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Green MJ, Raudino A, Cairns MJ, Wu J, Tooney PA, Scott RJ, Carr VJ. Do common genotypes of FK506 binding protein 5 (FKBP5) moderate the effects of childhood maltreatment on cognition in schizophrenia and healthy controls? J Psychiatr Res 2015; 70:9-17. [PMID: 26424418 DOI: 10.1016/j.jpsychires.2015.07.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 07/14/2015] [Accepted: 07/17/2015] [Indexed: 11/24/2022]
Abstract
Common variants of the FK506 binding protein 5 (FKBP5) gene are implicated in psychotic and other disorders, via their role in regulating glucocorticoid receptor (GR) receptor sensitivity and effects on the broader function of the HPA system in response to stress. In this study, the effects of four FKBP5 polymorphisms (rs1360780, rs9470080, rs4713902, rs9394309) on IQ and eight other cognitive domains were examined in the context of exposure to childhood maltreatment in 444 cases with schizophrenia and 292 healthy controls (from a total sample of 617 cases and 659 controls obtained from the Australian Schizophrenia Research Bank; ASRB). Participants subjected to any kind of maltreatment (including physical, emotional, or sexual abuse or physical or emotional neglect) in childhood were classified as 'exposed'; cognitive functioning was measured with Repeatable Battery for the Assessment of Neuropsychological Status, the Controlled Oral Word Association Test, and IQ was estimated with the Weschler Test of Adult Reading. Hierarchical regressions were used to test the main effects of genotype and childhood maltreatment, and their additive interactive effects, on cognitive function. For rs1360870, there were significant main effects of genotype and childhood maltreatment, and a significant interaction of genotype with childhood trauma affecting attention in both schizophrenia and healthy participants (C-homozygotes in both groups showed worse attention in the context of maltreatment); in SZ, this SNP also affected global neuropsychological function regardless of exposure to childhood trauma, with T-homozygotes showing worse cognition than other genotypes. The mechanisms of trauma-dependent effects of FKBP5 following early life trauma deserve further exploration in healthy and psychotic samples, in the context of epigenetic effects and perhaps epistasis with other genes. Study of these processes may be particularly informative in subgroups exposed to various other forms of early life adversity (i.e., birth complications, immigration).
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Affiliation(s)
- Melissa J Green
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Schizophrenia Research Institute, Darlinghurst, NSW, Australia.
| | - Alessandra Raudino
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Schizophrenia Research Institute, Darlinghurst, NSW, Australia
| | - Murray J Cairns
- Schizophrenia Research Institute, Darlinghurst, NSW, Australia; School of Biomedical Sciences and Pharmacy, Faculty of Health, The University of Newcastle, Callaghan, NSW 2308, Australia; Centre for Brain and Mental Health and Centre for Information-Based Medicine, University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Jingqin Wu
- School of Biomedical Sciences and Pharmacy, Faculty of Health, The University of Newcastle, Callaghan, NSW 2308, Australia; Centre for Brain and Mental Health and Centre for Information-Based Medicine, University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Paul A Tooney
- Schizophrenia Research Institute, Darlinghurst, NSW, Australia; School of Biomedical Sciences and Pharmacy, Faculty of Health, The University of Newcastle, Callaghan, NSW 2308, Australia; Centre for Brain and Mental Health and Centre for Information-Based Medicine, University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Rodney J Scott
- Schizophrenia Research Institute, Darlinghurst, NSW, Australia; School of Biomedical Sciences and Pharmacy, Faculty of Health, The University of Newcastle, Callaghan, NSW 2308, Australia; Centre for Brain and Mental Health and Centre for Information-Based Medicine, University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia; Hunter Area Pathology Service, Newcastle, NSW, Australia
| | - Vaughan J Carr
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Schizophrenia Research Institute, Darlinghurst, NSW, Australia
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Sharma S, Powers A, Bradley B, Ressler KJ. Gene × Environment Determinants of Stress- and Anxiety-Related Disorders. Annu Rev Psychol 2015; 67:239-61. [PMID: 26442668 DOI: 10.1146/annurev-psych-122414-033408] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The burgeoning field of gene-by-environment (G×E) interactions has revealed fascinating biological insights, particularly in the realm of stress-, anxiety-, and depression-related disorders. In this review we present an integrated view of the study of G×E interactions in stress and anxiety disorders, including the evolution of genetic association studies from genetic epidemiology to contemporary large-scale genome-wide association studies and G×E studies. We convey the importance of consortia efforts and collaboration to gain the large sample sizes needed to move the field forward. Finally, we discuss several robust and well-reproduced G×E interactions and demonstrate how epidemiological identification of G×E interactions has naturally led to a plethora of basic research elucidating the mechanisms of high-impact genetic variants.
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Affiliation(s)
- Sumeet Sharma
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia 30322.,McLean Hospital, Harvard Medical School, Belmont, Massachusetts 02478,
| | - Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia 30322
| | - Bekh Bradley
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia 30322.,Atlanta VA Medical Center, US Department of Veterans Affairs, Decatur, Georgia 30033
| | - Kerry J Ressler
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia 30322.,McLean Hospital, Harvard Medical School, Belmont, Massachusetts 02478,
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53
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Abstract
Traumatic events are ubiquitous exposures that interact with life course events to increase risk of acute psychopathology and alter mental health trajectories. While the majority of persons exposed to trauma experience mild to moderate psychological distress followed by a return to pre-trauma health, many persons exposed to trauma experience substantial distress that lasts for several years. Therefore, in an effort to understand why exposure to trauma can provoke such a range of reactions, we apply a life course approach that considers the complex accumulation and interaction of life experiences that range from social to biological factors, which occur over the life span-from gestation to death and across generations. We present this evidence in three categories: genetics and biology, individual exposures, and community experiences, followed by discussing challenges in existing research and directions for future study.
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54
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van Dam DS, van Nierop M, Viechtbauer W, Velthorst E, van Winkel R, Bruggeman R, Cahn W, de Haan L, Kahn RS, Meijer CJ, Myin-Germeys I, van Os J, Wiersma D. Childhood abuse and neglect in relation to the presence and persistence of psychotic and depressive symptomatology. Psychol Med 2015; 45:1363-1377. [PMID: 25065372 DOI: 10.1017/s0033291714001561] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The association between childhood trauma and psychotic and depressive symptomatology is well established. However, less is known about the specificity and course of these symptoms in relation to childhood trauma. METHOD In a large sample (n = 2765) of patients with psychosis (n = 1119), their siblings (n = 1057) and controls (n = 589), multivariate (mixed-effects) regression analyses with multiple outcomes were performed to examine the association between childhood trauma and psychotic and depressive symptomatology over a 3-year period. RESULTS A dose-response relationship was found between childhood trauma and psychosis. Abuse was more strongly associated with positive symptoms than with negative symptoms whereas the strength of the associations between neglect and positive and negative symptoms was comparable. In patients, similar associations between childhood trauma and psychotic or depressive symptoms were found, and in siblings and controls, stronger associations were found between trauma and depressive symptomatology. Childhood trauma was not related to a differential course of symptoms over a 3-year time period. CONCLUSIONS In congruence with earlier work, our findings suggest that childhood trauma, and abuse in particular, is associated with (subthreshold) psychosis. However, childhood trauma does not seem to be associated with a differential course of symptoms, nor does it uniquely heighten the chance of developing (subthreshold) psychotic symptomatology. Our results indicate that trauma may instead contribute to a shared vulnerability for psychotic and depressive symptoms.
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Affiliation(s)
- D S van Dam
- Department of Psychiatry, Academic Medical Center,University of Amsterdam,The Netherlands
| | - M van Nierop
- Maastricht University Medical Center,South Limburg Mental Health Research and Teaching Network,EURON, Maastricht,The Netherlands
| | - W Viechtbauer
- Maastricht University Medical Center,South Limburg Mental Health Research and Teaching Network,EURON, Maastricht,The Netherlands
| | - E Velthorst
- Department of Psychiatry, Academic Medical Center,University of Amsterdam,The Netherlands
| | - R van Winkel
- Maastricht University Medical Center,South Limburg Mental Health Research and Teaching Network,EURON, Maastricht,The Netherlands
| | - R Bruggeman
- Department of Psychiatry, University Medical Center Groningen,University of Groningen,The Netherlands
| | - W Cahn
- Department of Psychiatry,Rudolf Magnus Institute of Neuroscience,University Medical Center Utrecht,The Netherlands
| | - L de Haan
- Department of Psychiatry, Academic Medical Center,University of Amsterdam,The Netherlands
| | - R S Kahn
- Department of Psychiatry,Rudolf Magnus Institute of Neuroscience,University Medical Center Utrecht,The Netherlands
| | - C J Meijer
- Department of Psychiatry, Academic Medical Center,University of Amsterdam,The Netherlands
| | - I Myin-Germeys
- Maastricht University Medical Center,South Limburg Mental Health Research and Teaching Network,EURON, Maastricht,The Netherlands
| | - J van Os
- Maastricht University Medical Center,South Limburg Mental Health Research and Teaching Network,EURON, Maastricht,The Netherlands
| | - D Wiersma
- Department of Psychiatry, University Medical Center Groningen,University of Groningen,The Netherlands
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55
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Novel antidepressant candidate RO-05 modulated glucocorticoid receptors activation and FKBP5 expression in chronic mild stress model in rats. Neuroscience 2015; 290:255-65. [DOI: 10.1016/j.neuroscience.2015.01.044] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 01/04/2015] [Accepted: 01/06/2015] [Indexed: 12/25/2022]
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56
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Daskalakis NP, Binder EB. Schizophrenia in the spectrum of gene-stress interactions: the FKBP5 example. Schizophr Bull 2015; 41:323-9. [PMID: 25592294 PMCID: PMC4332957 DOI: 10.1093/schbul/sbu189] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Many studies have demonstrated that genotype (G) interacts with adverse life experiences (E) to produce individual differences in vulnerability and resilience to mental disorders, including schizophrenia. Genetic susceptibility to stress and the timing of the environmental exposure(s) are relevant for these interactions and represent common risk factors. We take the example of the FKBP5 gene to illustrate G × E interactions that predict pleiotropic psychiatric outcomes, including schizophrenia.
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Affiliation(s)
- Nikolaos P. Daskalakis
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY;,Mental Health Care Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY;,*To whom correspondence should be addressed; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, US; tel: +1-212-241-0250, fax: +1-212-828-4221, e-mail:
| | - Elisabeth B. Binder
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany;,Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
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57
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Kohrt BA, Worthman CM, Ressler KJ, Mercer KB, Upadhaya N, Koirala S, Nepal MK, Sharma VD, Binder EB. Cross-cultural gene- environment interactions in depression, post-traumatic stress disorder, and the cortisol awakening response: FKBP5 polymorphisms and childhood trauma in South Asia. Int Rev Psychiatry 2015; 27:180-96. [PMID: 26100613 PMCID: PMC4623577 DOI: 10.3109/09540261.2015.1020052] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Despite increased attention to global mental health, psychiatric genetic research has been dominated by studies in high-income countries, especially with populations of European descent. The objective of this study was to assess single nucleotide polymorphisms (SNPs) in the FKBP5 gene in a population living in South Asia. Among adults in Nepal, depression was assessed with the Beck Depression Inventory (BDI), post-traumatic stress disorder (PTSD) with the PTSD Checklist-Civilian Version (PCL-C), and childhood maltreatment with the Childhood Trauma Questionnaire (CTQ). FKBP5 SNPs were genotyped for 682 participants. Cortisol awakening response (CAR) was assessed in a subsample of 118 participants over 3 days. The FKBP5 tag-SNP rs9296158 showed a main effect on depressive symptoms (p = 0.03). Interaction of rs9296158 and childhood maltreatment predicted adult depressive symptoms (p = 0.02) but not PTSD. Childhood maltreatment associated with endocrine response in individuals homozygous for the A allele, demonstrated by a negative CAR and overall hypocortisolaemia in the rs9296158 AA genotype and childhood maltreatment group (p < 0.001). This study replicated findings related to FKBP5 and depression but not PTSD. Gene-environment studies should take differences in prevalence and cultural significance of phenotypes and exposures into account when interpreting cross-cultural findings.
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Affiliation(s)
- Brandon A. Kohrt
- Duke Global Health Institute and Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, U.S.A
| | | | - Kerry J. Ressler
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia; Yerkes National Primate Research Center, Atlanta, Georgia; Howard Hughes Medical Institute, Chevy Chase, Maryland
| | - Kristina B. Mercer
- Howard Hughes Medical Institute, Chevy Chase, Maryland; Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Nawaraj Upadhaya
- HealthNetTPO, Amsterdam, the Netherlands and Transcultural Psychosocial Organization, Nepal, Kathmandu, Nepal
| | - Suraj Koirala
- Transcultural Psychosocial Organization, Nepal, Kathmandu, Nepal
| | - Mahendra K. Nepal
- Department of Psychiatry, Tribhuvan University Teaching Hospital/Institute of Medicine, Maharajgunj, Nepal
| | - Vidya Dev Sharma
- Department of Psychiatry, Tribhuvan University Teaching Hospital/Institute of Medicine, Maharajgunj, Nepal
| | - Elisabeth B. Binder
- Dept. of Translational Research in Psychiatry, Max-Planck Institute of Psychiatry, Munich, Germany and Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
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58
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Provençal N, Binder EB. The effects of early life stress on the epigenome: From the womb to adulthood and even before. Exp Neurol 2014; 268:10-20. [PMID: 25218020 DOI: 10.1016/j.expneurol.2014.09.001] [Citation(s) in RCA: 145] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 08/26/2014] [Accepted: 09/02/2014] [Indexed: 12/29/2022]
Abstract
Exposure to early life stress (ELS), such as childhood abuse and neglect is a well established major risk factor for developing psychiatric and behavioral disorders later in life. Both prenatal and postnatal stressors have been shown to have a long-lasting impact on adult pathological states where the type and timing of the stressor are important factors to consider. There is a growing body of evidence suggesting that epigenetic mechanisms play a major role in the biological embedding of ELS. A number of studies now indicate that the epigenome is responsive to external environmental exposures, including the social environment, both during intra-uterine development and after birth. In this review, we summarize the evidence of long-lasting effects of ELS on mental health and behavior and highlight common and distinct epigenetic effects of stress exposure at different stages during development. These stages include postnatal stress, prenatal stress, i.e. in utero and stress occurring pre-conception, i.e. effects of stress exposure transmitted to the next generation. We also delineate the evidence for the possible molecular mechanisms involved in epigenetic programming by ELS and how these maybe distinct, according to the timing of the stress exposure.
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Affiliation(s)
- Nadine Provençal
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich 80804, Germany
| | - Elisabeth B Binder
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich 80804, Germany; Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA.
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59
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Upthegrove R, Ross K, Brunet K, McCollum R, Jones L. Depression in first episode psychosis: the role of subordination and shame. Psychiatry Res 2014; 217:177-84. [PMID: 24726817 DOI: 10.1016/j.psychres.2014.03.023] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 03/11/2014] [Accepted: 03/21/2014] [Indexed: 12/22/2022]
Abstract
Depression in early psychosis is linked to poor outcome, relapse and risk of suicide, yet remains poorly understood. This article aims to examine the development of depression in acute and post psychotic phases of first episode psychosis (FEP), and its relationship to persecutors, voices, insight, and recovery. Data were gathered on 92 patients with acute FEP on depression course, severity and experience of positive symptoms, insight and appraisals of illness using validated semi-structured interviews and questionnaires. Measures were repeated at 12 months. Malevolent voices, use of safety behaviours and subordination to persecutors were associated with depression and suicidal behaviour in acute FEP. Loss, Shame, low level continuing positive symptoms and longer duration of untreated psychosis were associated with post psychotic depression. Negative appraisals remained stable despite recovery in other symptom domains. Thus, depression and risk in early psychosis may be propagated by the personal significance and content of positive symptoms experienced. When in recovery, low level symptoms, longer period of illness and negative appraisals are significant factors.
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Affiliation(s)
- Rachel Upthegrove
- University of Birmingham, School of Clinical and Experimental Medicine, Birmingham, UK; Birmingham and Solihull Mental Health Foundation Trust, Early Intervention Service, Birmingham, UK.
| | - Kerry Ross
- Wolverhampton Early Intervention Service, Wolverhampton, UK
| | - Katerine Brunet
- University of Birmingham, School of Psychology, Birmingham, UK
| | - Richard McCollum
- Birmingham and Solihull Mental Health Foundation Trust, Early Intervention Service, Birmingham, UK
| | - Lisa Jones
- University of Birmingham, School of Clinical and Experimental Medicine, Birmingham, UK
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60
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Balsevich G, Uribe A, Wagner KV, Hartmann J, Santarelli S, Labermaier C, Schmidt MV. Interplay between diet-induced obesity and chronic stress in mice: potential role of FKBP51. J Endocrinol 2014; 222:15-26. [PMID: 24781256 DOI: 10.1530/joe-14-0129] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
While it is known that stress promotes obesity, the effects of stress within an obesogenic context are not so clear and molecular targets at the interface remain elusive. The FK506-binding protein 51 (FKBP51, gene: Fkbp5) has been identified as a target gene implicated in the development of stress-related psychiatric disorders and is a possible candidate for involvement in stress and metabolic regulation. The aims of the current study are to investigate the interaction between chronic stress and an obesogenic context and to additionally examine whether FKBP51 is involved in this interaction. For this purpose, male C57BL/6 mice were exposed to a high-fat diet for 8 weeks before being challenged with chronic social defeat stress. Herein, we demonstrate that chronic stress induces hypophagia and weight loss, ultimately improving features arising from an obesogenic context, including glucose tolerance and levels of insulin and leptin. We show that Fkbp5 expression is responsive to diet and stress in the hypothalamus and hippocampus respectively. Furthermore, under basal conditions, higher levels of hypothalamic Fkbp5 expression were related to increased body weight gain. Our data indicate that Fkbp5 may represent a novel target in metabolic regulation.
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Affiliation(s)
- Georgia Balsevich
- Max Planck Institute of PsychiatryKraepelinstr. 2-10, 80804 Munich, Germany
| | - Andres Uribe
- Max Planck Institute of PsychiatryKraepelinstr. 2-10, 80804 Munich, Germany
| | - Klaus V Wagner
- Max Planck Institute of PsychiatryKraepelinstr. 2-10, 80804 Munich, Germany
| | - Jakob Hartmann
- Max Planck Institute of PsychiatryKraepelinstr. 2-10, 80804 Munich, Germany
| | - Sara Santarelli
- Max Planck Institute of PsychiatryKraepelinstr. 2-10, 80804 Munich, Germany
| | | | - Mathias V Schmidt
- Max Planck Institute of PsychiatryKraepelinstr. 2-10, 80804 Munich, Germany
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61
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Fujii T, Hori H, Ota M, Hattori K, Teraishi T, Sasayama D, Yamamoto N, Higuchi T, Kunugi H. Effect of the common functional FKBP5 variant (rs1360780) on the hypothalamic-pituitary-adrenal axis and peripheral blood gene expression. Psychoneuroendocrinology 2014; 42:89-97. [PMID: 24636505 DOI: 10.1016/j.psyneuen.2014.01.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 01/10/2014] [Accepted: 01/10/2014] [Indexed: 10/25/2022]
Abstract
Regulation of hypothalamic-pituitary-adrenal (HPA) axis reactivity plays an important role in the development of stress-related psychiatric disorders. FK506 binding protein 5 (FKBP5) modulates HPA axis reactivity via glucocorticoid receptor (GR; NR3C1) sensitivity and signaling. The T allele of the single nucleotide polymorphism, FKBP5 rs1360780 (C/T), is associated with higher FKBP5 induction by glucocorticoids. In the present study, we performed the dexamethasone/corticotropin releasing hormone (DEX/CRH) test and quantitative real-time PCR analysis of peripheral blood mononuclear cell (PBMC) cDNA samples in 174 and 278 non-clinical individuals, respectively. We found increased suppression of the stress hormone (cortisol) response to the DEX/CRH test (P=0.0016) in aged (>50 years) individuals carrying the T allele compared with aged non-T allele carriers. T carriers showed significant age-related changes in GR and FKBP5 mRNA expression levels in PBMCs (P=0.0013 and P=0.00048, respectively). Our results indicate that FKBP5 rs1360780 regulates HPA axis reactivity and expression levels of GR and FKBP5 in PBMCs in an age-dependent manner. Because these phenotypes of aged T carriers are similar to endophenotypes of people with post-traumatic stress disorder, our findings may be useful for determining the molecular mechanisms, treatment, and preventive strategies for this disease.
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Affiliation(s)
- Takashi Fujii
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo 187-8502, Japan
| | - Hiroaki Hori
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo 187-8502, Japan
| | - Miho Ota
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo 187-8502, Japan
| | - Kotaro Hattori
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo 187-8502, Japan
| | - Toshiya Teraishi
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo 187-8502, Japan
| | - Daimei Sasayama
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo 187-8502, Japan
| | - Noriko Yamamoto
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo 187-8502, Japan
| | - Teruhiko Higuchi
- National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo 187-8502, Japan
| | - Hiroshi Kunugi
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo 187-8502, Japan.
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62
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Fani N, King TZ, Reiser E, Binder EB, Jovanovic T, Bradley B, Ressler KJ. FKBP5 genotype and structural integrity of the posterior cingulum. Neuropsychopharmacology 2014; 39:1206-13. [PMID: 24253961 PMCID: PMC3957115 DOI: 10.1038/npp.2013.322] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 10/27/2013] [Accepted: 11/11/2013] [Indexed: 11/09/2022]
Abstract
Alterations in the microarchitecture of the posterior cingulum (PC), a white matter tract proximal to the hippocampus that facilitates communication between the entorhinal and cingulate cortices, have been observed in individuals with psychiatric disorders, such as depression and post-traumatic stress disorder (PTSD). PC decrements may be a heritable source of vulnerability for the development of affective disorders; however, genetic substrates for these white matter abnormalities have not been identified. The FKBP5 gene product modulates glucocorticoid receptor function and has been previously associated with differential hippocampal structure, function, and affect disorder risk. Thus, FKBP5 is an attractive genetic target for investigations of PC integrity. We examined associations between PC integrity, measured through diffusion tensor imaging (DTI) and fractional anisotropy (FA; an index of white matter integrity), and polymorphisms in the FKBP5 SNP rs1360780 in a sample of 82 traumatized female civilians. Findings indicated that, compared with individuals without this allele, individuals who carried two 'risk' alleles for this FKBP5 SNP (T allele; previously associated with mood and anxiety disorder risk) demonstrated significantly lower FA in the left PC, even after statistically controlling for variance associated with age, trauma exposure, and PTSD symptoms. These data suggest that specific allelic variants for an FKBP5 polymorphism are associated with decrements in the left PC microarchitecture. These white matter abnormalities may be a heritable biological marker that indicates increased vulnerability for the development of psychiatric disorders, such as PTSD.
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Affiliation(s)
- Negar Fani
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Tricia Z King
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Emily Reiser
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Elisabeth B Binder
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
- Max Planck Institute of Psychiatry, Munich, Germany
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Kerry J Ressler
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
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63
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Hernaus D, van Winkel R, Gronenschild E, Habets P, Kenis G, Marcelis M, van Os J, Myin-Germeys I, Collip D. Brain-derived neurotrophic factor/FK506-binding protein 5 genotype by childhood trauma interactions do not impact on hippocampal volume and cognitive performance. PLoS One 2014; 9:e92722. [PMID: 24658422 PMCID: PMC3962453 DOI: 10.1371/journal.pone.0092722] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 02/25/2014] [Indexed: 01/19/2023] Open
Abstract
In the development of psychotic symptoms, environmental and genetic factors may both play a role. The reported association between childhood trauma and psychotic symptoms could therefore be moderated by single nucleotide polymorphisms (SNPs) associated with the stress response, such as FK506-binding protein 5 (FKBP5) and brain-derived neurotrophic factor (BDNF). Recent studies investigating childhood trauma by SNP interactions have inconsistently found the hippocampus to be a potential target underlying these interactions. Therefore, more detailed modelling of these effects, using appropriate covariates, is required. We examined whether BDNF/FKBP5 and childhood trauma interactions affected two proxies of hippocampal integrity: (i) hippocampal volume and (ii) cognitive performance on a block design (BD) and delayed auditory verbal task (AVLT). We also investigated whether the putative interaction was different for patients with a psychotic disorder (n = 89) compared to their non-psychotic siblings (n = 95), in order to elicit possible group-specific protective/vulnerability effects. SNPs were rs9296158, rs4713916, rs992105, rs3800373 (FKBP5) and rs6265 (BDNF). In the combined sample, no BDNF/FKBP5 by childhood trauma interactions were apparent for either outcome, and BDNF/FKBP5 by childhood trauma interactions were not different for patients and siblings. The omission of drug use and alcohol consumption sometimes yielded false positives, greatly affected explained error and influenced p-values. The consistent absence of any significant BDNF/FKBP5 by childhood trauma interactions on assessments of hippocampal integrity suggests that the effect of these interactions on psychotic symptoms is not mediated by hippocampal integrity. The importance of appropriate statistical designs and inclusion of relevant covariates should be carefully considered.
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Affiliation(s)
- Dennis Hernaus
- Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, School for Mental Health and NeuroScience MHeNS Maastricht University, Maastricht, The Netherlands
| | - Ruud van Winkel
- Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, School for Mental Health and NeuroScience MHeNS Maastricht University, Maastricht, The Netherlands
- University Psychiatric Centre Catholic University Leuven, Kortenberg, Belgium
| | - Ed Gronenschild
- Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, School for Mental Health and NeuroScience MHeNS Maastricht University, Maastricht, The Netherlands
| | - Petra Habets
- Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, School for Mental Health and NeuroScience MHeNS Maastricht University, Maastricht, The Netherlands
| | - Gunter Kenis
- Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, School for Mental Health and NeuroScience MHeNS Maastricht University, Maastricht, The Netherlands
| | - Machteld Marcelis
- Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, School for Mental Health and NeuroScience MHeNS Maastricht University, Maastricht, The Netherlands
| | - Jim van Os
- Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, School for Mental Health and NeuroScience MHeNS Maastricht University, Maastricht, The Netherlands
- King's College London, King's Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, United Kingdom
| | - Inez Myin-Germeys
- Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, School for Mental Health and NeuroScience MHeNS Maastricht University, Maastricht, The Netherlands
| | - Dina Collip
- Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, School for Mental Health and NeuroScience MHeNS Maastricht University, Maastricht, The Netherlands
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Pishva E, Kenis G, van den Hove D, Lesch KP, Boks MPM, van Os J, Rutten BPF. The epigenome and postnatal environmental influences in psychotic disorders. Soc Psychiatry Psychiatr Epidemiol 2014; 49:337-48. [PMID: 24549836 DOI: 10.1007/s00127-014-0831-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 02/02/2014] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Schizophrenia spectrum disorders and bipolar spectrum disorders are the product of both heritable and non-heritable factors, the impact of which converges at different biological levels. Recent evidence from molecular approaches has provided new insights about how environmental exposures cause persistent alterations in the regulation of gene expression, particularly by so-called epigenetic mechanisms. The aim of this review is to provide an overview of findings of epigenetic studies in psychotic disorders, summarizing findings of human and animal studies on epigenetic alterations due to postnatal environmental exposures associated with psychotic disorders. METHODS Electronic and manual literature search of MEDLINE, EMBASE and PSYCHINFO, using a range of search terms around epigenetics, DNA methylation, histone modifications, psychoses, schizophrenia, bipolar disorder and environmental risks associated with psychotic disorders as observed in human and experimental animal studies, complemented by review articles and cross-references. RESULTS Despite several promising findings of differential epigenetic profiles in individuals with psychotic disorders in the studies published to date, the knowledge of the role of epigenetic processes in psychotic disorder remains very limited, and should be interpreted cautiously given various challenges in this rapidly evolving field of research. CONCLUSIONS Integration of epigenetic findings into biopsychosocial models of the etiology of psychotic disorders eventually may yield important insights into the biological underpinnings of the onset and course of psychotic disorders.
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Affiliation(s)
- Ehsan Pishva
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
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Leszczyńska-Rodziewicz A, Szczepankiewicz A, Narożna B, Skibińska M, Pawlak J, Dmitrzak-Węglarz M, Hauser J. Possible association between haplotypes of the FKBP5 gene and suicidal bipolar disorder, but not with melancholic depression and psychotic features, in the course of bipolar disorder. Neuropsychiatr Dis Treat 2014; 10:243-8. [PMID: 24523589 PMCID: PMC3921086 DOI: 10.2147/ndt.s54538] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
We aimed to analyzed the association between polymorphisms of the FKBP5 (FK506 binding protein 5) gene and subtypes of bipolar disorder. In the study, we included 195 bipolar disorder patients with psychotic features, 129 bipolar patients with melancholic depression, and 156 bipolar patients with a history of suicidal attempts. We found weak association between the haplotypes of the FKBP5 gene and bipolar patients with suicidal attempts. We did not find an association between polymorphisms of the FKBP5 gene and bipolar disorder with psychotic features, nor with bipolar disorder with melancholic depression. Limitations of our study are the absence of data about previous trauma exposure and the small sample size of patients, which of course can lead to false-positive results, so further validation and replication of the present findings are still needed.
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Affiliation(s)
| | - Aleksandra Szczepankiewicz
- Laboratory of Molecular and Cell Biology, Department of Pulmonology, Pediatric Allergy and Clinical Immunology, Poznań University of Medical Sciences, Poznań, Poland
| | - Beata Narożna
- Laboratory of Molecular and Cell Biology, Department of Pulmonology, Pediatric Allergy and Clinical Immunology, Poznań University of Medical Sciences, Poznań, Poland
| | - Maria Skibińska
- Psychiatric Genetics Unit, Poznań University of Medical Sciences, Poznań, Poland
| | - Joanna Pawlak
- Psychiatric Genetics Unit, Poznań University of Medical Sciences, Poznań, Poland
| | | | - Joanna Hauser
- Psychiatric Genetics Unit, Poznań University of Medical Sciences, Poznań, Poland
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Abstract
Severe mental illness (SMI) is a broad category that includes schizophrenia, bipolar disorder, and severe depression. Both genetic disposition and environmental exposures play important roles in the development of SMI. Multiple lines of evidence suggest that the roles of genetic and environmental factors depend on each other. Gene-environment interactions may underlie the paradox of strong environmental factors for highly heritable disorders, the low estimates of shared environmental influences in twin studies of SMI, and the heritability gap between twin and molecular heritability estimates. Sons and daughters of parents with SMI are more vulnerable to the effects of prenatal and postnatal environmental exposures, suggesting that the expression of genetic liability depends on environment. In the last decade, gene-environment interactions involving specific molecular variants in candidate genes have been identified. Replicated findings include an interaction between a polymorphism in the AKT1 gene and cannabis use in the development of psychosis and an interaction between the length polymorphism of the serotonin transporter gene and childhood maltreatment in the development of persistent depressive disorder. Bipolar disorder has been underinvestigated, with only a single study showing an interaction between a functional polymorphism in the BDNF gene and stressful life events triggering bipolar depressive episodes. The first systematic search for gene-environment interactions has found that a polymorphism in CTNNA3 may sensitize the developing brain to the pathogenic effect of cytomegalovirus in utero, leading to schizophrenia in adulthood. Strategies for genome-wide investigations will likely include coordination between epidemiological and genetic research efforts, systematic assessment of multiple environmental factors in large samples, and prioritization of genetic variants.
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Affiliation(s)
- Rudolf Uher
- Department of Psychiatry, Dalhousie University , Halifax, NS , Canada ; Department of Psychology and Neuroscience, Dalhousie University , Halifax, NS , Canada ; Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London , London , UK
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Ajnakina O, Borges S, Di Forti M, Patel Y, Xu X, Green P, Stilo SA, Kolliakou A, Sood P, Marques TR, David AS, Prata D, Dazzan P, Powell J, Pariante C, Mondelli V, Morgan C, Murray RM, Fisher HL, Iyegbe C. Role of Environmental Confounding in the Association between FKBP5 and First-Episode Psychosis. Front Psychiatry 2014; 5:84. [PMID: 25101008 PMCID: PMC4101879 DOI: 10.3389/fpsyt.2014.00084] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 07/03/2014] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Failure to account for the etiological diversity that typically occurs in psychiatric cohorts may increase the potential for confounding as a proportion of genetic variance will be specific to exposures that have varying distributions in cases. This study investigated whether minimizing the potential for such confounding strengthened the evidence for a genetic candidate currently unsupported at the genome-wide level. METHODS Two hundred and ninety-one first-episode psychosis cases from South London, UK and 218 unaffected controls were evaluated for a functional polymorphism at the rs1360780 locus in FKBP5. The relationship between FKBP5 and psychosis was modeled using logistic regression. Cannabis use (Cannabis Experiences Questionnaire) and parental separation (Childhood Experience of Care and Abuse Questionnaire) were included as confounders in the analysis. RESULTS Association at rs1360780 was not detected until the effects of the two environmental factors had been adjusted for in the model (OR = 2.81, 95% CI 1.23-6.43, p = 0.02). A statistical interaction between rs1360780 and parental separation was confirmed by stratified tests (OR = 2.8, p = 0.02 vs. OR = 0.89, p = 0.80). The genetic main effect was directionally consistent with findings in other (stress-related) clinical phenotypes. Moreover, the variation in effect magnitude was explained by the level of power associated with different cannabis constructs used in the model (r = 0.95). CONCLUSION Our results suggest that the extent to which genetic variants in FKBP5 can influence susceptibility to psychosis may depend on other etiological factors. This finding requires further validation in large independent cohorts. Potentially this work could have translational implications; the ability to discriminate between genetic etiologies based on a case-by-case understanding of previous environmental exposures would confer an important clinical advantage that would benefit the delivery of personalizable treatment strategies.
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Affiliation(s)
- Olesya Ajnakina
- Department of Psychosis Studies, Institute of Psychiatry, King's College London , London , UK
| | - Susana Borges
- Department of Health Services and Population Research, Institute of Psychiatry, King's College London , London , UK
| | - Marta Di Forti
- Department of Psychosis Studies, Institute of Psychiatry, King's College London , London , UK
| | - Yogen Patel
- Department of Neuroscience, Institute of Psychiatry, King's College London , London , UK
| | - Xiaohui Xu
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London , London , UK
| | - Priscilla Green
- Department of Neuroscience, Institute of Psychiatry, King's College London , London , UK
| | - Simona A Stilo
- Department of Psychosis Studies, Institute of Psychiatry, King's College London , London , UK
| | - Anna Kolliakou
- Department of Psychosis Studies, Institute of Psychiatry, King's College London , London , UK
| | - Poonam Sood
- Department of Psychosis Studies, Institute of Psychiatry, King's College London , London , UK
| | - Tiago Reis Marques
- Department of Psychosis Studies, Institute of Psychiatry, King's College London , London , UK
| | - Anthony S David
- Department of Psychosis Studies, Institute of Psychiatry, King's College London , London , UK
| | - Diana Prata
- Department of Psychosis Studies, Institute of Psychiatry, King's College London , London , UK
| | - Paola Dazzan
- Department of Psychosis Studies, Institute of Psychiatry, King's College London , London , UK
| | - John Powell
- Department of Neuroscience, Institute of Psychiatry, King's College London , London , UK
| | - Carmine Pariante
- Department of Psychological Medicine, Institute of Psychiatry, King's College London , London , UK
| | - Valeria Mondelli
- Department of Psychological Medicine, Institute of Psychiatry, King's College London , London , UK
| | - Craig Morgan
- Department of Health Services and Population Research, Institute of Psychiatry, King's College London , London , UK
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, King's College London , London , UK
| | - Helen L Fisher
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London , London , UK
| | - Conrad Iyegbe
- Department of Psychosis Studies, Institute of Psychiatry, King's College London , London , UK ; MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London , London , UK
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Zannas AS, Binder EB. Gene-environment interactions at theFKBP5locus: sensitive periods, mechanisms and pleiotropism. GENES BRAIN AND BEHAVIOR 2013; 13:25-37. [DOI: 10.1111/gbb.12104] [Citation(s) in RCA: 209] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 11/06/2013] [Accepted: 11/10/2013] [Indexed: 12/13/2022]
Affiliation(s)
- A. S. Zannas
- Max Planck Institute of Psychiatry; Munich Germany
- Department of Psychiatry; Duke University Medical Center; Durham NC USA
| | - E. B. Binder
- Max Planck Institute of Psychiatry; Munich Germany
- Department of Psychiatry and Behavioral Sciences; Emory University Medical School; Atlanta GA USA
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Smoller JW. Disorders and borders: psychiatric genetics and nosology. Am J Med Genet B Neuropsychiatr Genet 2013; 162B:559-78. [PMID: 24132891 DOI: 10.1002/ajmg.b.32174] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 05/07/2013] [Indexed: 01/10/2023]
Abstract
Over the past century, the definition and classification of psychiatric disorders has evolved through a combination of historical trends, clinical observations, and empirical research. The current nosology, instantiated in the DSM-5 and ICD-10, rests on descriptive criteria agreed upon by a consensus of experts. While the development of explicit criteria has enhanced the reliability of diagnosis, the validity of the current diagnostic categories has been the subject of debate and controversy. Genetic studies have long been regarded as a key resource for validating the boundaries among diagnostic categories. Genetic epidemiologic studies have documented the familiality and heritability of clinically defined psychiatric disorders and molecular genetic studies have begun to identify specific susceptibility variants. At the same time, there is growing evidence from family, twin and genomic studies that genetic influences on psychiatric disorders transcend clinical boundaries. Here I review this evidence for cross-disorder genetic effects and discuss the implications of these findings for psychiatric nosology. Psychiatric genetic research can inform a bottom-up reappraisal of psychopathology that may help the field move beyond a purely descriptive classification and toward an etiology-based nosology.
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Affiliation(s)
- Jordan W Smoller
- Psychiatric and Neurodevelopmental Genetics Unit and Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
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A review of hypothalamic-pituitary-adrenal axis function in chronic fatigue syndrome. ISRN NEUROSCIENCE 2013; 2013:784520. [PMID: 24959566 PMCID: PMC4045534 DOI: 10.1155/2013/784520] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 08/29/2013] [Indexed: 02/06/2023]
Abstract
Hypothalamic-pituitary-adrenal (HPA) axis dysfunction has been found in a high proportion of chronic fatigue syndrome (CFS) patients and includes enhanced corticosteroid-induced negative feedback, basal hypocortisolism, attenuated diurnal variation, and a reduced responsivity to challenge. A putative causal role for genetic profile, childhood trauma, and oxidative stress has been considered. In addition, the impact of gender is demonstrated by the increased frequency of HPA axis dysregulation in females. Despite the temporal relationship, it is not yet established whether the endocrine dysregulation is causal, consequent, or an epiphenomenon of the disorder. Nonetheless, given the interindividual variation in the effectiveness of existing biological and psychological treatments, the need for novel treatment strategies such as those which target the HPA axis is clear.
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van Os J, Delespaul P, Wigman J, Myin-Germeys I, Wichers M. Beyond DSM and ICD: introducing "precision diagnosis" for psychiatry using momentary assessment technology. World Psychiatry 2013; 12:113-7. [PMID: 23737412 PMCID: PMC3683255 DOI: 10.1002/wps.20046] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Jim van Os
- Department of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre6200, MD Maastricht, the Netherlands,Department of Psychosis Studies, Institute of Psychiatry, King's College London, King's Health PartnersDe Crespigny Park, London, SE5 8AF, UK
| | - Philippe Delespaul
- Department of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre6200, MD Maastricht, the Netherlands
| | - Johanna Wigman
- Department of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre6200, MD Maastricht, the Netherlands
| | - Inez Myin-Germeys
- Department of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre6200, MD Maastricht, the Netherlands
| | - Marieke Wichers
- Department of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre6200, MD Maastricht, the Netherlands
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