed and provided genetic counselling to more than 100 individuals referred from psychiatric and clinical genetics services and research studies. In a subset of individuals, we have identified rare pathogenic copy number variants, enabling us to provide information on the genomic contribution to their clinical presentation, add to our patients’ narratives, and tailor physical healthcare monitoring and intervention. Conclusion The AWPGS demonstrates the feasibility of integrating psychiatric genomics into routine NHS clinical care. Key components include close collaboration between psychiatry and clinical genetics, multidisciplinary genomic interpretation, and flexible clinic delivery models that accommodate individuals with complex psychiatric presentations. This model provides a practical framework for translating advances in psychiatric genetics into clinical services and may inform the development of similar services internationally.