Co-aggregation of major psychiatric disorders in individuals with first-degree relatives with schizophrenia: a nationwide population-based study

Using big data of genetics, health claims, and brain imaging to challenge the categorical classification in mental illness

Psychiatric disorders in first-degree relatives (FDRs) often differ from the index patient's diagnosis, suggesting that there is genetic contribution to psychiatric disorders in which related cases do not all map to the same diagnosis as the index case. Our aim is to look for psychiatric comorbidities across major mental illnesses using three approaches, genetics, clinical diagnosis, and brain imaging to address common associations and pathology among mental illnesses. Genome-wide association studies from the Psychiatric Genomics Consortium showed single gene polymorphisms are common across 5 major psychiatric disorders, including schizophrenia (SZ), bipolar disorder (BD), major depressive disorder (MDD), autism spectrum disorder (ASD), and attention deficit hyperactivity disorder (ADHD). Clinically, results of Taiwan's nationwide population studies showed that other major psychiatric disorders were more likely to coaggregate in families with an index case of an individual with a psychiatric disorder, compared to control families. Finally, resting functional connectivity (FC) magnetic resonance imaging (MRI) and whole-brain connectomic analysis of SZ, BD I, BD II, MDD, and healthy controls revealed that the four groups of patients shared similar patterns of abnormal neural substrate in the brain that differed from controls. In conclusion, using big data from genetics, administrative health claims, and brain imaging, we identified concordance, indicating dimensional coherence of genetic heritability, clinical mutual associations, and common neurobiological substrates across major psychiatric disorders. These results will challenge the current diagnostic classification system and possibly move psychiatry beyond descriptive syndromes towards a nosology informed by disease cause.

Type 1 Diabetes Mellitus and Risks of Major Psychiatric Disorders: A Nationwide Population-Based Cohort Study

BACKGROUND

The temporal association between type 1 diabetes mellitus (T1DM) and major psychiatric disorders, including schizophrenia, major affective disorder, autism spectrum disorder (ASD), and attention-deficit hyperactivity disorder (ADHD), remains elusive.

METHODS

The specialized databases of catastrophic diseases and mental disorders and the longitudinal health insurance database of Taiwan National Health Insurance Research Database were used in current study. A total of 6,226 patients with T1DM and 62,260 age- and sex-matched controls were recruited between 2001 and 2010 and were followed until the end of 2011 for the identification of diagnoses of schizophrenia (International Classification of Clinical Diseases, Ninth Edition, Clinical Modification [ICD-9-CM] code: 295), bipolar disorder (ICD-9-CM codes: 296 except 296.2x, 296.3x, 296.9x, and 296.82), major depressive disorder (ICD-9-CM codes: 296.2x and 296.3x), ASD (ICD-9-CM code: 299), and ADHD (ICD-9-CM code: 314).

RESULTS

Cox regression analysis revealed increased hazard ratios of schizophrenia (12.28), bipolar disorder (13.80), major depressive disorder (10.41), ASD (14.52), and ADHD (8.19) in patients with T1DM compared with controls.

DISCUSSION

Our findings indicate the importance of clinicians closely monitoring the mental health condition of children, adolescents, and adults with T1DM. Additional studies should be conducted to elucidate the definite pathomechanisms of comorbidities between T1DM and major psychiatric disorders.

Dengue Virus Infection and Risk of Parkinson's Disease: A Nationwide Longitudinal Study

Background: Increasing evidence suggests a potential relationship between viral infection and Parkinson’s disease (PD). Objective: Herein, we explore the association between infection by dengue virus and PD. Methods: Between 1997 and 2012, we recruited 1,422 patients with dengue fever and 14,220 matched controls (age, sex, time of enrollment, and medical and mental comorbidities) from the Taiwan National Health Insurance Research Database. We identified new onset of PD to the end of 2013. The Kaplan-Meier method was used to estimate the incidence rate of PD. Cox-regression analysis was applied to calculate the hazard ratios (HRs) with 95% confidence intervals (CIs) after adjustment for confounders. Results: During the follow up period, the dengue group had higher incidence of PD than the control group (1.2% vs. 0.4% , p = 0.001). Patients with dengue fever had a significantly higher risk of developing PD [HR, 2.59; 95% CI, 1.51–4.44] compared with the controls, after adjustments for demographic data, PD-related comorbidities, and all-cause clinical visits. The subgroup analysis, stratified by age and sex, found that higher risk for PD was statistically significant for male (HR, 3.51; 95% CI, 1.76–7.00) and patients aged >60 years (HR, 2.96; 95% CI, 1.62–5.41). Conclusion: The risk of PD was 2.59-fold higher in patients with dengue fever than in non-infected controls during the follow-up period. Clinicians need to monitor signs of PD during patient recovery from dengue fever. Additional studies are needed to confirm our results and investigate the mechanisms linking PD and dengue virus infection.

Risks of major mental disorders after parental death in children, adolescents, and young adults and the role of premorbid mental comorbidities: a population-based cohort study

Previous studies have shown an association between early parental death and the risk of subsequent major mental disorders (MMDs) among the bereaved children and adolescents; however, it is unclear whether this risk exists in young adults and in individuals with premorbid mental comorbidities. We aimed to explore differences between children, adolescents, and young adults in the risk of MMDs after parental death. We analyzed data from the Taiwan National Health Research Database. The index cohort was offspring (divided into four groups: aged < 6, 6-11, 12-17, and 18-29 years) whose parents had died. The control cohort was demographically matched offspring whose parents were still alive. Cox regression with adjustments for demographics was used to estimate the risk of subsequent MMDs between the index and control cohorts, including schizophrenia, bipolar disorder, and depressive disorder. We included 202,837 cases and 2,028,370 matched controls. As with the bereaved children and adolescents, the bereaved young adults had a significantly higher risk of schizophrenia (hazard ratio with 95% confidence interval: 5.63; 5.01-6.33), bipolar disorder (3.37; 2.96-3.84), and depressive disorder (2.78; 2.68-2.90) than the control cohort. The risk of MMDs was similar for maternal death and paternal death. Among premorbid mental comorbidities, bereaved individuals with premorbid substance use disorder were associated with the highest risk of schizophrenia (10.43; 8.57-12.71), bipolar disorder (12.93; 10.59-15.79), and depressive disorder (10.97; 10.22-11.78). Healthcare workers should be aware that young adults and individuals with premorbid mental comorbidities are at a higher risk of subsequent MMDs than those without premorbid mental comorbidities after parental death.

Cancer Risk in Patients With Bipolar Disorder and Unaffected Siblings of Such Patients: A Nationwide Population-Based Study

Increasing evidence suggests that patients with bipolar disorder are more likely to develop malignant cancer than is the general population. However, the overall cancer risk in the unaffected siblings of such patients remains unknown. From the National Health Insurance Research Database of Taiwan, 25,356 patients with bipolar disorder, 25,356 age-matched unaffected siblings of patients with bipolar disorder, and 101,422 age-matched controls without severe mental disorders between 1996 and 2010 were enrolled in this study. Patients who developed cancer between the time of enrollment and the end of 2011 were identified. Cancers were divided into 3 subgroups based on the related layer of embryonic development: ectodermal, mesodermal, and endodermal cancers. Patients with bipolar disorder (odds ratio [OR] = 1.22, 95% confidence interval [CI]: [1.06, 1.40]) and unaffected siblings of such patients (OR = 1.17, 95% CI [1.02, 1.34]) had greater risk of developing malignant cancer than did controls. Furthermore, only those aged <50 years, for both patients with bipolar disorder (OR = 1.90, 95% CI [1.38, 2.61]) and unaffected siblings (OR = 1.65, 95% CI [1.19, 2.28]), were more likely to develop the ectodermal cancer, especially breast cancer, than the control group. The associations of bipolar disorder and susceptibility to bipolar disorder with increased cancer risk in the younger population may imply a genetic overlap in neurodevelopment and malignancy pathogenesis. Our findings may encourage clinicians to monitor cancer risk factors and warning sings closely in patients with bipolar disorder and in unaffected siblings of such patients. This article is protected by copyright. All rights reserved.

Bipolar women's antepartum psychotropic exposure and offspring risk of attention-deficit/hyperactivity disorder and autism spectrum disorder

BACKGROUND

Women with bipolar disorder (BD) may continue psychotropics during pregnancy. The association of exposure to antidepressant, antipsychotics, and mood stabilizers with offspring risks of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) remains unexplored in mothers with BD.

METHODS

A total of 5669 pregnant women with BD and 5669 psychiatrically healthy controls were identified between 2002 and 2011 from the Taiwan Longitudinal Health Insurance Database. We analyzed the odds ratios (ORs) of psychotropic types and exposure periods (3 months before pregnancy [3MbPreg] and first, second, and third trimesters [T1, T2, T3, respectively]) on the risk of ADHD and ASD by using adjusted logistic regression analyses.

RESULTS

Antidepressant exposure during 3MbPreg (OR=2.15, 95% CI=1.45-3.20), T1 (OR=2.62, 95% CI=1.68-4.09), T2 (OR=2.33, 95% CI=1.18-4.63), and T3 (OR=2.33, 95% CI=1.67-6.61) was associated with increased offspring risk of ADHD, particularly for selective serotonin reuptake inhibitor and serotonin norepinephrine reuptake inhibitor. Mood stabilizer exposure during 3MbPreg increased the risks of ADHD (OR=2.39, 95% CI=1.45-3.95) and ASD (OR=3.89, 95% CI=1.30-11.65); a higher ADHD risk was associated with valproic acid (OR=2.43, 95% CI=1.32-4.47) and lamotrigine exposure (OR=8.24, 95% CI = 1.49-45.67); ASD risk was higher for lithium exposure (OR=6.75, 95% CI=1.41-32.28).

LIMITATION

In claims-data analyses, several clinical parameters or potential confounders may be incompletely captured.

CONCLUSIONS

Antidepressants were associated with higher offspring risk of ADHD over all gestation periods among mothers with BD than psychiatrically healthy controls, while mood stabilizers were associated with higher risk of ADHD and ASD during 3MbPreg.

Diagnostic progression to bipolar disorder in 17,285 adolescents and young adults with attention deficit hyperactivity disorder: A longitudinal follow-up study

OBJECTIVE

We investigated the diagnostic progression to bipolar disorder (BD) among adolescents and young adults with attention-deficit/hyperactivity disorder (ADHD).

METHODS

Using the Taiwan National Health Insurance Research Database, we enrolled adolescents and young adults aged 10-29 years with ADHD between January 1, 2001, and December 31, 2010, who were followed up until December 31, 2011, to determine progression to BD. Cox regression analysis was used to examine candidate risk and protective factors.

RESULTS

At the 11-year follow-up, the progression rate from ADHD to BD was 5.12%. Of the participants who progressed, 62.16% (322/518) progressed within the first 3 years. Risk factors for progression were as follows: older age (hazard ratio [HR], 1.058; 95% confidence interval [CI], 1.033-1.084), comorbidity with autistic spectrum disorder (HR, 1.839; 95% CI, 1.415-2.391), disruptive behavior disorder (HR, 1.434; 95% CI, 1.132-1.816), intelligence disability (HR, 1.744; 95% CI, 1.399-2.176), depressive disorder (HR, 1.978; 95% CI, 1.577-2.482), alcohol use disorder (HR, 1.705; 95% CI, 1.057-2.751), cluster A (HR, 2.508; 95% CI, 1.167-5.391) or B (HR, 2.718; 95% CI, 1.974-3.741) personality disorder, and a family history of BD (HR, 2.618; 95% CI, 1.823-3.758) Identified protective factors were male sex (HR, 0.771; 95% CI, 0.630-0.943) and cluster C personality disorder (HR, 0.278; 95% CI, 0.086-0.898).

CONCLUSION

The study demonstrated the specific risk and protective factors for BD progression among adolescents and young adults with ADHD. It is important for clinician and mental health care providers to recognize identified factors to focus on early detection and prompt intervention.

Antipsychotic use in pregnancy and risk of attention/deficit-hyperactivity disorder and autism spectrum disorder: a Nordic cohort study

Background

Antipsychotics are increasingly used among women of childbearing age and during pregnancy.

Objective

To determine whether children exposed to antipsychotics in utero are at increased risk of attention-deficit/hyperactivity disorder (ADHD) or autism spectrum disorder (ASD), accounting for maternal diagnoses of bipolar, psychotic and other psychiatric disorders.

Design

Population-based cohort study, including a sibling analysis.

Setting

Nationwide data on all pregnant women and their live-born singletons in Denmark (1997-2017), Finland (1996-2016), Iceland (2004-2017), Norway (2004-2017), and Sweden (2006-2016).

Participants

4 324 086 children were eligible for inclusion to the study cohort.

Intervention

Antipsychotic exposure in utero, assessed by pregnancy trimester, type of antipsychotic, and varying patterns of use.

Main outcome measures

Non-mutually exclusive diagnoses of ADHD and ASD. We used Cox proportional hazard models to calculate hazard ratios (HRs) controlling for maternal psychiatric disorders and other potential confounding factors.

Findings

Among 4 324 086 singleton births, 15 466 (0.4%) were exposed to antipsychotics in utero. During a median follow-up of 10 years, we identified 72 257 children with ADHD and 38 674 children with ASD. Unadjusted HRs were raised for both outcomes but shifted substantially towards the null after adjustment; 1.10 (95%CI 1.00 to 1.27) for ADHD and 1.12 (0.97 to 1.29) for ASD. Adjusted HRs remained consistent by trimester of exposure and type of antipsychotic. Comparing in utero exposure with pre-pregnancy use yielded HRs of 0.74 (0.62 to 0.87) for ADHD and 0.88 (0.70 to 1.10) for ASD. Sibling analyses yielded HRs of 1.14 (0.79 to 1.64) for ADHD and 1.34 (0.75 to 2.39) for ASD.

Discussion

Our findings suggest little or no increased risk of child ADHD or ASD after in utero exposure to antipsychotics.

Clinical implications

Results regarding child neurodevelopment are reassuring for women who need antipsychotics during pregnancy.

Associations of parental mental disorders and age with childhood mental disorders: a population-based cohort study with four million offspring

This Taiwan study examined the associations of parental age and mental disorders with the offspring risks of attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), major depressive disorder (MDD), and bipolar disorder (BD). Children born between January 1991 and December 2004 in Taiwan were enrolled as the birth cohort (n = 4,138,151) and followed up until December 2011. A logistic regression analysis was performed to identify the odds ratio (OR). The advanced age effects were significant in ADHD (range of OR: 1.04 to 1.49) and ASD (range of OR: 1.35 to 2.27). Teenage mothers, teenage fathers, and fathers ≥ 50 years had higher offspring risks of MDD (range of OR: 1.24 to 1.46); and teenage mothers and fathers ≥ 50 years had increased offspring risks of BD (range of OR: 1.23 to 1.87). Both paternal and maternal mental disorders were associated with higher risks of within-disorder transmission for ADHD, ASD, MDD, and BD (range of OR: 2.64 to 30.41). Besides, parents with one of these four mental disorders (ADHD, ASD, MDD, and BD) might have higher risk of cross-disorder transmission to at least one of the other three mental disorders in the offspring (range of OR: 1.35 to 7.15). Parental age and mental disorders had complex and nuanced patterns in association with offspring mental disorders.

Multigenerational health research using population-based linked databases: an international review

Family health history is a well-established risk factor for many health conditions but the systematic collection of health histories, particularly for multiple generations and multiple family members, can be challenging. Routinely-collected electronic databases in a select number of sites worldwide offer a powerful tool to conduct multigenerational health research for entire populations. At these sites, administrative and healthcare records are used to construct familial relationships and objectively-measured health histories. We review and synthesize published literature to compare the attributes of routinely-collected, linked databases for three European sites (Denmark, Norway, Sweden) and three non-European sites (Canadian province of Manitoba, Taiwan, Australian state of Western Australia) with the capability to conduct population-based multigenerational health research. Our review found that European sites primarily identified family structures using population registries, whereas non-European sites used health insurance registries (Manitoba and Taiwan) or linked data from multiple sources (Western Australia). Information on familial status was reported to be available as early as 1947 (Sweden); Taiwan had the fewest years of data available (1995 onwards). All centres reported near complete coverage of familial relationships for their population catchment regions. Challenges in working with these data include differentiating biological and legal relationships, establishing accurate familial linkages over time, and accurately identifying health conditions. This review provides important insights about the benefits and challenges of using routinely-collected, population-based linked databases for conducting population-based multigenerational health research, and identifies opportunities for future research within and across the data-intensive environments at these six sites.

Proton Pump Inhibitors Are Associated with Increased Risk of Psoriasis: A Nationwide Nested Case-Control Study

BACKGROUND

Proton pump inhibitors (PPIs) are among the most widely used drugs. Little is known about the association between PPI use and risk of psoriasis.

OBJECTIVE

To investigate the association between PPI use and subsequent psoriasis risk.

METHODS

We included participants from the Taiwan National Health Insurance Research Database. Patients with PPI use and an incidence of psoriasis (n = 5,756) were assigned to the case cohort and 1:1 matched to controls. PPI use was defined as >30 cumulative defined daily doses (cDDDs); PPI nonuse was defined as ≤30 cDDDs. Logistic regression was used for the analyses.

RESULTS

There was a significant association between PPI use and psoriasis risk. The confounder-adjusted odd ratios (95% confidence interval [CI]) were 1.52 (1.31-1.76) and 1.54 (1.22-1.93) for patients with 120-365 cDDDs and >365 cDDDs, respectively, compared with PPI nonusers. Stratified analyses based on PPI type showed that exposure to lansoprazole (OR, 1.25; 95% CI, 1.11-1.41) was associated with subsequent psoriasis risk.

CONCLUSIONS

PPI use might be associated with an increased risk of developing psoriasis or as an epiphenomenon. Further prospective studies are needed to elucidate the association and underlying mechanisms.

Dengue and dementia risk: A nationwide longitudinal study

BACKGROUND

Accumulating evidence suggests neurological manifestations after dengue infection. However, the relationship between dengue and long-term neurocognitive sequel remains unclear.

METHODS

We recruited 816 patients with dengue and 8,160 controls between 1997 and 2012 using data from Taiwan National Health Insurance Research Database and followed them up until the end of 2013. Individuals who exhibited any type of dementia were identified during the follow-up period. Cox regression analyses were performed with adjustments for demographic data and medical and mental comorbidities (cerebrovascular diseases, traumatic brain injury, hypertension, dyslipidemia, diabetes mellitus, depression, alcohol use disorder, and substance use disorder). The E-value for the causality of the evidence was calculated. Sensitivity analysis was conducted to exclude patients with prodromal dementia.

RESULTS

Patients with dengue were more likely to develop dementia (hazard ratio [HR]: 2.23, 95% confidence interval [CI]: 1.51-3.28), Alzheimer's disease (HR: 3.03, 95% CI: 1.08-8.45), and unspecified dementia (HR: 2.25, 95% CI: 1.43-3.53), but not vascular dementia compared to controls during the follow-up period. Sensitivity analyses after exclusion of the observation period over the first three years or first five years and after exclusion of patients' enrollment before 2010 or 2008 showed consistent findings. The E-values for the HR (range 3.62-5.51) supported the association between dengue and subsequent dementia among the whole population, men, and women.

CONCLUSION

The risk of dementia was 2.23-fold higher in patients diagnosed with dengue during the follow-up period than in the controls. Further studies are necessary to investigate the underlying pathophysiology of dengue and dementia.

Sexually transmitted infections among adolescents with conduct disorder: a nationwide longitudinal study

Studies have demonstrated that conduct disorder is related to risky sexual behaviors, the dominant risk factor for contracting a sexually transmitted infection (STI). However, the association between conduct disorder and STIs remains unclear. Using the Taiwan National Health Insurance Research Database, 5733 adolescents with conduct disorder and 22,932 age- and sex-matched controls without conduct disorder were enrolled from 2001 to 2009 and were subject to follow-up until the end of 2011. Participants who contracted any STI during the follow-up period were identified. Cox regression analysis was performed to examine the likelihood of subsequently contracting an STI for patients and controls. Patients with conduct disorder were more likely than controls to develop any STI (HR 3.95, 95% CI 2.97-5.26) after adjusting for demographic data, psychiatric comorbidities, and use of medications. Long-term use of second-generation antipsychotics (SGAs) was related to a reduced risk (HR 0.36, 95% CI 0.14-0.91) of developing an STI among patients with conduct disorder. Adolescents with conduct disorder had an increased risk of developing any STI later in life compared with those without conduct disorder. Long-term use of SGAs was associated with a lower risk of subsequent STI.

Increased risk of short-term depressive disorder after Helicobacter pylori eradication: A population-based nested cohort study

BACKGROUND

Depressive disorder is a major psychiatric illness, and a disturbed brain-gut-microbiome axis may contribute to its pathophysiology. Chronic Helicobacter pylori (H. pylori) infections are common in the general population and using multiple antibiotics is required for its eradication, which is associated with gut dysbiosis and may lead to depression. We aimed to evaluate the risk of psychiatrist-diagnosed depression in patients with peptic ulcer diseases (PUD) receiving anti-H. pylori therapy.

MATERIALS AND METHODS

We collected data from the National Health Insurance Research Database (NHIRD) in Taiwan on PUD patients undergoing antibiotic treatment for H. pylori infection; patients and controls were matched for age, sex, income, level of urbanization, and comorbidities.

RESULTS

Of the 1 million beneficiaries in the NHIRD, we identified 7087 patients for inclusion in the eradication cohort and 7087 matched non-eradication controls with PUD. Antibiotic therapy is associated with a short-term (<30 days) increase in the incidence of psychiatrist-diagnosed depressive disorder (p = 0.009, after multiple comparisons with Bonferroni correction) in the eradication cohort compared with the controls. Female (OR: 4.55, 95% CI: 1.53-13.48) PUD patients were more likely to display an increased risk of depression within 30 days after eradication therapy. Clarithromycin use was related to an elevated likelihood (OR: 3.14, 95% CI: 1.45-6.80) of subsequent depressive disorder within 30 days after eradication therapy.

CONCLUSIONS

Antibiotic eradication treatment for H. pylori infection is associated with a significant short-term (less than 30 days) increase in the incidence of psychiatrist-diagnosed depressive disorder, which can be overlooked by gastroenterologists and general practitioners.

Month of birth and mental disorders: A population-based study and validation using global meta-analysis

OBJECTIVE

Month of birth (MOB) is associated with specified mental disorders (MDs). However, whether these relationships extend to all MDs remains unclear. We investigate the association using a population-based cohort study and a meta-analysis.

METHODS

First, we examined patients with 34 DSM-5-classified MDs in the Taiwan national database. We estimated the relative risk ratios (RR) of each illness in each MOB relative to that in the general population and assessed the periodicity, with six further sensitivity analyses. Second, we searched PubMed, Embase, and Cochrane for related articles through 31 December 2020. We used a random-effects model, pooled RRs with 95% confidence intervals of each MOB from the identified studies, and transformed them from MOB to relative age in a year or season.

RESULTS

The cohort included 1,951,777 patients. Except for posttraumatic stress disorder, dissociative disorders, feeding/eating disorders, gender dysphoria, and paraphilic disorders, the other MDs had significant MOB periodicity. The meta-analysis included 51 studies investigating 10 MDs. The youngest age at the start of school owing to MOB was associated with the highest RRs of intellectual disability (1.13), autism (1.05), attention-deficit/hyperactivity disorder (1.13). Winter births had significant risks of schizophrenia (1.04), bipolar I disorder (1.02), and major depressive disorder (1.01), and autumn births had a significant risk of alcohol use disorder (1.02). No significant associations between season of birth and Alzheimer's disease, or eating disorders were found.

CONCLUSIONS

MOB is related to the risks of certain MDs. This finding provides a reference for future research on the etiology of MDs.

Differences in Psychiatric Comorbidities and Gender Distribution among Three Clusters of Personality Disorders: A Nationwide Population-Based Study

Personality disorders (PDs) are grouped into clusters A, B, and C. However, whether the three clusters of PDs have differences in comorbid mental disorders or gender distribution is still lacking sufficient evidence. We aim to investigate the distribution pattern across the three clusters of PDs with a population-based cohort study. This study used the Taiwan national database between 1995 and 2013 to examine the data of patients with cluster A PDs, cluster B PDs, or cluster C PDs. We compared the differences of psychiatric comorbidities classified in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition across the three clusters of PDs. Moreover, we formed gender subgroups of the three PDs to observe the discrepancy between male and female. Among the 9845 patients, those with cluster A PDs had the highest proportion of neurodevelopmental disorders, schizophrenia and neurocognitive disorders, those with cluster B PDs demonstrated the largest percentage of bipolar disorders, trauma and stressor disorders, feeding and eating disorders, and substance and addictive disorders, and those with cluster C PDs had the greatest proportion of depressive disorders, anxiety disorders, obsessive–compulsive disorders, somatic symptom disorders, and sleep–wake disorders. The gender subgroups revealed significant male predominance in neurodevelopmental disorders and female predominance in sleep–wake disorders across all three clusters of PDs. Our findings support that some psychiatric comorbidities are more prevalent in specified cluster PDs and that gender differences exist across the three clusters of PDs. These results are an important reference for clinicians who are developing services that target real-world patients with PDs.

The Risk of Alzheimer's Disease After Acute Appendicitis With or Without Appendectomy

OBJECTIVE

Previous epidemiologic studies have suggested an association between appendectomy and Parkinson's disease. The aim of the current study was to examine the risk of Alzheimer's disease (AD) and other types of dementia following appendicitis or appendectomy for appendicitis.

DESIGN

Population-based cohort study.

SETTING AND PARTICIPANTS

We used claims data from the Taiwan National Health Insurance Research Database. Participants aged ≥45 years with acute appendicitis or who received appendectomy for appendicitis were enrolled and followed up for more than 15 years. Cases and controls underwent 1:1 matching by age, sex, index date, and dementia-related comorbidities.

METHODS

The primary outcome was AD, and secondary outcomes included other dementia types. Adjusted hazard ratios (aHRs) were calculated, and a competing risk regression model was created. The E value for causality of evidence was calculated.

RESULTS

Patients developing appendicitis (0.6% vs 0.1%, P = .005) and those receiving appendectomy for appendicitis (0.4% vs 0.1%, P = .003) had higher incidences of AD than the controls during the follow-up period. A Cox regression analysis with adjustment for potential confounders showed that patients with appendicitis [aHR 6.68, 95% confidence interval (CI) 1.84-24.48] and those receiving appendectomy for appendicitis (aHR 5.01, 95% CI 1.33-18.85) were more likely to develop AD than the controls. These 2 groups also had higher risks for unspecified dementia and all types of dementia but not for vascular dementia than the controls. The age at dementia diagnosis was 88.51 years in the controls; however, among people who developed dementia following appendicitis, the mean age at diagnosis was 70.18 years, and dementia occurred 5.84 years after appendicitis. The competing risk regression models and the E values support the study findings.

CONCLUSIONS AND IMPLICATIONS

After recovery from appendicitis, these patients should be followed up for signs of AD.

Prenatal exposure to acetaminophen increases the risk of atopic dermatitis in children: A nationwide nested case-control study in Taiwan

BACKGROUND

Acetaminophen (APAP) has been associated with the development of atopic diseases. However, little is known about the relationship between prenatal APAP exposure and atopic dermatitis (AD) in offspring.

OBJECTIVE

To investigate the association between prenatal APAP exposure and AD risk in offspring.

METHODS

In this study, 2029 study pairs (AD-affected children and their mothers) and 5,058 control pairs were identified between 1998 and 2008 from the Taiwan Longitudinal Health Insurance Database. Maternal APAP exposure during pregnancy was assessed.

RESULTS

After adjustment for potential confounders, there was a significant association between risk of offspring AD and exposure to acetaminophen in the first trimester (OR 1.16; 95% CI 1.05-1.28), the second trimester (OR 1.14; 95% CI 1.03-1.27), both first and second trimesters (OR 1.30; 95% CI 1.13-1.51), both first and third trimester (OR 1.20; 95% CI 1.04-1.39), any trimester (OR 1.12; 95% CI 1.00-1.26), and all three trimesters (OR 1.32; 95% CI 1.08-1.62) in a dose-response manner.

CONCLUSIONS

Prenatal exposure to acetaminophen was associated with an increased incidence of offspring AD.

Early Pregnancy Risk Among Adolescents With ADHD: A Nationwide Longitudinal Study

Objective: ADHD potentially leads to risky sexual behaviors, and is considered a major risk factor for early pregnancy (EP). However, the association between ADHD and subsequent EP remains unknown. Method: Seven thousand five hundred five adolescents with ADHD and 30,020 age- and sex-matched individuals without ADHD were enrolled from 2001 to 2009 and were followed until the end of 2011. Adolescents who developed any pregnancy (at age ≤30 years) or EP (at age <20 years) during the follow-up period were identified. Results: Adolescents with ADHD were found to be prone to pregnancy (hazard ratio [HR] = 1.27) and EP (HR = 2.30) compared with those without ADHD. Long-term ADHD medication use was related to a lower risk of subsequent any pregnancy (HR = 0.72) and EP (HR = 0.69). Conclusion: Adolescents with ADHD had an increased risk of any pregnancy and EP compared with their non-ADHD counterparts. Long-term ADHD medication use was associated with a lower subsequent EP risk.

Dorsal attention network centrality increases during recovery from acute stress exposure

Stress is a major risk factor for the development of almost all psychiatric disorders. In addition to the acute stress response, an efficient recovery in the aftermath of stress is important for optimal resilience. Increased stress vulnerability across psychiatric disorders may therefore be related to altered trajectories during the recovery phase following stress. Such recovery trajectories can be quantified by changes in functional brain networks. This study therefore evaluated longitudinal functional network changes related to stress in healthy individuals (N = 80), individuals at risk for psychiatric disorders (healthy siblings of schizophrenia patients) (N = 39), and euthymic bipolar I disorder (BD) patients (N = 36). Network changes were evaluated before and at 20 and 90 min after onset of an experimental acute stress task (Trier Social Stress Test) or a control condition. Whole-brain functional networks were analyzed using eigenvector centrality as a proxy for network importance, centrality change over time was related to the acute stress response and recovery for each group. In healthy individuals, centrality of the dorsal attention network (DAN; p = 0.007) changed over time in relation to stress. More specifically, DAN centrality increased during the recovery phase after acute stress exposure (p = 0.020), while no DAN centrality change was observed during the initial stress response (p = 0.626). Such increasing DAN centrality during stress recovery was also found in healthy siblings (p = 0.016), but not in BD patients (p = 0.554). This study highlights that temporally complex and precise changes in network configuration are vital to understand the response to and recovery from stress.

Increased Risk of Stroke in Patients With Obsessive-Compulsive Disorder: A Nationwide Longitudinal Study

[Figure: see text].

Risks of Major Mental Disorders and Irritable Bowel Syndrome among the Offspring of Parents with Irritable Bowel Syndrome: A Nationwide Study

Irritable bowel syndrome (IBS) is a functional bowel disorder that is highly comorbid with mental disorders. However, few studies have examined the risk of attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), bipolar disorder, major depressive disorder (MDD), and schizophrenia in the offspring of parents with IBS. We used nationally representative cross-sectional survey data to analyze cross-generational transmission patterns of both IBS and major mental disorders. Odds ratio (OR) was calculated by using logistic regression models with adjustment for potential confounding factors. Offspring of parents with IBS were more likely to develop IBS themselves (OR = 2.41, 95% confidence interval (CI), 2.09–2.78), ADHD (OR = 1.33, 95% CI, 1.08–1.62), and MDD (OR = 1.32, 95% CI, 1.04–1.68) than the controls. Data stratification by parental sex revealed that paternal IBS increased risk of ADHD (OR = 1.34, 95% CI, 1.01–1.77) in the offspring, while maternal IBS increased the risk of MDD (OR = 1.51, 95% CI, 1.11–2.06). This is the first study to reveal parental IBS is associated with IBS, ADHD, and MDD among offspring, suggesting the necessity for early implementation of prevention strategies for at-risk children.

Factors Affecting Delayed Initiation and Continuation of Medication Use for Attention-Deficit/Hyperactivity Disorder: A Nationwide Study

Objective: This study evaluated the predictors for delayed initiation and continuation of ADHD medication use in children and adolescents with ADHD in Taiwan. Methods: This longitudinal cohort study enrolled 188,061 children and adolescents with ADHD between 2001 and 2011. Delayed initiation of ADHD medications was defined as the interval >365 days between diagnosis and first prescription, and continuation of ADHD medications was defined as ≥365 defined daily doses of ADHD medications. Results: Of the included patients, 39.2% were never treated with ADHD medications. Delayed initiation and continuation of ADHD medication use were found in 11.9% and 19.9% of the ever-treated patients, respectively. Younger age at ADHD diagnosis, male sex, older mother's age at child's ADHD diagnosis, and higher family income were associated with more delayed initiation but were also associated with more continuation of ADHD medication use. Conclusions: The initiation and continuation of ADHD medication use might be underlined by different mechanisms and warrant different strategies.

Disrupted upregulation of salience network connectivity during acute stress in siblings of schizophrenia patients

BACKGROUND

An adaptive neural stress response is essential to adequately cope with a changing environment. It was previously argued that sympathetic/noradrenergic activity during acute stress increases salience network (SN) connectivity and reduces executive control network (ECN) connectivity in healthy controls, with opposing effects in the late aftermath of stress. Altered temporal dynamics of these networks in response to stress are thought to play a role in the development of psychopathology in vulnerable individuals.

METHODS

We exposed male healthy controls (n = 40, mean age = 33.9) and unaffected siblings of schizophrenia patients (n = 39, mean age = 33.2) to the stress or control condition of the trier social stress test and subsequently investigated resting state functional connectivity of the SN and ECN directly after and 1.5 h after stress.

RESULTS

Acute stress resulted in increased functional connectivity within the SN in healthy controls, but not in siblings (group × stress interaction pfwe < 0.05). In the late aftermath of stress, stress reduced functional connectivity within the SN in both groups. Moreover, we found increased functional connectivity between the ECN and the cerebellum in the aftermath of stress in both healthy controls and siblings of schizophrenia patients.

CONCLUSIONS

The results show profound differences between siblings of schizophrenia patients and controls during acute stress. Siblings lacked the upregulation of neural resources necessary to quickly and adequately cope with a stressor. This points to a reduced dynamic range in the sympathetic response, and may constitute a vulnerability factor for the development of psychopathology in this at-risk group.

Atopic dermatitis and dementia risk: A nationwide longitudinal study

BACKGROUND

Retrospective studies have suggested that patients with dementia have higher prevalence of atopic dermatitis (AD) than those without dementia. However, the temporal association of AD with subsequent dementia remains unknown.

OBJECTIVE

To assess the temporal association of AD with subsequent dementia.

METHODS

We included data of patients with AD aged 45 years and older (n = 1059) and 1:10 age, sex, residence, income, and dementia-related comorbidity-matched controls (n = 10,590) from the Taiwan National Health Insurance Research Database and reviewed their subsequent dementia development from the enrollment date to the end of 2013.

RESULTS

After adjustments for dementia-related comorbidities, patients with AD were found to be more likely to develop any dementia (hazard ratio [HR], 2.02; 95% confidence interval [CI], 1.24-3.29), particularly Alzheimer's disease (HR, 3.74; 95% CI, 1.17-11.97), during the follow-up period than those in the control group. Moderate-to-severe AD was associated with a high subsequent dementia risk (HR, 4.64; 95% CI, 2.58-8.33). Sensitivity analyses with the exclusion of the first 3 (HR, 2.20; 95% CI, 1.28-3.80) or 5 (HR, 2.05; 95% CI, 1.08-3.89) years of observation revealed consistent findings.

CONCLUSION

AD may be an independent risk factor for new-onset dementia. Clinicians may monitor the trajectory of neurocognitive function among elderly patients with AD. Additional studies elucidating the pathomechanisms between AD and subsequent dementia are warranted.

Familial coaggregation of major psychiatric disorders among first-degree relatives of patients with obsessive-compulsive disorder: a nationwide study

BACKGROUND

Whether the first-degree relatives (FDRs) of patients with obsessive-compulsive disorder (OCD) have an increased risk of the major psychiatric disorders, namely schizophrenia, bipolar disorder, OCD, major depressive disorder (MDD), autism spectrum disorder (ASD), and attention deficit hyperactivity disorder (ADHD), remains unclear.

METHODS

Using the Taiwan National Health Insurance Research Database with the whole population sample size (n = 23 258 175), 89 500 FDRs, including parents, offspring, siblings, and twins, of patients with OCD were identified in our study. The relative risks (RRs) of major psychiatric disorders were assessed among FDRs of patients with OCD.

RESULTS

FDRs of patients with OCD had higher RRs of major psychiatric disorders, namely OCD (RR 8.11, 95% confidence interval (CI) 7.68-8.57), bipolar disorder (RR 2.85, 95% CI 2.68-3.04), MDD (RR 2.67, 95% CI 2.58-2.76), ASD (RR 2.38, 95% CI 2.10-2.71), ADHD (RR 2.19, 95% CI 2.07-2.32), and schizophrenia (RR 1.97, 95% CI 1.86-2.09), compared with the total population. Different familial kinships of FDRs, such as parents, offspring, siblings, and twins consistently had increased risks for these disorders. In addition, a dose-dependent relationship was found between the numbers of OCD probands and the risk of each major psychiatric disorder.

CONCLUSIONS

The FDRs, including parents, offspring, siblings, and twins, of patients with OCD have a higher risk of OCD, schizophrenia, bipolar disorder, MDD, ADHD, and ASD. The familial co-aggregation of OCD with OCD and other major psychiatric disorders was existent in a dose-dependent manner. Given the increased risks of psychiatric disorders, medical practitioners should closely monitor the mental health of the FDRs of patients with OCD.

Proton Pump Inhibitor Exposure and Acute Myocardial Infarction Risk: A Nested Cohort Study

BACKGROUND

Association of proton pump inhibitor (PPI) exposure with acute myocardial infarction (AMI) risk in the Caucasian population remains under debate. Here, we clarified whether PPI exposure might be related to an increased new-onset AMI risk in an Asian population.

METHOD

Data of 27,624 patients with PPI exposure followed by new-onset AMI development were extracted from Taiwan National Health Insurance Research Database and age- and sex-matched with 27,624 controls with PPIs exposure, but without subsequent AMI and ischemic heart disease development. The amount of PPI exposure was calculated based on the cumulative defined daily dose (cDDD) during the follow-up period. Subsequent AMI risk was measured after adjustments of demographic data and indication of PPI use.

RESULTS

AMI risk increased with an increase in PPI exposure: with cDDD ≤ 30 as the reference, the odds ratios (95% confidence intervals) for cDDDs of > 365 was 1.56 (1.45-1.69). All five PPI categories, including pantoprazole, lansoprazole, omeprazole, esomeprazole, and rabeprazole, increased AMI risk.

CONCLUSIONS

Our study demonstrated long-term or high-dose PPI exposure associated with increased new-onset AMI risk in patients without a history of any ischemic heart disease. The underlying mechanisms of PPI-related cardiovascular effects deserve more investigation.

Psychiatric symptoms and syndromes transcending diagnostic boundaries in Indian multiplex families: The cohort of ADBS study

Syndromes of schizophrenia, bipolar disorder, obsessive-compulsive disorder, substance use disorders and Alzheimer's dementia are highly heritable. About 10-20% of subjects have another affected first degree relative (FDR), and thus represent a 'greater' genetic susceptibility. We screened 3583 families to identify 481 families with multiple affected members, assessed 1406 individuals in person, and collected information systematically about other relatives. Within the selected families, a third of all FDRs were affected with serious mental illness. Although similar diagnoses aggregated within families, 62% of the families also had members with other syndromes. Moreover, 15% of affected individuals met criteria for co-occurrence of two or more syndromes, across their lifetime. Using dimensional assessments, we detected a range of symptom clusters in both affected and unaffected individuals, and across diagnostic categories. Our findings suggest that in multiplex families, there is considerable heterogeneity of clinical syndromes, as well as sub-threshold symptoms. These families would help provide an opportunity for further research using both genetic analyses and biomarkers.

Bidirectional association between migraine and depression among probands and unaffected siblings: A nationwide population-based study

BACKGROUND

Evidence suggests a bidirectional association between migraine and depression in individuals and in twins. However, whether a bidirectional association between migraine and depression also occurs among siblings (probands and unaffected nontwin siblings) remains unknown.

METHODS

Using the Taiwan National Health Insurance Research Database, we examined the data of 1504 probands with migraine, 1595 unaffected siblings, and 6380 nonmigrainous controls born before 2000 to identify new-onset depression for the period between 1996 and 2011. Conversely, 31824 probands with depression, 34325 unaffected siblings, and 137300 nondepressive controls were examined for the identification of new-onset migraine.

RESULTS

Logistic regression analyses demonstrated that compared with the controls, patients with migraine (odds ratio [OR]: 4.09; 95% confidence interval [CI]: 3.75-4.46) and unaffected siblings (OR: 1.40; 95% CI: 1.24-1.58) were more likely to develop depression during the follow-up period. Moreover, patients with depression and unaffected siblings had a 4.13-fold (95% CI: 3.18-5.36) and 1.45-fold (95% CI: 1.03-2.05) increased risk of migraine.

DISCUSSION

The bidirectional association between migraine and depression among probands and unaffected siblings suggests a familial coaggregation of these two conditions. Additional studies are required to investigate the genetic and environmental etiologies for this coaggregation.

The Role of Stress in Bipolar Disorder

Stress is a major risk factor for bipolar disorder. Even though we do not completely understand how stress increases the risk for the onset and poorer course of bipolar disorder, knowledge of stress physiology is rapidly evolving. Following stress, stress hormones - including (nor)adrenaline and corticosteroid - reach the brain and change neuronal function in a time-, region-, and receptor-dependent manner. Stress has direct consequences for a range of cognitive functions which are time-dependent. Directly after stress, emotional processing is increased at the cost of higher brain functions. In the aftermath of stress, the reverse is seen, i.e., increased executive function and contextualization of information. In bipolar disorder, basal corticosteroid levels (under non-stressed conditions) are generally found to be increased with blunted responses in response to experimental stress. Moreover, patients who have bipolar disorder generally show impaired brain function, including reward processing. There is some evidence for a causal role of (dysfunction of) the stress system in the etiology of bipolar disorder and their effects on brain system functionality. However, longitudinal studies investigating the functionality of the stress systems in conjunction with detailed information on the development and course of bipolar disorder are vital to understand in detail how stress increases the risk for bipolar disorder.

Inflammatory bowel disease is associated with higher dementia risk: a nationwide longitudinal study

OBJECTIVE

Increasing evidence supports reciprocal communication between the enteric and the central nervous system in disease, termed the 'gut-brain axis'. Recent findings suggest a connection between IBD and development of Parkinson's disease. The role of IBD in dementia, another insidious neurodegenerative disorder, has not been explored.

DESIGN

Using the Taiwanese National Health Insurance Research Database, we performed comparative analysis of 1742 patients with IBD ≥45 years old against 17 420 controls to assess dementia risk following IBD diagnosis. Controls were matched on bases of sex, access to healthcare, income and dementia-related comorbidities. All individuals were followed for dementia diagnosis for up to 16 years. Subanalyses included the relationship between sex, ulcerative colitis (UC) and Crohn's disease (CD), and dementia risk.

RESULTS

Overall incidence of dementia among patients with IBD was significantly elevated (5.5% vs 1.4% among controls). Patients with IBD were diagnosed with dementia at 76.24 years old on average, compared with 83.45 among controls. The HR of developing dementia among patients with IBD was 2.54 (95% CI 1.91 to 3.37). Among dementia types, the risk of developing Alzheimer's dementia demonstrated the greatest increase. Dementia risk did not differ between sex differences nor UC versus CD.

CONCLUSION

This population-based cohort study demonstrates significant association between IBD and subsequent development of dementia. Dementia was diagnosed at an earlier age among patients with IBD, and disease risk appeared to increase with IBD chronicity. These findings highlight the need for future research to elucidate the relationship between IBD and dementia.

Association of parental depression with offspring attention deficit hyperactivity disorder and autism spectrum disorder: A nationwide birth cohort study

BACKGROUND

Studies have indicated that parental depression was slightly related to the increased risk of offspring attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). However, the association between exposure to parental depression at different neurodevelopmental stages (i.e., perinatal or postnatal period) and subsequent ADHD and ASD development remained uncertain.

METHOD

708,515 children born between 2001 and 2008 were screened for ADHD and ASD based on ICD-9-CM codes of 314 and 299 given by psychiatrists from their birth to the end of 2011. Paternal and maternal depression was separately assessed during five periods, namely those before pregnancy (pre-pregnancy), during pregnancy (perinatal), and <1, 1-3, and >3 years after childbirth (postnatal). Cox regression analyses were performed.

RESULTS

Both paternal and maternal depression occurring in the pre-pregnancy, perinatal and postnatal periods were significantly associated with subsequent ADHD and ASD in the offspring, with hazard ratios between 1.42 (95% confidence interval [CI]: 1.35-1.49) and 2.25 (2.09-2.41). The chronicity and additive effect of paternal and maternal depression were related to increased risks of offspring ADHD and ASD. The effects of maternal depression were stronger than the effects of paternal depression for offspring ADHD (HR: 1.35, 95% CI: 1.27-1.45) and ASD (HR: 1.23, 95% CI: 1.05-1.46) risks.

CONCLUSION

Both paternal depression and maternal depression in the pre-pregnancy, perinatal and postnatal periods increases offspring ADHD and ASD risks, and these risks increase further with increases in the duration of parental depression and with the additive effect of parental and maternal depression.

Functional genomics links genetic origins to pathophysiology in neurodegenerative and neuropsychiatric disease

Neurodegenerative and neuropsychiatric disorders are pervasive and debilitating conditions characterized by diverse clinical syndromes and comorbidities, whose origins are as complex and heterogeneous as their associated phenotypes. Risk for these disorders involves substantial genetic liability, which has fueled large-scale genetic studies that have led to a flood of discoveries. In turn, these discoveries have exposed substantial gaps in our knowledge with regards to the complicated genetic architecture of each disorder and the substantial amount of genetic overlap among disorders, which implies some degree of shared pathophysiology underlying these clinically distinct, multifactorial disorders. Understanding the role of specific genetic variants will involve resolving the connections between molecular pathways, heterogeneous cell types, specific circuits and disease pathogenesis at the tissue and patient level. We consider the current known genetic basis of these disorders and highlight the utility of molecular systems approaches that establish the function of genetic variation in the context of specific neurobiological networks, cell-types, and life stages. Beyond expanding our knowledge of disease mechanisms, understanding these relationships provides promise for early detection and potential therapeutic interventions.

Cardiometabolic disease risk among siblings of patients with major depressive disorder

Studies have suggested an association between metabolic and cerebrocardiovascular diseases and major depressive disorder (MDD). However, the risk of metabolic and cerebrocardiovascular diseases in the unaffected siblings of patients with MDD remains uncertain. Using the Taiwan National Health Insurance Research Database, 22,438 unaffected siblings of patients with MDD and 89,752 age-/sex-matched controls were selected and followed up from 1996 to the end of 2011. Individuals who developed metabolic and cerebrocardiovascular diseases during the follow-up period were identified. Compared with the controls, the unaffected siblings of patients with MDD had a higher prevalence of metabolic diseases, such as hypertension (5.0% vs. 4.5%, p = 0.007), dyslipidemia (5.6% vs. 4.8%, p < 0.001), and obesity (1.7% vs. 1.5%, p = 0.028), and cerebrocardiovascular diseases, such as ischemic stroke (0.6% vs. 0.4%, p < 0.005) and ischemic heart disease (2.1% vs. 1.7%, p < 0.001). Logistic regression analyses revealed that the unaffected siblings of patients with MDD were more likely to develop hypertension, dyslipidemia, ischemic stroke, and ischemic heart diseases during the follow-up period than the controls. Our study revealed a familial coaggregation between MDD and metabolic and cerebrocardiovascular diseases. Additional studies are required to investigate the shared pathophysiology of MDD and metabolic and cerebrocardiovascular diseases.

Brain structural correlates of familial risk for mental illness: a meta-analysis of voxel-based morphometry studies in relatives of patients with psychotic or mood disorders

Schizophrenia (SCZ), bipolar disorder (BD), and major depressive disorder (MDD) are heritable psychiatric disorders with partially overlapping genetic liability. Shared and disorder-specific neurobiological abnormalities associated with familial risk for developing mental illnesses are largely unknown. We performed a meta-analysis of structural brain imaging studies in relatives of patients with SCZ, BD, and MDD to identify overlapping and discrete brain structural correlates of familial risk for mental disorders. Search for voxel-based morphometry studies in relatives of patients with SCZ, BD, and MDD in PubMed and Embase identified 33 studies with 2292 relatives and 2052 healthy controls (HC). Seed-based d Mapping software was used to investigate global differences in gray matter volumes between relatives as a group versus HC, and between those of each psychiatric disorder and HC. As a group, relatives exhibited gray matter abnormalities in left supramarginal gyrus, right striatum, right inferior frontal gyrus, left thalamus, bilateral insula, right cerebellum, and right superior frontal gyrus, compared with HC. Decreased right cerebellar gray matter was the only abnormality common to relatives of all three conditions. Subgroup analyses showed disorder-specific gray matter abnormalities in left thalamus and bilateral insula associated with risk for SCZ, in left supramarginal gyrus and right frontal regions with risk for BD, and in right striatum with risk for MDD. While decreased gray matter in right cerebellum might be a common brain structural abnormality associated with shared risk for SCZ, BD, and MDD, regional gray matter abnormalities in neocortex, thalamus, and striatum appear to be disorder-specific.

Dissecting the Epigenetic Changes Induced by Non-Antipsychotic Mood Stabilizers on Schizophrenia and Affective Disorders: A Systematic Review

BACKGROUND

Epimutations secondary to gene-environment interactions have a key role in the pathophysiology of major psychiatric disorders. In vivo and in vitro evidence suggest that mood stabilizers can potentially reverse epigenetic deregulations found in patients with schizophrenia or mood disorders through mechanisms that are not yet fully understood. However, their activity on epigenetic processes has made them a research target for therapeutic approaches.

METHODS

We conducted a comprehensive literature search of PubMed and EMBASE for studies investigating the specific epigenetic changes induced by non-antipsychotic mood stabilizers (valproate, lithium, lamotrigine, and carbamazepine) in animal models, human cell lines, or patients with schizophrenia, bipolar disorder, or major depressive disorder. Each paper was reviewed for the nature of research, the species and tissue examined, sample size, mood stabilizer, targeted gene, epigenetic changes found, and associated psychiatric disorder. Every article was appraised for quality using a modified published process and those who met a quality score of moderate or high were included.

RESULTS

A total of 2,429 records were identified; 1,956 records remained after duplicates were removed and were screened via title, abstract and keywords; 129 records were selected for full-text screening and a remaining of 38 articles were included in the qualitative synthesis. Valproate and lithium were found to induce broader epigenetic changes through different mechanisms, mainly DNA demethylation and histones acetylation. There was less literature and hence smaller effects attributable to lamotrigine and carbamazepine could be associated overall with the small number of studies on these agents. Findings were congruent across sample types.

CONCLUSIONS

An advanced understanding of the specific epigenetic changes induced by classic mood stabilizers in patients with major psychiatric disorders will facilitate personalized interventions. Further related drug discovery should target the induction of selective chromatin remodeling and gene-specific expression effects.

Hypothesis: bipolar disorder is an Epstein-Barr virus-driven chronic autoimmune disease - implications for immunotherapy

Bipolar disorder (BD) is a chronic disease characterised by episodes of major depression and episodes of mania or hypomania, with a worldwide prevalence of 2.4%. The cause of BD is unknown. Here, I propose the hypothesis that BD is a chronic autoimmune disease caused by Epstein–Barr virus (EBV) infection of autoreactive B cells. It is postulated that EBV‐infected autoreactive B cells accumulate in the brain where they provide costimulatory survival signals to autoreactive T cells and differentiate into plasma cells producing pathogenic autoantibodies targeting brain components such as the N‐methyl‐D‐aspartate receptor. It is also proposed that the accumulation of EBV‐infected autoreactive B cells in the brain is a consequence of a genetically determined defect in the ability of CD8⁺ T cells to control EBV infection. The theory is supported by studies indicating that autoimmunity, EBV infection and CD8⁺ T‐cell deficiency all have roles in the pathogenesis of BD. According to the hypothesis, BD should be able to be treated by EBV‐specific T‐cell therapy and to be prevented by vaccination against EBV in early childhood. Exposure to sunlight or appropriate artificial light should also be beneficial in BD by augmenting CD8⁺ T‐cell control of EBV infection.

Antidepressant resistance in adolescents with major depressive disorder: A nationwide longitudinal study

BACKGROUND

Studies have suggested that psychiatric comorbidities have major effects on antidepressant resistance in adult patients with major depressive disorder (MDD). However, the association between psychiatric comorbidities and antidepressant resistance remains unclear in adolescents with MDD.

METHODS

A total of 10,624 adolescents with MDD were selected from the Taiwan National Health Insurance Research Database between 2001 and 2010 and followed for one year. Treatment-resistant depression (TRD) was defined as unresponsiveness to at least two antidepressants, and treatment resistant tendency was defined as unresponsiveness to the first antidepressant. Psychiatric comorbidities, such as anxiety disorders, substance use disorders, and attention deficit hyperactivity disorder (ADHD), were assessed as confounding factors.

RESULTS

In our study, only 1.7% (n = 184) of adolescents with MDD met the TRD criteria but 23.3% (n = 2480) were classified as exhibiting treatment resistant tendency. Anxiety disorders (OR: 2.34, 95% CI: 1.73-3.16) and substance use disorders (OR: 2.41, 95% CI: 1.28-4.54) exhibited a correlation with TRD, and ADHD (OR: 1.34, 95% CI: 1.08-1.66) was associated with treatment resistant tendency.

CONCLUSIONS

Approximately one-fourth of adolescents with MDD respond poorly to the first antidepressant treatment. The psychiatric comorbidities of anxiety disorders, substance use disorders, and ADHD may increase the risk of treatment resistance in adolescents with MDD.

Bidirectional association between alopecia areata and major depressive disorder among probands and unaffected siblings: A nationwide population-based study

BACKGROUND

Alopecia areata (AA) has long been associated with major depressive disorder (MDD). However, most evidence to date has derived from cross-sectional or case-control studies.

OBJECTIVE

To investigate the bidirectional association between AA and MDD among probands and unaffected siblings.

METHODS

Study participants were recruited from the National Health Insurance Research Database in Taiwan. We included 2123 probands with AA, 2298 unaffected siblings, and 9192 matched controls to assess the risk of MDD. We included 16,543 probands with MDD, 17,352 unaffected siblings, and 69,408 matched controls to assess the risk of AA. The Breslow-Cox model was used to calculate the adjusted relative risk.

RESULTS

Compared with controls, AA probands and unaffected siblings had adjusted relative risks of 8.22 (95% confidence interval [CI], 6.41-10.54) and 2.55 (95% CI, 1.91-3.40), respectively, for MDD. MDD probands and unaffected siblings had adjusted relative risks for AA of 1.66 (95% CI, 1.24-2.22) and 1.64 (95% CI, 1.27-2.12), respectively.

LIMITATION

The National Health Insurance Research Database lacked information on disease severity, body mass index, smoking habit, alcohol consumption, and stressful life events.

CONCLUSION

Our study demonstrated a bidirectional association between AA and MDD among probands and unaffected siblings, thus suggesting shared familial mechanisms underlying AA and MDD.

Increased Risk of Atopic Diseases in the Siblings of Patients with Autism Spectrum Disorder: A Nationwide Population-Based Cohort Study

Several studies have shown a strong association between atopic diseases and autism spectrum disorder (ASD). However, the risk of atopic diseases in individuals having ASD-affected siblings has never been investigated. This nationwide population-based cohort study included 2762 individuals with ASD-affected siblings and 11,048 controls. Diagnoses of atopic diseases, including asthma, atopic dermatitis, allergic rhinitis, and allergic conjunctivitis, were ascertained from 1996 or the birth data to the end of 2011. Individuals with ASD-affected siblings had a higher risk for asthma, atopic dermatitis, allergic rhinitis, allergic conjunctivitis, and multiple atopic diseases compared with controls. In conclusion, individuals with ASD-affected siblings were more likely than were the controls to develop atopic diseases, suggesting shared familial mechanisms underlying the two conditions.

Risk and coaggregation of major psychiatric disorders among first-degree relatives of patients with bipolar disorder: a nationwide population-based study

BACKGROUND

Bipolar disorder is a highly heritable mental illness that transmits intergeneratively. Previous studies supported that first-degree relatives (FDRs), such as parents, offspring, and siblings, of patients with bipolar disorder, had a higher risk of bipolar disorder. However, whether FDRs of bipolar patients have an increased risk of schizophrenia, major depressive disorder (MDD), autism spectrum disorder (ASD), and attention deficit hyperactivity disorder (ADHD) remains unclear.

METHODS

Among the entire population in Taiwan, 87 639 patients with bipolar disorder and 188 290 FDRs of patients with bipolar disorder were identified in our study. The relative risks (RRs) of major psychiatric disorders were assessed among FDRs of patients with bipolar disorder.

RESULTS

FDRs of patients with bipolar disorder were more likely to have a higher risk of major psychiatric disorders, including bipolar disorder (RR 6.12, 95% confidence interval (CI) 5.95-6.30), MDD (RR 2.89, 95% CI 2.82-2.96), schizophrenia (RR 2.64, 95% CI 2.55-2.73), ADHD (RR 2.21, 95% CI 2.13-2.30), and ASD (RR 2.10, 95% CI 1.92-2.29), than the total population did. These increased risks for major psychiatric disorders were consistent across different familial kinships, such as parents, offspring, siblings, and twins. A dose-dependent relationship was also found between risk of each major psychiatric disorder and numbers of bipolar patients.

CONCLUSIONS

Our study was the first study to support the familial coaggregation of bipolar disorder with other major psychiatric disorders, including schizophrenia, MDD, ADHD, and ASD, in a Taiwanese (non-Caucasian) population. Given the elevated risks of major psychiatric disorders, the public health government should pay more attention to the mental health of FDRs of patients with bipolar disorder.

Mitochondria, Metabolism, and Redox Mechanisms in Psychiatric Disorders

Significance: Our current knowledge of the pathophysiology and molecular mechanisms causing psychiatric disorders is modest, but genetic susceptibility and environmental factors are central to the etiology of these conditions. Autism, schizophrenia, bipolar disorder and major depressive disorder show genetic gene risk overlap and share symptoms and metabolic comorbidities. The identification of such common features may provide insights into the development of these disorders. Recent Advances: Multiple pieces of evidence suggest that brain energy metabolism, mitochondrial functions and redox balance are impaired to various degrees in psychiatric disorders. Since mitochondrial metabolism and redox signaling can integrate genetic and environmental environmental factors affecting the brain, it is possible that they are implicated in the etiology and progression of psychiatric disorders. Critical Issue: Evidence for direct links between cellular mitochondrial dysfunction and disease features are missing. Future Directions: A better understanding of the mitochondrial biology and its intracellular connections to the nuclear genome, the endoplasmic reticulum and signaling pathways, as well as its role in intercellular communication in the organism, is still needed. This review focuses on the findings that implicate mitochondrial dysfunction, the resultant metabolic changes and oxidative stress as important etiological factors in the context of psychiatric disorders. We also propose a model where specific pathophysiologies of psychiatric disorders depend on circuit-specific impairments of mitochondrial dysfunction and redox signaling at specific developmental stages.

Increased risk of type 2 diabetes among the siblings of patients with schizophrenia

BACKGROUND

Research suggests an association between metabolic disorders, such as type 2 diabetes mellitus (T2DM), and schizophrenia. However, the risk of metabolic disorders in the unaffected siblings of patients with schizophrenia remains unclear.

METHODS

Using the Taiwan National Health Insurance Research Database, 3135 unaffected siblings of schizophrenia probands and 12,540 age-/sex-matched control subjects were included and followed up to the end of 2011. Individuals who developed metabolic disorders during the follow-up period were identified.

RESULTS

The unaffected siblings of schizophrenia probands had a higher prevalence of T2DM (3.4% vs. 2.6%, p = 0.010) than the controls. Logistic regression analyses with the adjustment of demographic data revealed that the unaffected siblings of patients with schizophrenia were more likely to develop T2DM (odds ratio [OR]: 1.39, 95% confidence interval [CI]: 1.10-1.75) later in life compared with the control group. Moreover, only female siblings of schizophrenia probands had an increased risk of hypertension (OR: 1.47, 95% CI: 1.07-2.01) during the follow-up compared with the controls.DiscussionThe unaffected siblings, especially sisters, of schizophrenia probands had a higher prevalence of T2DM and hypertension compared with the controls. Our study revealed a familial link between schizophrenia and T2DM in a large sample. Additional studies are required to investigate the shared pathophysiology of schizophrenia and T2DM.

Examining the Importance of Family History in Pediatric Behavioural Referrals

In recent years, there has been a substantial increase in the diagnosis of attention deficit hyperactivity disorder (ADHD) in children. Without appropriate management of symptoms and care, ADHD has been associated with a variety of negative child and adult outcomes. Environmental and familial factors that may contribute to three different pediatric referral types (academic, behavioural, and attentional) associated with ADHD were examined in the current study. In total, data from 477 families who were interviewed as a part of the intake process to a pediatric clinic were included in this study. Data for the current study was extracted from the intake questionnaires and included information on family history of mental health issues, socioeconomic status, and family relationships. The sample included children between the ages of three and 17 and mostly comprised males (n = 340). A frequency analysis of the data demonstrated relatively high rates of mental health issues within families (61.4%); almost half of the mothers reported some post-secondary education (46.1%) and most reported having normal relationships with their children (mothers, 78%; fathers, 62.9%). Finally, three stepwise regression analyses were conducted to predict referral type. All three regressions yielded significant models. Fifteen percent of the variability of the academic referral type was predicted by being male, age at the time of referral, mother's education level, and mother's learning. The behavioural referral types were predicted by a family history of depression, being male, mother-child relationship, and age at the time of referral; these accounted for 23% of the variance. Attentional referral type was predicted only by mother-child relationship that captured 6% of the variance. Overall, this study describes a population of parents of children with academic, behavioural, and attention-related referrals to pediatrics. Results indicate that mothers have a profound influence on their child's referral types, something that may transfer into later diagnosis and perhaps prognosis. Clinicians and researchers alike should focus their efforts toward developing integrative service assessment and treatment approaches that include important people in the child's life. The implementation of Community Social Pediatrics (a streamlined, inclusive approach to care) should be considered in urban centres like this one, where referrals like this are prevalent.

Risks of bipolar disorder, depressive disorder, and traumatic brain injury among siblings of patients with attention-deficit hyperactivity disorder

BACKGROUND

Previous studies have suggested that the unaffected siblings of patients with attention-deficit hyperactivity disorder (ADHD) experience deficits in attention, impulsivity control, and behavior inhibition, which are associated with health-risk behaviors. However, risks to mental and physical health among the unaffected siblings of ADHD probands have rarely been investigated.

METHODS

Using the Taiwan National Health Insurance Research Database, 5128 unaffected siblings of ADHD probands born between 1980 and 2000 were included in our study along with 20,512 age- and sex-matched controls, and they were followed from 1996 or birth until the end of 2011. Mental and physical health risks, including affective disorders, traumatic brain injury (TBI), and sexually transmitted infection were identified during the follow-up period.

RESULTS

Logistic regression analyses with adjustments for demographic data showed that the unaffected siblings were more likely to develop unipolar depression (odds ratio [OR]: 1.76, 95% confidence interval [CI]: 1.39-2.22), bipolar disorder (OR: 2.10, 95% CI: 1. 09-4.05), and TBI (OR: 1.24, 95% CI: 1.14-1.36) than were the control group.

DISCUSSION

The unaffected siblings of patients with ADHD were prone to developing unipolar depression, bipolar disorder, and TBI later in life.

At-risk individuals display altered brain activity following stress

Stress is a major risk factor for almost all psychiatric disorders, however, the underlying neurobiological mechanisms remain largely elusive. In healthy individuals, a successful stress response involves an adequate neuronal adaptation to a changing environment. This adaptive response may be dysfunctional in vulnerable individuals, potentially contributing to the development of psychopathology. In the current study, we investigated brain responses to emotional stimuli following stress in healthy controls and at-risk individuals. An fMRI study was conducted in healthy male controls (N = 39) and unaffected healthy male siblings of schizophrenia patients (N = 39) who are at increased risk for the development of a broad range of psychiatric disorders. Brain responses to pictures from the International Affective Picture System (IAPS) were measured 33 min after exposure to stress induced by the validated trier social stress test (TSST) or a control condition. Stress-induced levels of cortisol, alpha-amylase, and subjective stress were comparable in both groups. Yet, stress differentially affected brain responses of schizophrenia siblings versus controls. Specifically, control subjects, but not schizophrenia siblings, showed reduced brain activity in key nodes of the default mode network (PCC/precuneus and mPFC) and salience network (anterior insula) as well as the STG, MTG, MCC, vlPFC, precentral gyrus, and cerebellar vermis in response to all pictures following stress. These results indicate that even in the absence of a psychiatric disorder, at-risk individuals display abnormal functional activation following stress, which in turn may increase their vulnerability and risk for adverse outcomes.

Mapping a shared genetic basis for neurodevelopmental disorders

Distinct neurodevelopmental disorders have a common genetic etiology that explains the high degree of comorbidity among these disorders. A recent study sought to identify copy number variants across five neurodevelopmental disorders, and detected an enrichment for chromosome 9p24.3 duplication encompassing DOCK8 and KANK1 in affected individuals. Such large-scale studies will help uncover additional causative and modifier loci within common pathways, which will enable the development of therapeutic targets for the treatment of multiple disorders.

See related research 10.1186/s13073-017-0494-1