1
|
Merner AR, Trotter PM, Ginn LA, Bach J, Freedberg KJ, Soda T, Storch EA, Pereira S, Lázaro-Muñoz G. Psychiatric polygenic risk scores: Experience, hope for utility, and concerns among child and adolescent psychiatrists. Psychiatry Res 2024; 339:116080. [PMID: 39002500 PMCID: PMC11321910 DOI: 10.1016/j.psychres.2024.116080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 06/26/2024] [Accepted: 07/05/2024] [Indexed: 07/15/2024]
Abstract
Recent advances in psychiatric genetics have enabled the use of polygenic risk scores (PRS) to estimate genetic risk for psychiatric disorders. However, the potential use of PRS in child and adolescent psychiatry has raised concerns. This study provides an in-depth examination of attitudes among child and adolescent psychiatrists (CAP) regarding the use of PRS in psychiatry. We conducted semi-structured interviews with U.S.-based CAP (n = 29) who possess expertise in genetics. The majority of CAP indicated that PRS have limited clinical utility in their current form and are not ready for clinical implementation. Most clinicians stated that nothing would motivate them to generate PRS at present; however, some exceptions were noted (e.g., parent/family request). Clinicians spoke to challenges related to ordering, interpreting, and explaining PRS to patients and families. CAP raised concerns regarding the potential for this information to be misinterpreted or misused by patients, families, clinicians, and outside entities such as insurance companies. Finally, some CAP noted that PRS may lead to increased stigmatization of psychiatric disorders, and at the extreme, could be used to support eugenics. As PRS testing increases, it will be critical to examine CAP and other stakeholders' views to ensure responsible implementation of this technology.
Collapse
Affiliation(s)
- Amanda R Merner
- Center for Bioethics, Harvard Medical School, Boston, MA 02115, United States
| | - Page M Trotter
- Center for Medical Ethics & Health Policy at Baylor College of Medicine, United States
| | - Lauren A Ginn
- Center for Medical Ethics & Health Policy at Baylor College of Medicine, United States; Department of Biosciences, Rice University, Houston, Texas, United States
| | - Jason Bach
- University of Pennsylvania Law School, Philadelphia, Pennsylvania, United States
| | | | - Takahiro Soda
- Department of Psychiatry, University of Florida, Gainesville, Florida, United States; Center for Autism and Neurodevelopment, University of Florida, Gainesville, Florida, United States
| | - Eric A Storch
- Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, Texas, United States
| | - Stacey Pereira
- Center for Medical Ethics & Health Policy at Baylor College of Medicine, United States
| | - Gabriel Lázaro-Muñoz
- Center for Bioethics, Harvard Medical School, Boston, MA 02115, United States; Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States.
| |
Collapse
|
2
|
Cortese S, Solmi M, Michelini G, Bellato A, Blanner C, Canozzi A, Eudave L, Farhat LC, Højlund M, Köhler-Forsberg O, Leffa DT, Rohde C, de Pablo GS, Vita G, Wesselhoeft R, Martin J, Baumeister S, Bozhilova NS, Carlisi CO, Leno VC, Floris DL, Holz NE, Kraaijenvanger EJ, Sacu S, Vainieri I, Ostuzzi G, Barbui C, Correll CU. Candidate diagnostic biomarkers for neurodevelopmental disorders in children and adolescents: a systematic review. World Psychiatry 2023; 22:129-149. [PMID: 36640395 PMCID: PMC9840506 DOI: 10.1002/wps.21037] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/07/2022] [Indexed: 01/15/2023] Open
Abstract
Neurodevelopmental disorders - including attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, communication disorders, intellectual disability, motor disorders, specific learning disorders, and tic disorders - manifest themselves early in development. Valid, reliable and broadly usable biomarkers supporting a timely diagnosis of these disorders would be highly relevant from a clinical and public health standpoint. We conducted the first systematic review of studies on candidate diagnostic biomarkers for these disorders in children and adolescents. We searched Medline and Embase + Embase Classic with terms relating to biomarkers until April 6, 2022, and conducted additional targeted searches for genome-wide association studies (GWAS) and neuroimaging or neurophysiological studies carried out by international consortia. We considered a candidate biomarker as promising if it was reported in at least two independent studies providing evidence of sensitivity and specificity of at least 80%. After screening 10,625 references, we retained 780 studies (374 biochemical, 203 neuroimaging, 133 neurophysiological and 65 neuropsychological studies, and five GWAS), including a total of approximately 120,000 cases and 176,000 controls. While the majority of the studies focused simply on associations, we could not find any biomarker for which there was evidence - from two or more studies from independent research groups, with results going into the same direction - of specificity and sensitivity of at least 80%. Other important metrics to assess the validity of a candidate biomarker, such as positive predictive value and negative predictive value, were infrequently reported. Limitations of the currently available studies include mostly small sample size, heterogeneous approaches and candidate biomarker targets, undue focus on single instead of joint biomarker signatures, and incomplete accounting for potential confounding factors. Future multivariable and multi-level approaches may be best suited to find valid candidate biomarkers, which will then need to be validated in external, independent samples and then, importantly, tested in terms of feasibility and cost-effectiveness, before they can be implemented in daily clinical practice.
Collapse
Affiliation(s)
- Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, USA
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Marco Solmi
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- Department of Mental Health, Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Giorgia Michelini
- Department of Biological & Experimental Psychology, School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Alessio Bellato
- School of Psychology, University of Nottingham, Semenyih, Malaysia
| | - Christina Blanner
- Mental Health Center, Glostrup, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Andrea Canozzi
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Luis Eudave
- Faculty of Education and Psychology, University of Navarra, Pamplona, Spain
| | - Luis C Farhat
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Mikkel Højlund
- Department of Psychiatry Aabenraa, Mental Health Services in the Region of Southern Denmark, Aabenraa, Denmark
- Clinical Pharmacology, Pharmacy, and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Ole Köhler-Forsberg
- Psychosis Research Unit, Aarhus University Hospital - Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Douglas Teixeira Leffa
- ADHD Outpatient Program & Development Psychiatry Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Christopher Rohde
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Affective Disorders, Aarhus University Hospital - Psychiatry, Aarhus, Denmark
| | - Gonzalo Salazar de Pablo
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Child and Adolescent Mental Health Services, South London and Maudsley NHS Foundation Trust, London, UK
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Institute of Psychiatry and Mental Health, Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, CIBERSAM, Madrid, Spain
| | - Giovanni Vita
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Rikke Wesselhoeft
- Clinical Pharmacology, Pharmacy, and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Child and Adolescent Mental Health Odense, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
| | - Joanna Martin
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Sarah Baumeister
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Natali S Bozhilova
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- School of Psychology, University of Surrey, Guilford, UK
| | - Christina O Carlisi
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Virginia Carter Leno
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Dorothea L Floris
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Donders Institute for Brain, Cognition, and Behavior, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Nathalie E Holz
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
- Donders Institute for Brain, Cognition, and Behavior, Radboud University Nijmegen, Nijmegen, The Netherlands
- Department for Cognitive Neuroscience, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
- Institute of Medical Psychology and Medical Sociology, University Medical Center Schleswig Holstein, Kiel University, Kiel, Germany
| | - Eline J Kraaijenvanger
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Seda Sacu
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Isabella Vainieri
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Giovanni Ostuzzi
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Corrado Barbui
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
- Psychiatry Research, Northwell Health, Zucker Hillside Hospital, New York, NY, USA
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine, Hempstead, NY, USA
- Center for Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA
| |
Collapse
|
3
|
Lencz T, Sabatello M, Docherty A, Peterson RE, Soda T, Austin J, Bierut L, Crepaz-Keay D, Curtis D, Degenhardt F, Huckins L, Lazaro-Munoz G, Mattheisen M, Meiser B, Peay H, Rietschel M, Walss-Bass C, Davis LK. Concerns about the use of polygenic embryo screening for psychiatric and cognitive traits. Lancet Psychiatry 2022; 9:838-844. [PMID: 35931093 PMCID: PMC9930635 DOI: 10.1016/s2215-0366(22)00157-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/01/2022] [Accepted: 04/23/2022] [Indexed: 12/19/2022]
Abstract
Private companies have begun offering services to allow parents undergoing in-vitro fertilisation to screen embryos for genetic risk of complex diseases, including psychiatric disorders. This procedure, called polygenic embryo screening, raises several difficult scientific and ethical issues, as discussed in this Personal View. Polygenic embryo screening depends on the statistical properties of polygenic risk scores, which are complex and not well studied in the context of this proposed clinical application. The clinical, social, and ethical implications of polygenic embryo screening have barely been discussed among relevant stakeholders. To our knowledge, the International Society of Psychiatric Genetics is the first professional biomedical organisation to issue a statement regarding polygenic embryo screening. For the reasons discussed in this Personal View, the Society urges caution and calls for additional research and oversight on the use of polygenic embryo screening.
Collapse
Affiliation(s)
- Todd Lencz
- Divison of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY, USA; Department of Psychiatry, Division of Research, The Zucker Hillside Hospital Division of Northwell Health, Glen Oaks, NY, USA; Institute for Behavioral Science, The Feinstein Institutes for Medical Research, Manhasset, NY, USA.
| | - Maya Sabatello
- Division of Ethics, Department of Medical Humanities and Ethics, Columbia University, New York, NY, USA
| | - Anna Docherty
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Roseann E Peterson
- Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - Takahiro Soda
- Department of Psychiatry, University of Florida College of Medicine, Gainesville, FL, USA
| | - Jehannine Austin
- Departments of Psychiatry and Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Laura Bierut
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
| | | | - David Curtis
- UCL Genetics Institute, University College London, London, United Kingdom
| | - Franziska Degenhardt
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Duisburg, Germany
| | - Laura Huckins
- Departments of Psychiatry and Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Manuel Mattheisen
- Department of Psychiatry, Dalhousie Medical School, Halifax, NS, Canada
| | - Bettina Meiser
- Prince of Wales Clinical School, University of New South Wales, NSW, Australia
| | - Holly Peay
- Genomics, Bioinformatics, and Translational Research Center, RTI International, Raleigh, NC, USA
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Consuelo Walss-Bass
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Lea K Davis
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| |
Collapse
|
6
|
Lázaro-Muñoz G, Sabatello M, Huckins L, Peay H, Degenhardt F, Meiser B, Lencz T, Soda T, Docherty A, Crepaz-Keay D, Austin J, Peterson RE, Davis LK. International Society of Psychiatric Genetics Ethics Committee: Issues facing us. Am J Med Genet B Neuropsychiatr Genet 2019; 180:543-554. [PMID: 31124312 PMCID: PMC6861601 DOI: 10.1002/ajmg.b.32736] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 03/21/2019] [Accepted: 05/10/2019] [Indexed: 12/19/2022]
Abstract
Psychiatric genetics research is improving our understanding of the biological underpinnings of neurodiversity and mental illness. Using psychiatric genetics in ways that maximize benefits and minimize harms to individuals and society depends largely on how the ethical, legal, and social implications (ELSI) of psychiatric genetics are managed. The International Society of Psychiatric Genetics (ISPG) is the largest international organization dedicated to psychiatric genetics. Given its history, membership, and international reach, we believe the ISPG is well-equipped to contribute to the resolution of these ELSI challenges. As such, we recently created the ISPG Ethics Committee, an interdisciplinary group comprised of psychiatric genetics researchers, clinical geneticists, genetic counselors, mental health professionals, patients, patient advocates, bioethicists, and lawyers. This article highlights key ELSI challenges identified by the ISPG Ethics Committee to be of paramount importance for the ethical translation of psychiatric research into society in three contexts: research settings, clinical settings, and legal proceedings. For each of these arenas, we identify and discuss pressing psychiatric genetics ELSI dilemmas that merit attention and require action. The goal is to increase awareness about psychiatric genetics ELSI issues and encourage dialogue and action among stakeholders.
Collapse
Affiliation(s)
| | | | - Laura Huckins
- Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029
| | - Holly Peay
- RTI International, Research Triangle Park, NC, USA 27709
| | | | - Bettina Meiser
- University of New South Wales, UNSW Sydney 2052, Australia
| | - Todd Lencz
- Hofstra University, Hempstead, NY, USA 11549
| | - Takahiro Soda
- University of North Carolina at Chapel Hill, NC, USA 27599
| | | | | | | | | | | |
Collapse
|