1
|
Segura AG, Serna EDL, Sugranyes G, Baeza I, Valli I, Martínez-Serrano I, Díaz-Caneja CM, Andreu-Bernabeu Á, Moreno DM, Gassó P, Rodríguez N, Martínez-Pinteño A, Prohens L, Torrent C, García-Rizo C, Mas S, Castro-Fornieles J. Polygenic risk scores mediating functioning outcomes through cognitive and clinical features in youth at family risk and controls. Eur Neuropsychopharmacol 2024; 81:28-37. [PMID: 38310718 DOI: 10.1016/j.euroneuro.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/23/2024] [Accepted: 01/26/2024] [Indexed: 02/06/2024]
Abstract
Schizophrenia and bipolar disorder exhibit substantial clinical overlap, particularly in individuals at familial high risk, who frequently present sub-threshold symptoms before the onset of illness. Severe mental disorders are highly polygenic traits, but their impact on the stages preceding the manifestation of mental disorders remains relatively unexplored. Our study aimed to examine the influence of polygenic risk scores (PRS) on sub-clinical outcomes over a 2-year period in youth at familial high risk for schizophrenia and bipolar disorder and controls. The sample included 222 children and adolescents, comprising offspring of parents with schizophrenia (n = 38), bipolar disorder (n = 80), and community controls (n = 104). We calculated PRS for psychiatric disorders, neuroticism and cognition using the PRS-CS method. Linear mixed-effects models were employed to investigate the association between PRS and cognition, symptom severity and functioning. Mediation analyses were conducted to explore whether clinical features acted as intermediaries in the impact of PRS on functioning outcomes. SZoff exhibited elevated PRS for schizophrenia. In the entire sample, PRS for depression, neuroticism, and cognitive traits showed associations with sub-clinical features. The effect of PRS for neuroticism and general intelligence on functioning outcomes were mediated by cognition and symptoms severity, respectively. This study delves into the interplay among genetics, the emergence of sub-clinical symptoms and functioning outcomes, providing novel evidence on mechanisms underpinning the continuum from sub-threshold features to the onset of mental disorders. The findings underscore the interplay of genetics, cognition, and clinical features, providing insights for personalized early interventions.
Collapse
Affiliation(s)
- Alex G Segura
- Department of Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain
| | - Elena de la Serna
- Child and Adolescent Psychiatry and Psychology Department, 2021SGR01319, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain; Department of Medicine, Institute of Neuroscience, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Child and Adolescent Psychiatry and Psychology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Gisela Sugranyes
- Child and Adolescent Psychiatry and Psychology Department, 2021SGR01319, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain; Department of Medicine, Institute of Neuroscience, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Child and Adolescent Psychiatry and Psychology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Inmaculada Baeza
- Child and Adolescent Psychiatry and Psychology Department, 2021SGR01319, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain; Department of Medicine, Institute of Neuroscience, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Child and Adolescent Psychiatry and Psychology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Isabel Valli
- Child and Adolescent Psychiatry and Psychology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Irene Martínez-Serrano
- Child and Adolescent Psychiatry and Psychology Department, 2021SGR01319, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Covadonga M Díaz-Caneja
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Álvaro Andreu-Bernabeu
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Dolores M Moreno
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Adolescent Inpatient Unit, Department of Psychiatry, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Psychiatry Department, Universidad Complutense de Madrid, Madrid, Spain
| | - Patricia Gassó
- Department of Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Child and Adolescent Psychiatry and Psychology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Natalia Rodríguez
- Department of Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain
| | - Albert Martínez-Pinteño
- Department of Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain
| | - Llucia Prohens
- Department of Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain
| | - Carla Torrent
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Barcelona Bipolar Disorders Program, Clinical Institute of Neuroscience, Hospital Clinic, University of Barcelona, Fundació Clinic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Clemente García-Rizo
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Barcelona Clinic Schizophrenia Unit, Institute of Neuroscience, Hospital Clinic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Sergi Mas
- Department of Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Child and Adolescent Psychiatry and Psychology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| | - Josefina Castro-Fornieles
- Child and Adolescent Psychiatry and Psychology Department, 2021SGR01319, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain; Department of Medicine, Institute of Neuroscience, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Child and Adolescent Psychiatry and Psychology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| |
Collapse
|
2
|
Forsyth JK, Bearden CE. Rethinking the First Episode of Schizophrenia: Identifying Convergent Mechanisms During Development and Moving Toward Prediction. Am J Psychiatry 2023; 180:792-804. [PMID: 37908094 DOI: 10.1176/appi.ajp.20230736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Affiliation(s)
- Jennifer K Forsyth
- Department of Psychology, University of Washington, Seattle (Forsyth); Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Behavioral Sciences, and Department of Psychology, University of California, Los Angeles (Bearden)
| | - Carrie E Bearden
- Department of Psychology, University of Washington, Seattle (Forsyth); Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Behavioral Sciences, and Department of Psychology, University of California, Los Angeles (Bearden)
| |
Collapse
|
3
|
Saarinen A, Hietala J, Lyytikäinen LP, Hamal Mishra B, Sormunen E, Kähönen M, Rovio S, Viikari J, Raitakari O, Lehtimäki T, Keltikangas-Järvinen L. Polygenic liabilities underlying job stress and exhaustion over a 10-year follow-up: A general population study. Psychiatry Res 2023; 326:115355. [PMID: 37487461 DOI: 10.1016/j.psychres.2023.115355] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 07/26/2023]
Abstract
We investigated whether individuals, who have a high polygenic loading for schizophrenia and major depression (PGL) but have not developed the respective disorders, are still susceptible to experience milder forms of ill-being in terms of job strain or exhaustion. We used the population-based Young Finns Study data (n = 928). PGL was assessed with a cumulative score of the polygenic risk scores for schizophrenia and depression. Participants (24-49-year-olds) evaluated their exhaustion levels and perceived job characteristics over a 10-year follow-up (2001, 2007, 2011). Participants with diagnosed psychotic or affective disorders were excluded. We found that high PGL did not predict less favorable perceptions of job environment (job strain, demands, control, satisfaction, social support at work) but high PGL predicted a higher trajectory of exhaustion in early adulthood and middle age. Additionally, high (vs. low) PGL predicted a stronger increase in exhaustion at increased levels of job strain. These findings remained after controlling for sex, socioeconomic factors, health behaviors, and cognitive performance. In conclusion, individuals with high PGL may have an elevated liability to experience exhaustion especially in early adulthood and middle age (despite they perceive their job environment similarly than others), and especially and at high levels of job strain.
Collapse
Affiliation(s)
- Aino Saarinen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland.
| | - Jarmo Hietala
- Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland
| | - Leo-Pekka Lyytikäinen
- Department of Clinical Chemistry, Fimlab Laboratories, and Finnish Cardiovascular Research Center, Tampere, Finland; Department of Cardiology, Heart Center, Tampere University Hospital, Tampere; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Binisha Hamal Mishra
- Department of Clinical Chemistry, Fimlab Laboratories, and Finnish Cardiovascular Research Center, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Elina Sormunen
- Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland
| | - Mika Kähönen
- Department of Clinical Physiology, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Suvi Rovio
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Jorma Viikari
- Department of Medicine, University of Turku and Division of Medicine, Turku University Hospital, Turku, Finland
| | - Olli Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland; Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories, and Finnish Cardiovascular Research Center, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | |
Collapse
|
4
|
Segura AG, Mezquida G, Martínez-Pinteño A, Gassó P, Rodriguez N, Moreno-Izco L, Amoretti S, Bioque M, Lobo A, González-Pinto A, García-Alcon A, Roldán-Bejarano A, Vieta E, de la Serna E, Toll A, Cuesta MJ, Mas S, Bernardo M. Link between cognitive polygenic risk scores and clinical progression after a first-psychotic episode. Psychol Med 2023; 53:4634-4647. [PMID: 35678455 PMCID: PMC10388335 DOI: 10.1017/s0033291722001544] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 05/05/2022] [Accepted: 05/09/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Clinical intervention in early stages of psychotic disorders is crucial for the prevention of severe symptomatology trajectories and poor outcomes. Genetic variability is studied as a promising modulator of prognosis, thus novel approaches considering the polygenic nature of these complex phenotypes are required to unravel the mechanisms underlying the early progression of the disorder. METHODS The sample comprised of 233 first-episode psychosis (FEP) subjects with clinical and cognitive data assessed periodically for a 2-year period and 150 matched controls. Polygenic risk scores (PRSs) for schizophrenia, bipolar disorder, depression, education attainment and cognitive performance were used to assess the genetic risk of FEP and to characterize their association with premorbid, baseline and progression of clinical and cognitive status. RESULTS Schizophrenia, bipolar disorder and cognitive performance PRSs were associated with an increased risk of FEP [false discovery rate (FDR) ⩽ 0.027]. In FEP patients, increased cognitive PRSs were found for FEP patients with more cognitive reserve (FDR ⩽ 0.037). PRSs reflecting a genetic liability for improved cognition were associated with a better course of symptoms, functionality and working memory (FDR ⩽ 0.039). Moreover, the PRS of depression was associated with a worse trajectory of the executive function and the general cognitive status (FDR ⩽ 0.001). CONCLUSIONS Our study provides novel evidence of the polygenic bases of psychosis and its clinical manifestation in its first stage. The consistent effect of cognitive PRSs on the early clinical progression suggests that the mechanisms underlying the psychotic episode and its severity could be partially independent.
Collapse
Affiliation(s)
- Alex G. Segura
- Department of Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain
| | - Gisela Mezquida
- Department of Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain
- Barcelona Clínic Schizophrenia Unit, Neuroscience Institute Hospital Clínic de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPs), Barcelona, Spain
| | - Albert Martínez-Pinteño
- Department of Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain
| | - Patricia Gassó
- Department of Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPs), Barcelona, Spain
| | - Natalia Rodriguez
- Department of Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain
| | - Lucía Moreno-Izco
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Silvia Amoretti
- Barcelona Clínic Schizophrenia Unit, Neuroscience Institute Hospital Clínic de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Group of Psychiatry, Mental Health and Addictions, Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Miquel Bioque
- Barcelona Clínic Schizophrenia Unit, Neuroscience Institute Hospital Clínic de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPs), Barcelona, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Antonio Lobo
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
| | - Ana González-Pinto
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Hospital Universitario de Alava, Vitoria-Gasteiz, Spain
- Instituto de Investigación Sanitaria Bioaraba, Vitoria-Gasteiz, Spain
- University of the Basque Country, Vizcaya, Spain
| | - Alicia García-Alcon
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Alexandra Roldán-Bejarano
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Psychiatry Department, Institut d'Investigació Biomèdica-SantPau (IIB-SANTPAU), Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Eduard Vieta
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, Barcelona, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Elena de la Serna
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPs), Barcelona, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
- Department of Child and Adolescent Psychiatry and Psychology, Clínic Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Alba Toll
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Institute of Neuropsychiatry and Addiction, Parc de Salut Mar, Barcelona, Spain
- Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Manuel J. Cuesta
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Sergi Mas
- Department of Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPs), Barcelona, Spain
| | - Miquel Bernardo
- Barcelona Clínic Schizophrenia Unit, Neuroscience Institute Hospital Clínic de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPs), Barcelona, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
| | - PEPs Group
- Department of Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain
| |
Collapse
|
5
|
Rammos A, Kirov G, Hubbard L, Walters JTR, Holmans P, Owen MJ, O'Donovan MC, Rees E. Family-based analysis of the contribution of rare and common genetic variants to school performance in schizophrenia. Mol Psychiatry 2023; 28:2081-2087. [PMID: 36914811 PMCID: PMC10575776 DOI: 10.1038/s41380-023-02013-2] [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: 11/09/2022] [Revised: 02/15/2023] [Accepted: 02/22/2023] [Indexed: 03/16/2023]
Abstract
Impaired cognition in schizophrenia is associated with worse functional outcomes. While genetic factors are known to contribute to variation in cognition in schizophrenia, few rare coding variants with strong effects have been identified, and the relative effects from de novo, inherited and non-transmitted alleles are unknown. We used array and exome sequencing data from 656 proband-parent trios to examine the contribution of common and rare variants to school performance, and by implication cognitive function, in schizophrenia. Parental transmission of common alleles contributing to higher educational attainment (p value = 0.00015; OR = 2.63) and intelligence (p value = 0.00009; OR = 2.80), but not to schizophrenia, were associated with higher proband school performance. No significant effects were seen for non-transmitted parental common alleles. Probands with lower school performance were enriched for damaging de novo coding variants in genes associated with developmental disorders (DD) (p value = 0.00026; OR = 11.6). Damaging, ultra-rare coding variants in DD genes that were transmitted or non-transmitted from parents, had no effects on school performance. Among probands with lower school performance, those with damaging de novo coding variants in DD genes had a higher rate of comorbid mild intellectual disability (p value = 0.0002; OR = 15.6). Overall, we provide evidence for rare and common genetic contributions to school performance in schizophrenia. The strong effects for damaging de novo coding variants in DD genes provide further evidence that cognitive impairment in schizophrenia has a shared aetiology with developmental disorders. Furthermore, we report no evidence in this sample that non-transmitted parental common alleles for cognitive traits contributed to school performance in schizophrenia via indirect effects on the environment.
Collapse
Affiliation(s)
- Alexandros Rammos
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK.
| | - George Kirov
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Leon Hubbard
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - James T R Walters
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Peter Holmans
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Michael J Owen
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Michael C O'Donovan
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Elliott Rees
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK.
| |
Collapse
|
6
|
Sørensen HJ, Antonsen S, Benros ME, Erlangsen A, Albiñana C, Nordentoft M, Børglum AD, Mors O, Werge T, Mortensen PB, Hougaard D, Webb RT, Agerbo E. School performance and genetic propensities for educational attainment and depression in the etiology of self-harm: a Danish population-based study. Nord J Psychiatry 2023; 77:179-187. [PMID: 35635301 PMCID: PMC9883111 DOI: 10.1080/08039488.2022.2078998] [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: 11/13/2021] [Revised: 04/21/2022] [Accepted: 04/29/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Poor school performance is linked to higher risks of self-harm. The association might be explained through genetic liabilities for depression or educational attainment. We investigated the association between school performance and self-harm in a population-based sample while assessing the potential influence of polygenic risk scores (PRSs) for depression (PRSMDD) and for educational attainment (PRSEDU). METHOD We conducted a follow-up study of individuals born 1987-98 and followed from age 18 until 2016. The total sample consisted of a case group (23,779 diagnosed with mental disorders; schizophrenia, bipolar disorder, depression, autism, and attention deficit hyperactivity disorder (ADHD) and a randomly sampled comparison group (n = 10,925). Genome-wide data were obtained from the Neonatal Screening Biobank and information on school performance, family psychiatric history, and socioeconomic status from national administrative registers. RESULTS Individuals in the top PRSMDD decile were at higher self-harm risk in the case group (IRR: 1.30; 95% CI 1.15-1.46), whereas individuals in the top PRSEDU decile were at lower self-harm risk (IRR: 0.63; 95% CI: 0.55-0.74). Poorer school performance was associated with higher self-harm risk in persons diagnosed with any mental disorder (IRR: 1.69; 95% CI: 1.44-1.99) and among the comparison group (IRR: 7.93; 95% CI: 4.47-15.18). Observed effects of PRSMDD and PRSEDU on self-harm risk were strongest for individuals with poor school performance. CONCLUSION Associations between PRSMDD and self-harm risk and between PRSEDU and self-harm risk were found. Nevertheless, these polygenic scores seem currently of limited clinical utility for identifying individuals at high self-harm risk.
Collapse
Affiliation(s)
- Holger J. Sørensen
- iPSYCH—The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- Copenhagen Research Center for Mental Health, CORE, University of Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Denmark
| | - Sussie Antonsen
- iPSYCH—The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- NCRR - National Centre for Register-Based Research, Department of Economics & Business Economics, Aarhus University, Denmark
| | - Michael E. Benros
- iPSYCH—The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- Copenhagen Research Center for Mental Health, CORE, University of Copenhagen, Denmark
| | - Annette Erlangsen
- iPSYCH—The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- Copenhagen Research Center for Mental Health, CORE, University of Copenhagen, Denmark
- Danish Research Institute for Suicide Prevention, Denmark
- Department of Mental Health, Bloomberg Johns Hopkins School of Public Health, USA
- Centre for Mental Health Research, Australian National University, Australia
| | - Clara Albiñana
- iPSYCH—The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- NCRR - National Centre for Register-Based Research, Department of Economics & Business Economics, Aarhus University, Denmark
| | - Merete Nordentoft
- iPSYCH—The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- Copenhagen Research Center for Mental Health, CORE, University of Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Denmark
| | - Anders D. Børglum
- iPSYCH—The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- Department of Biomedicine and Centre for Integrative Sequencing (iSEQ), Aarhus University, Aarhus, Denmark
- Center for Genomics and Personalized Medicine, Aarhus, Denmark
| | - Ole Mors
- iPSYCH—The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Thomas Werge
- iPSYCH—The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Denmark
- Institute of Biological Psychiatry, MHC, Sankt Hans Mental Health Services, Copenhagen, Roskilde, Denmark
| | - Preben B. Mortensen
- iPSYCH—The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- NCRR - National Centre for Register-Based Research, Department of Economics & Business Economics, Aarhus University, Denmark
| | - David Hougaard
- iPSYCH—The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- Centre for Neonatal Screening, Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | - Roger T. Webb
- Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Esben Agerbo
- iPSYCH—The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- NCRR - National Centre for Register-Based Research, Department of Economics & Business Economics, Aarhus University, Denmark
- CIRRAU - Centre for Integrated Register- Based Research, Aarhus University, Aarhus, Denmark
| |
Collapse
|
7
|
Ringbom I, Suvisaari J, Kääriälä A, Sourander A, Gissler M, Kelleher I, Gyllenberg D. Psychotic Disorders in Adolescence and Later Long-term Exclusion From Education and Employment. Schizophr Bull 2022; 49:90-98. [PMID: 36305161 PMCID: PMC9810018 DOI: 10.1093/schbul/sbac151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND HYPOTHESIS Psychotic disorders have been associated with not being in education, employment, and training (NEET). There is a lack of knowledge on the importance of risk markers for NEET among people with psychotic disorders and what rehabilitation they receive. STUDY DESIGN We based our research on the register-based 1987 Finnish Birth Cohort study, which included all live births in Finland during that year. The study cohort were 288 people who had been diagnosed with psychotic disorders during 2004-2007, when they were 16-20 year old, and 55 883 who had not. We looked at the national register data for those subjects in 2008-2015, when they were 20-28 year old, and compared any associations between sociodemographic factors and NEET status. STUDY RESULTS NEET for more than 5 year affected 2.2% of those without psychosis, 35.8% of those with any nonaffective psychotic disorder, and 57.0% of those with schizophrenia or schizoaffective disorders. Family-related risk factors were weaker predictors of long-term NEET in subjects with psychotic disorders than other cohort members. Having a psychotic disorder plus long-term NEET was associated with not applying for upper secondary education, not finishing upper secondary education, parents receiving welfare benefits, being diagnosed with schizophrenia or schizoaffective disorders and being hospitalized for psychosis. Only 24.3% with psychotic disorders had participated in vocational rehabilitation. CONCLUSIONS A diagnosis of psychosis in adolescence is independently associated with serious long term functional disability. Among those with psychotic disorders, educational problems are markers for adverse labor market outcomes. Despite this, vocational rehabilitation is seldom provided.
Collapse
Affiliation(s)
- Ida Ringbom
- To whom correspondence should be addressed; Department of Child Psychiatry, University of Turku, Lemminkäinenkatu 3, 3rd floor, 20014 Turku, Finland, e-mail:
| | | | | | - Andre Sourander
- Department of Child Psychiatry and Invest Flagship, University of Turku, Finland,Turku University Central Hospital, Department of Child Psychiatry, Finland
| | - Mika Gissler
- Department of Child Psychiatry and Invest Flagship, University of Turku, Finland,Finnish Institute for Health and Welfare, Finland,Karolinska Institute, Department of Molecular Medicine and Surgery, Sweden and Region Stockholm, Academic Primary Health Care Centre, Stockholm, Sweden
| | - Ian Kelleher
- School of Medicine, University College Dublin, Ireland
| | - David Gyllenberg
- Department of Child Psychiatry and Invest Flagship, University of Turku, Finland,Finnish Institute for Health and Welfare, Finland,Helsinki University Hospital, Department of Adolescent Psychiatry, Finland
| |
Collapse
|
8
|
Dwyer DB, Buciuman MO, Ruef A, Kambeitz J, Sen Dong M, Stinson C, Kambeitz-Ilankovic L, Degenhardt F, Sanfelici R, Antonucci LA, Lalousis PA, Wenzel J, Urquijo-Castro MF, Popovic D, Oeztuerk OF, Haas SS, Weiske J, Hauke D, Neufang S, Schmidt-Kraepelin C, Ruhrmann S, Penzel N, Lichtenstein T, Rosen M, Chisholm K, Riecher-Rössler A, Egloff L, Schmidt A, Andreou C, Hietala J, Schirmer T, Romer G, Michel C, Rössler W, Maj C, Borisov O, Krawitz PM, Falkai P, Pantelis C, Lencer R, Bertolino A, Borgwardt S, Noethen M, Brambilla P, Schultze-Lutter F, Meisenzahl E, Wood SJ, Davatzikos C, Upthegrove R, Salokangas RKR, Koutsouleris N. Clinical, Brain, and Multilevel Clustering in Early Psychosis and Affective Stages. JAMA Psychiatry 2022; 79:677-689. [PMID: 35583903 PMCID: PMC9118078 DOI: 10.1001/jamapsychiatry.2022.1163] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Approaches are needed to stratify individuals in early psychosis stages beyond positive symptom severity to investigate specificity related to affective and normative variation and to validate solutions with premorbid, longitudinal, and genetic risk measures. Objective To use machine learning techniques to cluster, compare, and combine subgroup solutions using clinical and brain structural imaging data from early psychosis and depression stages. Design, Setting, and Participants A multisite, naturalistic, longitudinal cohort study (10 sites in 5 European countries; including major follow-up intervals at 9 and 18 months) with a referred patient sample of those with clinical high risk for psychosis (CHR-P), recent-onset psychosis (ROP), recent-onset depression (ROD), and healthy controls were recruited between February 1, 2014, to July 1, 2019. Data were analyzed between January 2020 and January 2022. Main Outcomes and Measures A nonnegative matrix factorization technique separately decomposed clinical (287 variables) and parcellated brain structural volume (204 gray, white, and cerebrospinal fluid regions) data across CHR-P, ROP, ROD, and healthy controls study groups. Stability criteria determined cluster number using nested cross-validation. Validation targets were compared across subgroup solutions (premorbid, longitudinal, and schizophrenia polygenic risk scores). Multiclass supervised machine learning produced a transferable solution to the validation sample. Results There were a total of 749 individuals in the discovery group and 610 individuals in the validation group. Individuals included those with CHR-P (n = 287), ROP (n = 323), ROD (n = 285), and healthy controls (n = 464), The mean (SD) age was 25.1 (5.9) years, and 702 (51.7%) were female. A clinical 4-dimensional solution separated individuals based on positive symptoms, negative symptoms, depression, and functioning, demonstrating associations with all validation targets. Brain clustering revealed a subgroup with distributed brain volume reductions associated with negative symptoms, reduced performance IQ, and increased schizophrenia polygenic risk scores. Multilevel results distinguished between normative and illness-related brain differences. Subgroup results were largely validated in the external sample. Conclusions and Relevance The results of this longitudinal cohort study provide stratifications beyond the expression of positive symptoms that cut across illness stages and diagnoses. Clinical results suggest the importance of negative symptoms, depression, and functioning. Brain results suggest substantial overlap across illness stages and normative variation, which may highlight a vulnerability signature independent from specific presentations. Premorbid, longitudinal, and genetic risk validation suggested clinical importance of the subgroups to preventive treatments.
Collapse
Affiliation(s)
- Dominic B Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Madalina-Octavia Buciuman
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,International Max-Planck Research School for Translational Psychiatry, Munich, Germany
| | - Anne Ruef
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Mark Sen Dong
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Caedyn Stinson
- Max-Planck School of Cognition, Leipzig, Germany.,Center for Adaptive Rationality, Max Planck Institute for Human Development, Berlin, Germany
| | - Lana Kambeitz-Ilankovic
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Franziska Degenhardt
- Institute of Human Genetics, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany.,Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Rachele Sanfelici
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,Max-Planck Institute of Psychiatry, Munich, Germany
| | - Linda A Antonucci
- Department of Education, Psychology, Communication, University of Bari Aldo Moro, Bari, Italy
| | - Paris Alexandros Lalousis
- Institute for Mental Health and Centre for Brain Health, University of Birmingham, Birmingham, United Kingdom
| | - Julian Wenzel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | | | - David Popovic
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,International Max-Planck Research School for Translational Psychiatry, Munich, Germany
| | - Oemer Faruk Oeztuerk
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,International Max-Planck Research School for Translational Psychiatry, Munich, Germany
| | - Shalaila S Haas
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Johanna Weiske
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Daniel Hauke
- Department of Psychiatry (Psychiatric University Hospital, UPK), University of Basel, Basel, Switzerland.,Early Intervention Service, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom.,Department of Mathematics and Computer Science, University of Basel, Basel, Switzerland
| | - Susanne Neufang
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | | | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Nora Penzel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Theresa Lichtenstein
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Marlene Rosen
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Katharine Chisholm
- Institute for Mental Health and Centre for Brain Health, University of Birmingham, Birmingham, United Kingdom.,Department of Psychology, Aston University, Birmingham, United Kingdom
| | | | - Laura Egloff
- Department of Psychiatry (Psychiatric University Hospital, UPK), University of Basel, Basel, Switzerland
| | - André Schmidt
- Department of Psychiatry (Psychiatric University Hospital, UPK), University of Basel, Basel, Switzerland
| | - Christina Andreou
- Department of Psychiatry (Psychiatric University Hospital, UPK), University of Basel, Basel, Switzerland
| | - Jarmo Hietala
- Department of Psychiatry, University of Turku, Turku, Finland
| | - Timo Schirmer
- GE Healthcare GmbH (previously GE Global Research GmbH), Munich, Germany
| | - Georg Romer
- Department of Child and Adolescent Psychiatry, University of Münster, Münster, Germany
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Wulf Rössler
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Carlo Maj
- Institute of Genomic Statistics and Bioinformatics, University of Bonn, Bonn, Germany
| | - Oleg Borisov
- Institute of Genomic Statistics and Bioinformatics, University of Bonn, Bonn, Germany
| | - Peter M Krawitz
- Institute of Genomic Statistics and Bioinformatics, University of Bonn, Bonn, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,Max-Planck Institute of Psychiatry, Munich, Germany
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, University of Melbourne & Melbourne Health, Melbourne, Victoria, Australia
| | - Rebekka Lencer
- Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany.,Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Alessandro Bertolino
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Stefan Borgwardt
- Department of Psychiatry (Psychiatric University Hospital, UPK), University of Basel, Basel, Switzerland.,Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Markus Noethen
- Institute of Human Genetics, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.,University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Department of Psychology, Faculty of Psychology, Airlangga University, Surabaya, Indonesia
| | | | - Stephen J Wood
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia.,Orygen, the National Centre of Excellence for Youth Mental Health, Melbourne, Victoria, Australia
| | - Christos Davatzikos
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Rachel Upthegrove
- Institute for Mental Health and Centre for Brain Health, University of Birmingham, Birmingham, United Kingdom.,Early Intervention Service, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | | | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,Max-Planck Institute of Psychiatry, Munich, Germany.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | | |
Collapse
|
9
|
Song J, Yao S, Kowalec K, Lu Y, Sariaslan A, Szatkiewicz JP, Larsson H, Lichtenstein P, Hultman CM, Sullivan PF. The impact of educational attainment, intelligence and intellectual disability on schizophrenia: a Swedish population-based register and genetic study. Mol Psychiatry 2022; 27:2439-2447. [PMID: 35379910 PMCID: PMC9135619 DOI: 10.1038/s41380-022-01500-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 02/14/2022] [Accepted: 02/22/2022] [Indexed: 01/16/2023]
Abstract
Schizophrenia (SCZ) is highly heterogenous and no subtypes characterizing treatment response or longitudinal course well. Cognitive impairment is a core clinical feature of SCZ and a determinant of poorer outcome. Genetic overlap between SCZ and cognitive traits is complex, with limited studies of comprehensive epidemiological and genomic evidence. To examine the relation between SCZ and three cognitive traits, educational attainment (EDU), premorbid cognitive ability, and intellectual disability (ID), we used two Swedish samples: a national cohort (14,230 SCZ cases and 3,816,264 controls) and a subsample with comprehensive genetic data (4992 cases and 6009 controls). Population-based analyses confirmed worse cognition as a risk factor for SCZ, and the pedigree and SNP-based genetic correlations were comparable. In the genotyped cases, those with high EDU and premorbid cognitive ability tended to have higher polygenetic risk scores (PRS) of EDU and intelligence and fewer rare exonic variants. Finally, by applying an empirical clustering method, we dissected SCZ cases into four replicable subgroups characterized by EDU and ID. In particular, the subgroup with higher EDU in the national cohort had fewer adverse outcomes including long hospitalization and death. In the genotyped subsample, this subgroup had higher PRS of EDU and no excess of rare genetic burdens than controls. In conclusion, we found extensive evidence of a robust relation between cognitive traits and SCZ, underscoring the importance of cognition in dissecting the heterogeneity of SCZ.
Collapse
Affiliation(s)
- Jie Song
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Shuyang Yao
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kaarina Kowalec
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- College of Pharmacy, University of Manitoba, Winnipeg, MB, Canada
| | - Yi Lu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Amir Sariaslan
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Jin P Szatkiewicz
- Departments of Genetics and Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebo University, Örebo, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Christina M Hultman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Icahn School of Medicine, Department of Psychiatry, Mt Sinai Hospital, New York, NY, USA
| | - Patrick F Sullivan
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
- Departments of Genetics and Psychiatry, University of North Carolina, Chapel Hill, NC, USA.
| |
Collapse
|
10
|
Fusar-Poli L, Pries LK, van Os J, Erzin G, Delespaul P, Kenis G, Luykx JJ, Lin BD, Richards AL, Akdede B, Binbay T, Altınyazar V, Yalınçetin B, Gümüş-Akay G, Cihan B, Soygür H, Ulaş H, Cankurtaran EŞ, Kaymak SU, Mihaljevic MM, Andric-Petrovic S, Mirjanic T, Bernardo M, Mezquida G, Amoretti S, Bobes J, Saiz PA, García-Portilla MP, Sanjuan J, Aguilar EJ, Santos JL, Jiménez-López E, Arrojo M, Carracedo A, López G, González-Peñas J, Parellada M, Maric NP, Atbaşoğlu C, Üçok A, Alptekin K, Saka MC, Aguglia E, Arango C, O'Donovan M, Rutten BPF, Guloksuz S. Examining facial emotion recognition as an intermediate phenotype for psychosis: Findings from the EUGEI study. Prog Neuropsychopharmacol Biol Psychiatry 2022; 113:110440. [PMID: 34536513 DOI: 10.1016/j.pnpbp.2021.110440] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/12/2021] [Accepted: 09/12/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Social cognition impairments, such as facial emotion recognition (FER), have been acknowledged since the earliest description of schizophrenia. Here, we tested FER as an intermediate phenotype for psychosis using two approaches that are indicators of genetic risk for schizophrenia: the proxy-genetic risk approach (family design) and the polygenic risk score for schizophrenia (PRS-SCZ). METHODS The sample comprised 2039 individuals with schizophrenia, 2141 siblings, and 2049 healthy controls (HC). The Degraded Facial Affect Recognition Task (DFAR) was applied to measure the FER accuracy. Schizotypal traits in siblings and HC were assessed using the Structured Interview for Schizotypy-Revised (SIS-R). The PRS-SCZ was trained using the Psychiatric Genomics Consortium results. Regression models were applied to test the association of DFAR with psychosis risk, SIS-R, and PRS-SCZ. RESULTS The DFAR-total scores were lower in individuals with schizophrenia than in siblings (RR = 0.97 [95% CI 0.97, 0.97]), who scored lower than HC (RR = 0.99 [95% CI 0.99-1.00]). The DFAR-total scores were negatively associated with SIS-R total scores in siblings (B = -2.04 [95% CI -3.72, -0.36]) and HC (B = -2.93 [95% CI -5.50, -0.36]). Different patterns of association were observed for individual emotions. No significant associations were found between DFAR scores and PRS-SCZ. CONCLUSIONS Our findings based on a proxy genetic risk approach suggest that FER deficits may represent an intermediate phenotype for schizophrenia. However, a significant association between FER and PRS-SCZ was not found. In the future, genetic mechanisms underlying FER phenotypes should be investigated trans-diagnostically.
Collapse
Affiliation(s)
- Laura Fusar-Poli
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania, Italy
| | - Lotta-Katrin Pries
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Jim van Os
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Psychiatry, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands; Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Gamze Erzin
- Department of Psychiatry, University of Health Sciences Ankara Diskapi Training and Research Hospital, Ankara, Turkey
| | - Philippe Delespaul
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands; FACT, Mondriaan Mental Health, Maastricht, Netherlands
| | - Gunter Kenis
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Juryen J Luykx
- Department of Psychiatry, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands; Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; GGNet Mental Health, Apeldoorn, the Netherlands
| | - Bochao D Lin
- Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Alexander L Richards
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Berna Akdede
- Department of Psychiatry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Tolga Binbay
- Department of Psychiatry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Vesile Altınyazar
- Department of Psychiatry, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey
| | - Berna Yalınçetin
- Department of Neuroscience, Graduate School of Health Sciences, Dokuz Eylul University, Izmir, Turkey
| | - Güvem Gümüş-Akay
- Department of Physiology, School of Medicine, Ankara University, Ankara, Turkey; Brain Research Center, Ankara University, Ankara, Turkey; Neuroscience and Neurotechnology Center of Excellence (NÖROM), Ankara, Turkey
| | - Burçin Cihan
- Department of Psychology, Middle East Technical University, Ankara, Turkey
| | - Haldun Soygür
- Turkish Federation of Schizophrenia Associations, Ankara, Turkey
| | - Halis Ulaş
- Department of Psychiatry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | | | | | - Marina M Mihaljevic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Clinic for Psychiatry Clinical Centre of Serbia, Belgrade, Serbia
| | - Sanja Andric-Petrovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Clinic for Psychiatry Clinical Centre of Serbia, Belgrade, Serbia
| | - Tijana Mirjanic
- Special Hospital for Psychiatric Disorders Kovin, Kovin, Serbia
| | - Miguel Bernardo
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain; Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
| | - Gisela Mezquida
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain; Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
| | - Silvia Amoretti
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain; Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
| | - Julio Bobes
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain; Department of Psychiatry, School of Medicine, University of Oviedo, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain; Mental Health Services of Principado de Asturias, Oviedo, Spain
| | - Pilar A Saiz
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain; Department of Psychiatry, School of Medicine, University of Oviedo, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain; Mental Health Services of Principado de Asturias, Oviedo, Spain
| | - Maria Paz García-Portilla
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain; Department of Psychiatry, School of Medicine, University of Oviedo, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain; Mental Health Services of Principado de Asturias, Oviedo, Spain
| | - Julio Sanjuan
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain; Department of Psychiatry, Hospital Clínico Universitario de Valencia, INCLIVA, School of Medicine, Universidad de Valencia, Valencia, Spain
| | - Eduardo J Aguilar
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain; Department of Psychiatry, Hospital Clínico Universitario de Valencia, INCLIVA, School of Medicine, Universidad de Valencia, Valencia, Spain
| | - José Luis Santos
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain; Department of Psychiatry, Hospital Virgen de la Luz, Cuenca, Spain
| | - Estela Jiménez-López
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain; Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
| | - Manuel Arrojo
- Department of Psychiatry, Instituto de Investigación Sanitaria, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Angel Carracedo
- Grupo de Medicina Genómica, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Universidad de Santiago de Compostela, Santiago de Compostela, Spain; Fundación Pública Galega de Medicina Xenómica (SERGAS), IDIS, Santiago de Compostela, Spain
| | - Gonzalo López
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain; Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Javier González-Peñas
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain; Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Mara Parellada
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain; Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Nadja P Maric
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Institute of Mental Health, Belgrade, Serbia
| | - Cem Atbaşoğlu
- Department of Psychiatry, School of Medicine, Ankara University, Ankara, Turkey
| | - Alp Üçok
- Department of Psychiatry, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Köksal Alptekin
- Department of Psychiatry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey; Department of Neuroscience, Graduate School of Health Sciences, Dokuz Eylul University, Izmir, Turkey
| | - Meram Can Saka
- Department of Psychiatry, School of Medicine, Ankara University, Ankara, Turkey
| | | | - Eugenio Aguglia
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania, Italy
| | - Celso Arango
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain; Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Michael O'Donovan
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Bart P F Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Sinan Guloksuz
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States of America.
| |
Collapse
|
11
|
Sex-specific effects of polygenic risk for schizophrenia on lifespan cognitive functioning in healthy individuals. Transl Psychiatry 2021; 11:520. [PMID: 34635642 PMCID: PMC8505489 DOI: 10.1038/s41398-021-01649-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/16/2021] [Accepted: 09/27/2021] [Indexed: 12/13/2022] Open
Abstract
Polygenic risk for schizophrenia has been associated with lower cognitive ability and age-related cognitive change in healthy individuals. Despite well-established neuropsychological sex differences in schizophrenia patients, genetic studies on sex differences in schizophrenia in relation to cognitive phenotypes are scarce. Here, we investigated whether the effect of a polygenic risk score (PRS) for schizophrenia on childhood, midlife, and late-life cognitive function in healthy individuals is modified by sex, and if PRS is linked to accelerated cognitive decline. Using a longitudinal data set from healthy individuals aged 25-100 years (N = 1459) spanning a 25-year period, we found that PRS was associated with lower cognitive ability (episodic memory, semantic memory, visuospatial ability), but not with accelerated cognitive decline. A significant interaction effect between sex and PRS was seen on cognitive task performance, and sex-stratified analyses showed that the effect of PRS was male-specific. In a sub-sample, we observed a male-specific effect of the PRS on school performance at age 12 (N = 496). Our findings of sex-specific effects of schizophrenia genetics on cognitive functioning across the lifespan indicate that the effects of underlying disease genetics on cognitive functioning is dependent on biological processes that differ between the sexes.
Collapse
|
12
|
Velthorst E, Mollon J, Murray RM, de Haan L, Germeys IM, Glahn DC, Arango C, van der Ven E, Di Forti M, Bernardo M, Guloksuz S, Delespaul P, Mezquida G, Amoretti S, Bobes J, Saiz PA, García-Portilla MP, Santos JL, Jiménez-López E, Sanjuan J, Aguilar EJ, Arrojo M, Carracedo A, López G, González-Peñas J, Parellada M, Atbaşoğlu C, Saka MC, Üçok A, Alptekin K, Akdede B, Binbay T, Altınyazar V, Ulaş H, Yalınçetin B, Gümüş-Akay G, Beyaz BC, Soygür H, Cankurtaran EŞ, Kaymak SU, Maric NP, Mihaljevic MM, Petrovic SA, Mirjanic T, Del-Ben CM, Ferraro L, Gayer-Anderson C, Jones PB, Jongsma HE, Kirkbride JB, La Cascia C, Lasalvia A, Tosato S, Llorca PM, Menezes PR, Morgan C, Quattrone D, Menchetti M, Selten JP, Szöke A, Tarricone I, Tortelli A, McGuire P, Valmaggia L, Kempton MJ, van der Gaag M, Riecher-Rössler A, Bressan RA, Barrantes-Vidal N, Nelson B, McGorry P, Pantelis C, Krebs MO, Ruhrmann S, Sachs G, Rutten BPF, van Os J, Alizadeh BZ, van Amelsvoort T, Bartels-Velthuis AA, Bruggeman R, van Beveren NJ, Luykx JJ, Cahn W, Simons CJP, Kahn RS, Schirmbeck F, van Winkel R, Reichenberg A. Cognitive functioning throughout adulthood and illness stages in individuals with psychotic disorders and their unaffected siblings. Mol Psychiatry 2021; 26:4529-4543. [PMID: 33414498 DOI: 10.1038/s41380-020-00969-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/03/2020] [Accepted: 11/18/2020] [Indexed: 01/29/2023]
Abstract
Important questions remain about the profile of cognitive impairment in psychotic disorders across adulthood and illness stages. The age-associated profile of familial impairments also remains unclear, as well as the effect of factors, such as symptoms, functioning, and medication. Using cross-sectional data from the EU-GEI and GROUP studies, comprising 8455 participants aged 18 to 65, we examined cognitive functioning across adulthood in patients with psychotic disorders (n = 2883), and their unaffected siblings (n = 2271), compared to controls (n = 3301). An abbreviated WAIS-III measured verbal knowledge, working memory, visuospatial processing, processing speed, and IQ. Patients showed medium to large deficits across all functions (ES range = -0.45 to -0.73, p < 0.001), while siblings showed small deficits on IQ, verbal knowledge, and working memory (ES = -0.14 to -0.33, p < 0.001). Magnitude of impairment was not associated with participant age, such that the size of impairment in older and younger patients did not significantly differ. However, first-episode patients performed worse than prodromal patients (ES range = -0.88 to -0.60, p < 0.001). Adjusting for cannabis use, symptom severity, and global functioning attenuated impairments in siblings, while deficits in patients remained statistically significant, albeit reduced by half (ES range = -0.13 to -0.38, p < 0.01). Antipsychotic medication also accounted for around half of the impairment in patients (ES range = -0.21 to -0.43, p < 0.01). Deficits in verbal knowledge, and working memory may specifically index familial, i.e., shared genetic and/or shared environmental, liability for psychotic disorders. Nevertheless, potentially modifiable illness-related factors account for a significant portion of the cognitive impairment in psychotic disorders.
Collapse
Affiliation(s)
- Eva Velthorst
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,Seaver Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,Department of Psychiatry, Amsterdam UMC, Amsterdam, The Netherlands.
| | - Josephine Mollon
- Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England, UK
| | - Lieuwe de Haan
- Department of Psychiatry, Amsterdam UMC, Amsterdam, The Netherlands.,Arkin Institute for Mental Health, Amsterdam, The Netherlands
| | - Inez Myin Germeys
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - David C Glahn
- Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Spanish Mental Health Research Network (CIBERSAM), Madrid, Spain
| | - Els van der Ven
- Mailman School of Public Health, Columbia University, New York, NY, USA.,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Marta Di Forti
- Department of Social Genetics and Developmental Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England, UK.,South London and Maudsley NHS Mental Health Foundation Trust, London, UK
| | - Miguel Bernardo
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS, Spanish Mental Health Research Network (CIBERSAM), Barcelona, Spain
| | - Sinan Guloksuz
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Philippe Delespaul
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands.,Mondriaan Mental Health Care, Heerlen/Maastricht, The Netherlands
| | - Gisela Mezquida
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS, Spanish Mental Health Research Network (CIBERSAM), Barcelona, Spain
| | - Silvia Amoretti
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS, Spanish Mental Health Research Network (CIBERSAM), Barcelona, Spain
| | - Julio Bobes
- Faculty of Medicine and Health Sciences - Psychiatry, Universidad de Oviedo, Mental Health Services of Principado de Asturias (SESPA), Instituto de Investigacion Sanitaria del Principado de Asturias (ISPA), INEUROPA, CIBERSAM, Oviedo, Spain
| | - Pilar A Saiz
- Faculty of Medicine and Health Sciences - Psychiatry, Universidad de Oviedo, Mental Health Services of Principado de Asturias (SESPA), Instituto de Investigacion Sanitaria del Principado de Asturias (ISPA), INEUROPA, CIBERSAM, Oviedo, Spain
| | - María Paz García-Portilla
- Faculty of Medicine and Health Sciences - Psychiatry, Universidad de Oviedo, Mental Health Services of Principado de Asturias (SESPA), Instituto de Investigacion Sanitaria del Principado de Asturias (ISPA), INEUROPA, CIBERSAM, Oviedo, Spain
| | - José Luis Santos
- Faculty of Medicine and Health Sciences - Psychiatry, Universidad de Oviedo, Mental Health Services of Principado de Asturias (SESPA), Instituto de Investigacion Sanitaria del Principado de Asturias (ISPA), INEUROPA, CIBERSAM, Oviedo, Spain.,Neurobiological Research Group, Institute of Technology, Universidad de Castilla-La Mancha, Cuenca, Spain.,Department of Psychiatry, Hospital "Virgen de la Luz", Cuenca, Spain
| | - Estela Jiménez-López
- Faculty of Medicine and Health Sciences - Psychiatry, Universidad de Oviedo, Mental Health Services of Principado de Asturias (SESPA), Instituto de Investigacion Sanitaria del Principado de Asturias (ISPA), INEUROPA, CIBERSAM, Oviedo, Spain.,Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
| | - Julio Sanjuan
- Department of Psychiatry, Hospital Clínico Universitario de Valencia, INCLIVA, CIBERSAM, School of Medicine, Universidad de Valencia, Valencia, Spain
| | - Eduardo J Aguilar
- Department of Psychiatry, Hospital Clínico Universitario de Valencia, INCLIVA, CIBERSAM, School of Medicine, Universidad de Valencia, Valencia, Spain
| | - Manuel Arrojo
- Department of Psychiatry, Instituto de Investigación Sanitaria (IDIS), Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Angel Carracedo
- Grupo de Medicina Xenómica, Fundación Pública Galega de Medicina Xenómica, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Galician Health Service (SERGAS), Santiago de Compostela, Spain.,Centro de Investigación en Red de Enfermedades Raras (CIBERER) y Centro Nacional de Genotipado (CEGEN-PRB3), Center for Research in Molecular Medicine and Chronic Diseases (CIMUS), Universidad de Santiago de Compostela, Santiago de Compostela, Spain
| | - Gonzalo López
- Faculty of Medicine and Health Sciences - Psychiatry, Universidad de Oviedo, Mental Health Services of Principado de Asturias (SESPA), Instituto de Investigacion Sanitaria del Principado de Asturias (ISPA), INEUROPA, CIBERSAM, Oviedo, Spain
| | - Javier González-Peñas
- Faculty of Medicine and Health Sciences - Psychiatry, Universidad de Oviedo, Mental Health Services of Principado de Asturias (SESPA), Instituto de Investigacion Sanitaria del Principado de Asturias (ISPA), INEUROPA, CIBERSAM, Oviedo, Spain
| | - Mara Parellada
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Spanish Mental Health Research Network (CIBERSAM), Madrid, Spain
| | - Cem Atbaşoğlu
- Department of Psychiatry, School of Medicine, Ankara University, Ankara, Turkey
| | - Meram Can Saka
- Department of Psychiatry, School of Medicine, Ankara University, Ankara, Turkey
| | - Alp Üçok
- Department of Psychiatry, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Köksal Alptekin
- Department of Psychiatry, Dokuz Eylül University, School of Medicine, Izmir, Turkey.,Department of Neuroscience, Health Sciences Institute, Dokuz Eylul University, Izmir, Turkey
| | - Berna Akdede
- Department of Psychiatry, Dokuz Eylül University, School of Medicine, Izmir, Turkey
| | - Tolga Binbay
- Department of Psychiatry, Dokuz Eylül University, School of Medicine, Izmir, Turkey
| | - Vesile Altınyazar
- Department of Psychiatry, Adnan Menderes University, School of Medicine, Aydın, Turkey
| | - Halis Ulaş
- Department of Psychiatry, Dokuz Eylül University, School of Medicine, Izmir, Turkey
| | - Berna Yalınçetin
- Department of Neuroscience, Health Sciences Institute, Dokuz Eylul University, Izmir, Turkey
| | - Güvem Gümüş-Akay
- Department of Physiology, School of Medicine, Ankara University, Ankara, Turkey.,Brain Research Center, Ankara University, Ankara, Turkey
| | - Burçin Cihan Beyaz
- Department of Psychology, Middle East Technical University, Ankara, Turkey
| | - Haldun Soygür
- Turkish Federation of Schizophrenia Associations, Ankara, Turkey
| | | | | | - Nadja P Maric
- Faculty of Medicine, University of Belgrade & Institute of Mental Health, Belgrade, Serbia
| | - Marina M Mihaljevic
- Faculty of Medicine, University of Belgrade & Institute of Mental Health, Belgrade, Serbia
| | - Sanja Andric Petrovic
- Faculty of Medicine, University of Belgrade & Clinic for Psychiatry, Belgrade, Serbia
| | - Tijana Mirjanic
- Special Hospital for Psychiatric Disorders Kovin, Kovin, Serbia
| | | | - Laura Ferraro
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England, UK
| | - Charlotte Gayer-Anderson
- Department of Health Service and Population Research, Institute of Psychiatry, King's College London, London, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, England, UK
| | - Hannah E Jongsma
- Department of Psychiatry, University of Cambridge, Cambridge, England, UK.,PsyLife Group, Division of Psychiatry, UCL, London, England, UK
| | | | - Caterina La Cascia
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Antonio Lasalvia
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Sarah Tosato
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | | | - Paulo Rossi Menezes
- Department of Preventive Medicine, Faculdade de Medicina, Universidade of São Paulo, São Paulo, Brazil
| | - Craig Morgan
- Department of Health Service and Population Research, Institute of Psychiatry, King's College London, London, UK.,ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Diego Quattrone
- Department of Social Genetics and Developmental Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England, UK
| | - Marco Menchetti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Jean-Paul Selten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands.,Rivierduinen Institute for Mental Health Care, Leiden, The Netherlands
| | | | - Ilaria Tarricone
- Department of Medical and Surgical Sciences, Psychiatry Unit, Alma Mater Studiorum Università di Bologna, Bologna, Italy
| | | | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England, UK
| | - Lucia Valmaggia
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Matthew J Kempton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England, UK
| | - Mark van der Gaag
- Amsterdam Public Mental Health Research Institute, Department of Clinical Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Rodrigo A Bressan
- LiNC-Lab Interdisciplinar Neurociências Clínicas, Depto Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Neus Barrantes-Vidal
- Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain.,Fundació Sanitària Sant Pere Claver, Spanish Mental Health Research Network (CIBERSAM), Barcelona, Spain
| | - Barnaby Nelson
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Patrick McGorry
- Orygen, Parkville, VIC, Australia.,Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne & Melbourne Health, Carlton South, VIC, Australia
| | - Chris Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne & Melbourne Health, Carlton South, VIC, Australia
| | - Marie-Odile Krebs
- University of Paris, GHU-Paris, Sainte-Anne, C'JAAD, Inserm U1266, Institut de Psychiatrie (CNRS 3557), Paris, France
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Gabriele Sachs
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Bart P F Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jim van Os
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England, UK.,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Psychiatry, Brain Centre Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Behrooz Z Alizadeh
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, Groningen, The Netherlands
| | - Therese van Amelsvoort
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Agna A Bartels-Velthuis
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, Groningen, The Netherlands
| | - Richard Bruggeman
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, Groningen, The Netherlands.,Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Nico J van Beveren
- Antes Center for Mental Health Care, Rotterdam, The Netherlands.,Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands.,Department of Neuroscience, Erasmus MC, Rotterdam, The Netherlands
| | - Jurjen J Luykx
- Department of Psychiatry, Brain Centre Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Outpatient Second Opinion Clinic, GGNet Mental Health, Apeldoorn, The Netherlands
| | - Wiepke Cahn
- Department of Psychiatry, Brain Centre Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Altrecht Science, Altrecht Mental Health Care, Utrecht, The Netherlands
| | - Claudia J P Simons
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands.,GGzE Institute for Mental Health Care, Eindhoven, The Netherlands
| | - Rene S Kahn
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Department of Veterans Affairs Medical Center, New York, NY, USA
| | - Frederike Schirmbeck
- Department of Psychiatry, Amsterdam UMC, Amsterdam, The Netherlands.,Arkin Institute for Mental Health, Amsterdam, The Netherlands
| | - Ruud van Winkel
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Neurosciences, Psychiatry Research Group, Center for Clinical Psychiatry, KU Leuven, Leuven, Belgium
| | | | - Abraham Reichenberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Seaver Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
13
|
Erzin G, Pries LK, van Os J, Fusar-Poli L, Delespaul P, Kenis G, Luykx JJ, Lin BD, Richards AL, Akdede B, Binbay T, Altınyazar V, Yalınçetin B, Gümüş-Akay G, Cihan B, Soygür H, Ulaş H, Cankurtaran EŞ, Kaymak SU, Mihaljevic MM, Andric-Petrovic S, Mirjanic T, Bernardo M, Mezquida G, Amoretti S, Bobes J, Saiz PA, García-Portilla MP, Sanjuan J, Aguilar EJ, Santos JL, Jiménez-López E, Arrojo M, Carracedo A, López G, González-Peñas J, Parellada M, Maric NP, Atbaşoğlu C, Ucok A, Alptekin K, Saka MC, Arango C, O'Donovan MC, Rutten BPF, Guloksuz S. Examining the association between exposome score for schizophrenia and functioning in schizophrenia, siblings, and healthy controls: Results from the EUGEI study. Eur Psychiatry 2021; 64:e25. [PMID: 33736735 PMCID: PMC8080213 DOI: 10.1192/j.eurpsy.2021.19] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background A cumulative environmental exposure score for schizophrenia (exposome score for schizophrenia [ES-SCZ]) may provide potential utility for risk stratification and outcome prediction. Here, we investigated whether ES-SCZ was associated with functioning in patients with schizophrenia spectrum disorder, unaffected siblings, and healthy controls. Methods This cross-sectional sample consisted of 1,261 patients, 1,282 unaffected siblings, and 1,525 healthy controls. The Global Assessment of Functioning (GAF) scale was used to assess functioning. ES-SCZ was calculated based on our previously validated method. The association between ES-SCZ and the GAF dimensions (symptom and disability) was analyzed by applying regression models in each group (patients, siblings, and controls). Additional models included polygenic risk score for schizophrenia (PRS-SCZ) as a covariate. Results ES-SCZ was associated with the GAF dimensions in patients (symptom: B = −1.53, p-value = 0.001; disability: B = −1.44, p-value = 0.001), siblings (symptom: B = −3.07, p-value < 0.001; disability: B = −2.52, p-value < 0.001), and healthy controls (symptom: B = −1.50, p-value < 0.001; disability: B = −1.31, p-value < 0.001). The results remained the same after adjusting for PRS-SCZ. The degree of associations of ES-SCZ with both symptom and disability dimensions were higher in unaffected siblings than in patients and controls. By analyzing an independent dataset (the Genetic Risk and Outcome of Psychosis study), we replicated the results observed in the patient group. Conclusions Our findings suggest that ES-SCZ shows promise for enhancing risk prediction and stratification in research practice. From a clinical perspective, ES-SCZ may aid in efforts of clinical characterization, operationalizing transdiagnostic clinical staging models, and personalizing clinical management.
Collapse
Affiliation(s)
- Gamze Erzin
- Department of Psychiatry, University of Health Sciences Ankara Diskapi Training and Research Hospital, Ankara, Turkey.,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Lotta-Katrin Pries
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jim van Os
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Psychiatry, UUMC Utrecht Brain Centre, University Medical Centre Utrecht, trecht University, Utrecht, The Netherlands.,Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Laura Fusar-Poli
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania, Italy
| | - Philippe Delespaul
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands.,FACT, Mondriaan Mental Health, Maastricht, The Netherlands
| | - Gunter Kenis
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jurjen J Luykx
- Department of Psychiatry, UUMC Utrecht Brain Centre, University Medical Centre Utrecht, trecht University, Utrecht, The Netherlands.,Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,GGNet Mental Health, Apeldoorn, The Netherlands
| | - Bochao D Lin
- Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Alexander L Richards
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Berna Akdede
- Department of Psychiatry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Tolga Binbay
- Department of Psychiatry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Vesile Altınyazar
- Department of Psychiatry, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey
| | - Berna Yalınçetin
- Department of Neuroscience, Graduate School of Health Sciences, Dokuz Eylul University, Izmir, Turkey
| | - Güvem Gümüş-Akay
- Department of Physiology, School of Medicine, Ankara University, Ankara, Turkey.,Brain Research Center, Ankara University, Ankara, Turkey.,Neuroscience and Neurotechnology Center of Excellence (NÖROM), Ankara, Turkey
| | - Burçin Cihan
- Department of Psychology, Middle East Technical University, Ankara, Turkey
| | - Haldun Soygür
- Turkish Federation of Schizophrenia Associations, Ankara, Turkey
| | - Halis Ulaş
- Department of Psychiatry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | | | | | - Marina M Mihaljevic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Psychiatry Clinical Centre of Serbia, Belgrade, Serbia
| | - Sanja Andric-Petrovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Psychiatry Clinical Centre of Serbia, Belgrade, Serbia
| | - Tijana Mirjanic
- Special Hospital for Psychiatric Disorders Kovin, Kovin, Serbia
| | - Miguel Bernardo
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain.,Biomedical Research Networking Centre in Mental Health (CIBERSAM), Barcelona, Spain
| | - Gisela Mezquida
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain.,Biomedical Research Networking Centre in Mental Health (CIBERSAM), Barcelona, Spain
| | - Silvia Amoretti
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain.,Biomedical Research Networking Centre in Mental Health (CIBERSAM), Barcelona, Spain
| | - Julio Bobes
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Barcelona, Spain.,Department of Psychiatry, School of Medicine, University of Oviedo, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain.,Mental Health Services of Principado de Asturias, Oviedo, Spain
| | - Pilar A Saiz
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Barcelona, Spain.,Department of Psychiatry, School of Medicine, University of Oviedo, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain.,Mental Health Services of Principado de Asturias, Oviedo, Spain
| | - Maria Paz García-Portilla
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Barcelona, Spain.,Department of Psychiatry, School of Medicine, University of Oviedo, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain.,Mental Health Services of Principado de Asturias, Oviedo, Spain
| | - Julio Sanjuan
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Barcelona, Spain.,Department of Psychiatry, Hospital Clínico Universitario de Valencia, INCLIVA, School of Medicine, Universidad de Valencia, Valencia, Spain
| | - Eduardo J Aguilar
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Barcelona, Spain.,Department of Psychiatry, Hospital Clínico Universitario de Valencia, INCLIVA, School of Medicine, Universidad de Valencia, Valencia, Spain
| | - Jose Luis Santos
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Barcelona, Spain.,Department of Psychiatry, Hospital Virgen de la Luz, Cuenca, Spain
| | - Estela Jiménez-López
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Barcelona, Spain.,Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Manuel Arrojo
- Department of Psychiatry, Instituto de Investigación Sanitaria, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Angel Carracedo
- Grupo de Medicina Genómica, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Universidad de Santiago de Compostela, Santiago de Compostela, Spain.,Fundación Pública Galega de Medicina Xenómica (SERGAS), Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Gonzalo López
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Barcelona, Spain.,Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón (IiSGM), School of Medicine, Universidad Complutense, Madrid, Spain
| | - Javier González-Peñas
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Barcelona, Spain.,Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón (IiSGM), School of Medicine, Universidad Complutense, Madrid, Spain
| | - Mara Parellada
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Barcelona, Spain.,Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón (IiSGM), School of Medicine, Universidad Complutense, Madrid, Spain
| | - Nadja P Maric
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Institute of Mental Health, Belgrade, Serbia
| | - Cem Atbaşoğlu
- Department of Psychiatry, School of Medicine, Ankara University, Ankara, Turkey
| | - Alp Ucok
- Department of Psychiatry, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Köksal Alptekin
- Department of Psychiatry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.,Department of Neuroscience, Graduate School of Health Sciences, Dokuz Eylul University, Izmir, Turkey
| | - Meram Can Saka
- Department of Psychiatry, School of Medicine, Ankara University, Ankara, Turkey
| | | | - Celso Arango
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Barcelona, Spain.,Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón (IiSGM), School of Medicine, Universidad Complutense, Madrid, Spain
| | - Micheal C O'Donovan
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Bart P F Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Sinan Guloksuz
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
14
|
Saarentaus EC, Havulinna AS, Mars N, Ahola-Olli A, Kiiskinen TTJ, Partanen J, Ruotsalainen S, Kurki M, Urpa LM, Chen L, Perola M, Salomaa V, Veijola J, Männikkö M, Hall IM, Pietiläinen O, Kaprio J, Ripatti S, Daly M, Palotie A. Polygenic burden has broader impact on health, cognition, and socioeconomic outcomes than most rare and high-risk copy number variants. Mol Psychiatry 2021; 26:4884-4895. [PMID: 33526825 PMCID: PMC8589645 DOI: 10.1038/s41380-021-01026-z] [Citation(s) in RCA: 5] [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: 03/19/2020] [Revised: 12/18/2020] [Accepted: 01/11/2021] [Indexed: 12/29/2022]
Abstract
Copy number variants (CNVs) are associated with syndromic and severe neurological and psychiatric disorders (SNPDs), such as intellectual disability, epilepsy, schizophrenia, and bipolar disorder. Although considered high-impact, CNVs are also observed in the general population. This presents a diagnostic challenge in evaluating their clinical significance. To estimate the phenotypic differences between CNV carriers and non-carriers regarding general health and well-being, we compared the impact of SNPD-associated CNVs on health, cognition, and socioeconomic phenotypes to the impact of three genome-wide polygenic risk score (PRS) in two Finnish cohorts (FINRISK, n = 23,053 and NFBC1966, n = 4895). The focus was on CNV carriers and PRS extremes who do not have an SNPD diagnosis. We identified high-risk CNVs (DECIPHER CNVs, risk gene deletions, or large [>1 Mb] CNVs) in 744 study participants (2.66%), 36 (4.8%) of whom had a diagnosed SNPD. In the remaining 708 unaffected carriers, we observed lower educational attainment (EA; OR = 0.77 [95% CI 0.66-0.89]) and lower household income (OR = 0.77 [0.66-0.89]). Income-associated CNVs also lowered household income (OR = 0.50 [0.38-0.66]), and CNVs with medical consequences lowered subjective health (OR = 0.48 [0.32-0.72]). The impact of PRSs was broader. At the lowest extreme of PRS for EA, we observed lower EA (OR = 0.31 [0.26-0.37]), lower-income (OR = 0.66 [0.57-0.77]), lower subjective health (OR = 0.72 [0.61-0.83]), and increased mortality (Cox's HR = 1.55 [1.21-1.98]). PRS for intelligence had a similar impact, whereas PRS for schizophrenia did not affect these traits. We conclude that the majority of working-age individuals carrying high-risk CNVs without SNPD diagnosis have a modest impact on morbidity and mortality, as well as the limited impact on income and educational attainment, compared to individuals at the extreme end of common genetic variation. Our findings highlight that the contribution of traditional high-risk variants such as CNVs should be analyzed in a broader genetic context, rather than evaluated in isolation.
Collapse
Affiliation(s)
- Elmo Christian Saarentaus
- grid.7737.40000 0004 0410 2071Institute for Molecular Medicine Finland FIMM, University of Helsinki, Helsinki, Finland
| | - Aki Samuli Havulinna
- grid.7737.40000 0004 0410 2071Institute for Molecular Medicine Finland FIMM, University of Helsinki, Helsinki, Finland ,grid.14758.3f0000 0001 1013 0499Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Nina Mars
- grid.7737.40000 0004 0410 2071Institute for Molecular Medicine Finland FIMM, University of Helsinki, Helsinki, Finland
| | - Ari Ahola-Olli
- grid.7737.40000 0004 0410 2071Institute for Molecular Medicine Finland FIMM, University of Helsinki, Helsinki, Finland ,grid.66859.34Stanley Center for Psychiatric Research, The Broad Institute of Harvard and MIT, Cambridge, MA USA ,grid.32224.350000 0004 0386 9924Analytical and Translational Genetics Unit, Massachusetts General Hospital, Boston, USA
| | | | - Juulia Partanen
- grid.7737.40000 0004 0410 2071Institute for Molecular Medicine Finland FIMM, University of Helsinki, Helsinki, Finland
| | - Sanni Ruotsalainen
- grid.7737.40000 0004 0410 2071Institute for Molecular Medicine Finland FIMM, University of Helsinki, Helsinki, Finland
| | - Mitja Kurki
- grid.7737.40000 0004 0410 2071Institute for Molecular Medicine Finland FIMM, University of Helsinki, Helsinki, Finland ,grid.66859.34Stanley Center for Psychiatric Research, The Broad Institute of Harvard and MIT, Cambridge, MA USA ,grid.32224.350000 0004 0386 9924Analytical and Translational Genetics Unit, Massachusetts General Hospital, Boston, USA
| | - Lea Martta Urpa
- grid.7737.40000 0004 0410 2071Institute for Molecular Medicine Finland FIMM, University of Helsinki, Helsinki, Finland
| | - Lei Chen
- grid.47100.320000000419368710Department of Genetics, Yale School of Medicine, New Haven, CT USA ,grid.4367.60000 0001 2355 7002McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO USA
| | - Markus Perola
- grid.14758.3f0000 0001 1013 0499Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Veikko Salomaa
- grid.14758.3f0000 0001 1013 0499Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Juha Veijola
- grid.10858.340000 0001 0941 4873Research Unit of Clinical Neuroscience, University of Oulu & Oulu University Hospital, Oulu, Finland
| | - Minna Männikkö
- grid.10858.340000 0001 0941 4873Northern Finland Birth Cohorts, Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Ira M. Hall
- grid.47100.320000000419368710Department of Genetics, Yale School of Medicine, New Haven, CT USA ,grid.4367.60000 0001 2355 7002McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO USA
| | - Olli Pietiläinen
- grid.66859.34Stanley Center for Psychiatric Research, The Broad Institute of Harvard and MIT, Cambridge, MA USA ,grid.38142.3c000000041936754XStem Cell and Regenerative Biology, Harvard University, Cambridge, USA ,grid.7737.40000 0004 0410 2071Neuroscience Center, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Jaakko Kaprio
- grid.7737.40000 0004 0410 2071Institute for Molecular Medicine Finland FIMM, University of Helsinki, Helsinki, Finland ,grid.7737.40000 0004 0410 2071Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Samuli Ripatti
- grid.7737.40000 0004 0410 2071Institute for Molecular Medicine Finland FIMM, University of Helsinki, Helsinki, Finland ,grid.66859.34Stanley Center for Psychiatric Research, The Broad Institute of Harvard and MIT, Cambridge, MA USA ,grid.32224.350000 0004 0386 9924Analytical and Translational Genetics Unit, Massachusetts General Hospital, Boston, USA ,grid.7737.40000 0004 0410 2071Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Mark Daly
- grid.7737.40000 0004 0410 2071Institute for Molecular Medicine Finland FIMM, University of Helsinki, Helsinki, Finland ,grid.66859.34Stanley Center for Psychiatric Research, The Broad Institute of Harvard and MIT, Cambridge, MA USA ,grid.32224.350000 0004 0386 9924Analytical and Translational Genetics Unit, Massachusetts General Hospital, Boston, USA
| | - Aarno Palotie
- Institute for Molecular Medicine Finland FIMM, University of Helsinki, Helsinki, Finland. .,Stanley Center for Psychiatric Research, The Broad Institute of Harvard and MIT, Cambridge, MA, USA. .,Analytic and Translational Genetics Unit, Department of Medicine, Department of Neurology and Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
| |
Collapse
|
15
|
Examining the independent and joint effects of genomic and exposomic liabilities for schizophrenia across the psychosis spectrum. Epidemiol Psychiatr Sci 2020; 29:e182. [PMID: 33200977 PMCID: PMC7681168 DOI: 10.1017/s2045796020000943] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
AIMS Psychosis spectrum disorder has a complex pathoetiology characterised by interacting environmental and genetic vulnerabilities. The present study aims to investigate the role of gene-environment interaction using aggregate scores of genetic (polygenic risk score for schizophrenia (PRS-SCZ)) and environment liability for schizophrenia (exposome score for schizophrenia (ES-SCZ)) across the psychosis continuum. METHODS The sample consisted of 1699 patients, 1753 unaffected siblings, and 1542 healthy comparison participants. The Structured Interview for Schizotypy-Revised (SIS-R) was administered to analyse scores of total, positive, and negative schizotypy in siblings and healthy comparison participants. The PRS-SCZ was trained using the Psychiatric Genomics Consortiums results and the ES-SCZ was calculated guided by the approach validated in a previous report in the current data set. Regression models were applied to test the independent and joint effects of PRS-SCZ and ES-SCZ (adjusted for age, sex, and ancestry using 10 principal components). RESULTS Both genetic and environmental vulnerability were associated with case-control status. Furthermore, there was evidence for additive interaction between binary modes of PRS-SCZ and ES-SCZ (above 75% of the control distribution) increasing the odds for schizophrenia spectrum diagnosis (relative excess risk due to interaction = 6.79, [95% confidential interval (CI) 3.32, 10.26], p < 0.001). Sensitivity analyses using continuous PRS-SCZ and ES-SCZ confirmed gene-environment interaction (relative excess risk due to interaction = 1.80 [95% CI 1.01, 3.32], p = 0.004). In siblings and healthy comparison participants, PRS-SCZ and ES-SCZ were associated with all SIS-R dimensions and evidence was found for an interaction between PRS-SCZ and ES-SCZ on the total (B = 0.006 [95% CI 0.003, 0.009], p < 0.001), positive (B = 0.006 [95% CI, 0.002, 0.009], p = 0.002), and negative (B = 0.006, [95% CI 0.004, 0.009], p < 0.001) schizotypy dimensions. CONCLUSIONS The interplay between exposome load and schizophrenia genetic liability contributing to psychosis across the spectrum of expression provide further empirical support to the notion of aetiological continuity underlying an extended psychosis phenotype.
Collapse
|
16
|
Dickson H, Hedges EP, Ma SY, Cullen AE, MacCabe JH, Kempton MJ, Downs J, Laurens KR. Academic achievement and schizophrenia: a systematic meta-analysis. Psychol Med 2020; 50:1949-1965. [PMID: 32684198 DOI: 10.1017/s0033291720002354] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Cognitive impairments in childhood are associated with increased risk of schizophrenia in later life, but the extent to which poor academic achievement is associated with the disorder is unclear. METHODS Major databases were searched for articles published in English up to 31 December 2019. We conducted random-effects meta-analyses to: (1) compare general academic and mathematics achievement in youth who later developed schizophrenia and those who did not; (2) to examine the association between education level achieved and adult-onset schizophrenia; and, (3) compare general academic achievement in youth at-risk for schizophrenia and typically developing peers. Meta-regression models examined the effects of type of academic assessment, educational system, age at assessment, measurement of educational level attained, school leaving age, and study quality on academic achievement and education level among individuals with schizophrenia. RESULTS Meta-analyses, comprising data of over four million individuals, found that: (1) by age 16 years, those who later developed schizophrenia had poorer general academic (Cohen's d = -0.29, p ⩽ 0.0001) and mathematics achievement (d = -0.23, p = 0.01) than those who did not; (2) individuals with schizophrenia were less likely to enter higher education (odds ratio = 0.49, p ⩽ 0.0001); and, (3) youth reporting psychotic-like experiences and youth with a family history of schizophrenia had lower general academic achievement (d = -0.54, p ⩽ 0.0001; d = -0.39, p ⩽ 0.0001, respectively). Meta-regression analyses determined no effect modifiers. DISCUSSION Despite significant heterogeneity across studies, various routinely collected indices of academic achievement can identify premorbid cognitive dysfunction among individuals who are vulnerable for schizophrenia, potentially aiding the early identification of risk in the population.
Collapse
Affiliation(s)
- Hannah Dickson
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Emily P Hedges
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Shin Y Ma
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alexis E Cullen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - James H MacCabe
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Matthew J Kempton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Johnny Downs
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kristin R Laurens
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Queensland University of Technology (QUT), School of Psychology and Counselling, and Institute of Health and Biomedical Innovation, Brisbane, QLD, Australia
- School of Psychiatry, University of New South Wales, NSW, Australia
| |
Collapse
|
17
|
Dalsgaard S, McGrath J, Østergaard SD, Wray NR, Pedersen CB, Mortensen PB, Petersen L. Association of Mental Disorder in Childhood and Adolescence With Subsequent Educational Achievement. JAMA Psychiatry 2020; 77:797-805. [PMID: 32211833 PMCID: PMC7097843 DOI: 10.1001/jamapsychiatry.2020.0217] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IMPORTANCE Onset of mental disorders during childhood or adolescence has been associated with underperformance in school and impairment in social and occupational life in adulthood, which has important implications for the affected individuals and society. OBJECTIVE To compare the educational achievements at the final examination of compulsory schooling in Denmark between individuals with and those without a mental disorder. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study was conducted in Denmark and obtained data from the Danish Civil Registration System and other nationwide registers. The 2 cohorts studied were (1) all children who were born in Denmark between January 1, 1988, and July 1, 1999, and were alive at age 17 years (n = 629 622) and (2) all children who took the final examination at the end of ninth grade in both Danish and mathematics subjects between January 1, 2002, and December 31, 2016 (n = 542 500). Data analysis was conducted from March 1, 2018, to March 1, 2019. EXPOSURES Clinical diagnosis by a psychiatrist of any mental disorder or 1 of 29 specific mental disorders before age 16 years. MAIN OUTCOMES AND MEASURES Taking the final examination at the end of ninth grade and mean examination grades standardized as z scores with differences measured in SDs (standardized mean grade difference). RESULTS Of the total study population (n = 629 622; 306 209 female and 323 413 male), 523 312 individuals (83%) took the final examination before 17 years of age and 38 001 (6%) had a mental disorder before that age. Among the 542 500 individuals (274 332 female and 268 168 male), the mean (SD) age was 16.1 (0.33) years for the females and 16.2 (0.34) years for the males. Among the 15 843 female and 22 158 male students with a mental disorder, a lower proportion took the final examination (0.52; 95% CI, 0.52-0.53) compared with individuals without a mental disorder (0.88; 95% CI, 0.88-0.88). Mental disorders affected the grades of male individuals (standardized mean grade difference, -0.30; 95% CI, -0.32 to -0.28) more than the grades of their female peers (standardized mean grade difference, -0.24; 95% CI, -0.25 to -0.22) when compared with same-sex individuals without mental disorders. Most specific mental disorders were associated with statistically significantly lower mean grades, with intellectual disability associated with the lowest grade in female and male students (standardized mean grade difference, -1.07 [95% CI, -1.23 to -0.91] and -1.03 [95% CI, -1.17 to -0.89]; P = .76 for sex differences in the mean grades). Female and male students with anorexia nervosa achieved statistically significantly higher grades on the final examination (standardized mean grade difference, 0.38 [95% CI, 0.32-0.44] and 0.31 [95% CI, 0.11-0.52]; P = .54 for sex differences in the mean grades) compared with their peers without this disorder. For those with anxiety, attachment, attention-deficit/hyperactivity, and other developmental disorders, female individuals attained relatively lower standardized mean grades compared with their male counterparts. CONCLUSIONS AND RELEVANCE Results of this study suggest that, in Denmark, almost all mental disorders in childhood or adolescence may be associated with a lower likelihood of taking the final examination at the end of ninth grade; those with specific disorders tended to achieve lower mean grades on the examination; and female, compared with male, individuals with certain mental disorders appeared to have relatively more impairment. These findings appear to emphasize the need to provide educational support to young people with mental disorders.
Collapse
Affiliation(s)
- Søren Dalsgaard
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
| | - John McGrath
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark,Queensland Brain Institute, The University of Queensland, St Lucia, Brisbane, Queensland, Australia,Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Richlands, Queensland, Australia
| | - Søren Dinesen Østergaard
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark,Department of Affective Disorders, Aarhus University Hospital–Psychiatry, Aarhus, Denmark,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Naomi R. Wray
- Queensland Brain Institute, The University of Queensland, St Lucia, Brisbane, Queensland, Australia
| | - Carsten Bøcker Pedersen
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark,Centre for Integrated Register-Based Research at Aarhus University, Aarhus, Denmark
| | - Preben Bo Mortensen
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark,Centre for Integrated Register-Based Research at Aarhus University, Aarhus, Denmark
| | - Liselotte Petersen
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
| |
Collapse
|
18
|
Luo Y, Pang L, Zhao Y, Guo C, Zhang L, Zheng X. Gender difference in the association between education and schizophrenia in Chinese adults. BMC Psychiatry 2020; 20:296. [PMID: 32532241 PMCID: PMC7291519 DOI: 10.1186/s12888-020-02700-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 05/28/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Improving education level was evidenced to decrease the risk of schizophrenia, but whether this strength of education role depends on gender is not. This study aimed to investigate whether there was gender difference in the association between education and schizophrenia in Chinese adults. METHODS Data were obtained from the Second China National Sample Survey on Disability in 2006, including 1,909,205 participants aged 18 years or older. Schizophrenia was ascertained according to the International Statistical Classification of Diseases, Tenth Revision. Logistics regression models were fitted to examine the combined effect of gender and education on schizophrenia. RESULTS The lifetime prevalence of schizophrenia in female groups was higher than in male groups, with 0.44% (95%CI: 0.42-0.45%) and 0.36% (95%CI: 0.35-0.37%), respectively. Compared with schizophrenia male patients, more females with schizophrenia experienced severe or extreme difficulty in understanding and communicating. However, more males with schizophrenia suffered from severe or extreme difficulty in the function of daily activities. The combined effect of education and schizophrenia was statistically significant, indicating that, as the level of education increased, schizophrenia risk of females decreased faster than the risk of males. CONCLUSIONS This study showed that additional years of education associated with lower risk of schizophrenia, and this association was stronger in females than in males. As education elevated, the risk of schizophrenia decreased more for women than for men. The findings indicate that improving education level may have an effect on reducing the gender disparities in mental health of China. Actions to prevent schizophrenia and address its gender disparities will require attention to the improving educational opportunities.
Collapse
Affiliation(s)
- Yanan Luo
- Institute of Population Research, Peking University, No.5 Yiheyuan Road Haidian District, Beijing, 100871, China
- APEC Health Science Academy, Peking University, No.5 Yiheyuan Road Haidian District, Beijing, 100871, China
- Advanced Systems Analysis, International Institute for Applied Systems Analysis, Schlossplatz 1, A-2361, Laxenburg, Austria
| | - Lihua Pang
- Institute of Population Research, Peking University, No.5 Yiheyuan Road Haidian District, Beijing, 100871, China
- APEC Health Science Academy, Peking University, No.5 Yiheyuan Road Haidian District, Beijing, 100871, China
| | - Yihao Zhao
- Institute of Population Research, Peking University, No.5 Yiheyuan Road Haidian District, Beijing, 100871, China
| | - Chao Guo
- Institute of Population Research, Peking University, No.5 Yiheyuan Road Haidian District, Beijing, 100871, China
- APEC Health Science Academy, Peking University, No.5 Yiheyuan Road Haidian District, Beijing, 100871, China
| | - Lei Zhang
- Institute of Population Research, Peking University, No.5 Yiheyuan Road Haidian District, Beijing, 100871, China
- APEC Health Science Academy, Peking University, No.5 Yiheyuan Road Haidian District, Beijing, 100871, China
| | - Xiaoying Zheng
- Institute of Population Research, Peking University, No.5 Yiheyuan Road Haidian District, Beijing, 100871, China.
- APEC Health Science Academy, Peking University, No.5 Yiheyuan Road Haidian District, Beijing, 100871, China.
| |
Collapse
|
19
|
Dwyer DB, Kalman JL, Budde M, Kambeitz J, Ruef A, Antonucci LA, Kambeitz-Ilankovic L, Hasan A, Kondofersky I, Anderson-Schmidt H, Gade K, Reich-Erkelenz D, Adorjan K, Senner F, Schaupp S, Andlauer TFM, Comes AL, Schulte EC, Klöhn-Saghatolislam F, Gryaznova A, Hake M, Bartholdi K, Flatau-Nagel L, Reitt M, Quast S, Stegmaier S, Meyers M, Emons B, Haußleiter IS, Juckel G, Nieratschker V, Dannlowski U, Yoshida T, Schmauß M, Zimmermann J, Reimer J, Wiltfang J, Reininghaus E, Anghelescu IG, Arolt V, Baune BT, Konrad C, Thiel A, Fallgatter AJ, Figge C, von Hagen M, Koller M, Lang FU, Wigand ME, Becker T, Jäger M, Dietrich DE, Scherk H, Spitzer C, Folkerts H, Witt SH, Degenhardt F, Forstner AJ, Rietschel M, Nöthen MM, Mueller N, Papiol S, Heilbronner U, Falkai P, Schulze TG, Koutsouleris N. An Investigation of Psychosis Subgroups With Prognostic Validation and Exploration of Genetic Underpinnings: The PsyCourse Study. JAMA Psychiatry 2020; 77:523-533. [PMID: 32049274 PMCID: PMC7042925 DOI: 10.1001/jamapsychiatry.2019.4910] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
IMPORTANCE Identifying psychosis subgroups could improve clinical and research precision. Research has focused on symptom subgroups, but there is a need to consider a broader clinical spectrum, disentangle illness trajectories, and investigate genetic associations. OBJECTIVE To detect psychosis subgroups using data-driven methods and examine their illness courses over 1.5 years and polygenic scores for schizophrenia, bipolar disorder, major depression disorder, and educational achievement. DESIGN, SETTING, AND PARTICIPANTS This ongoing multisite, naturalistic, longitudinal (6-month intervals) cohort study began in January 2012 across 18 sites. Data from a referred sample of 1223 individuals (765 in the discovery sample and 458 in the validation sample) with DSM-IV diagnoses of schizophrenia, bipolar affective disorder (I/II), schizoaffective disorder, schizophreniform disorder, and brief psychotic disorder were collected from secondary and tertiary care sites. Discovery data were extracted in September 2016 and analyzed from November 2016 to January 2018, and prospective validation data were extracted in October 2018 and analyzed from January to May 2019. MAIN OUTCOMES AND MEASURES A clinical battery of 188 variables measuring demographic characteristics, clinical history, symptoms, functioning, and cognition was decomposed using nonnegative matrix factorization clustering. Subtype-specific illness courses were compared with mixed models and polygenic scores with analysis of covariance. Supervised learning was used to replicate results in validation data with the most reliably discriminative 45 variables. RESULTS Of the 765 individuals in the discovery sample, 341 (44.6%) were women, and the mean (SD) age was 42.7 (12.9) years. Five subgroups were found and labeled as affective psychosis (n = 252), suicidal psychosis (n = 44), depressive psychosis (n = 131), high-functioning psychosis (n = 252), and severe psychosis (n = 86). Illness courses with significant quadratic interaction terms were found for psychosis symptoms (R2 = 0.41; 95% CI, 0.38-0.44), depression symptoms (R2 = 0.28; 95% CI, 0.25-0.32), global functioning (R2 = 0.16; 95% CI, 0.14-0.20), and quality of life (R2 = 0.20; 95% CI, 0.17-0.23). The depressive and severe psychosis subgroups exhibited the lowest functioning and quadratic illness courses with partial recovery followed by reoccurrence of severe illness. Differences were found for educational attainment polygenic scores (mean [SD] partial η2 = 0.014 [0.003]) but not for diagnostic polygenic risk. Results were largely replicated in the validation cohort. CONCLUSIONS AND RELEVANCE Psychosis subgroups were detected with distinctive clinical signatures and illness courses and specificity for a nondiagnostic genetic marker. New data-driven clinical approaches are important for future psychosis taxonomies. The findings suggest a need to consider short-term to medium-term service provision to restore functioning in patients stratified into the depressive and severe psychosis subgroups.
Collapse
Affiliation(s)
- Dominic B. Dwyer
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Janos L. Kalman
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany,Institute of Psychiatric Phenomics and Genomics, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany,International Max Planck Research School (IMPRS-TP), Munich, Germany
| | - Monika Budde
- Institute of Psychiatric Phenomics and Genomics, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Joseph Kambeitz
- Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Anne Ruef
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Linda A. Antonucci
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany,Department of Education, Psychology and Communication, University of Bari Aldo Moro, Bari, Italy
| | | | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Ivan Kondofersky
- Institute of Computational Biology, Helmholtz Zentrum Munich, Oberschleißheim, Germany,Department of Mathematics, Technical University of Munich Garching, Garching, Germany
| | - Heike Anderson-Schmidt
- Institute of Psychiatric Phenomics and Genomics, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany,Department of Psychiatry and Psychotherapy, University Medical Center Gottingen, Gottingen, Germany
| | - Katrin Gade
- Institute of Psychiatric Phenomics and Genomics, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany,Department of Psychiatry and Psychotherapy, University Medical Center Gottingen, Gottingen, Germany
| | - Daniela Reich-Erkelenz
- Institute of Psychiatric Phenomics and Genomics, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Kristina Adorjan
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany,Institute of Psychiatric Phenomics and Genomics, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Fanny Senner
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany,Institute of Psychiatric Phenomics and Genomics, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Sabrina Schaupp
- Institute of Psychiatric Phenomics and Genomics, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany,Department of Psychiatry and Psychotherapy, Bezirkskrankenhaus Augsburg, Augsburg, Germany
| | - Till F. M. Andlauer
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Ashley L. Comes
- Institute of Psychiatric Phenomics and Genomics, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany,International Max Planck Research School (IMPRS-TP), Munich, Germany
| | - Eva C. Schulte
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany,Institute of Psychiatric Phenomics and Genomics, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Farah Klöhn-Saghatolislam
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany,Institute of Psychiatric Phenomics and Genomics, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Anna Gryaznova
- Institute of Psychiatric Phenomics and Genomics, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Maria Hake
- Institute of Psychiatric Phenomics and Genomics, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Kim Bartholdi
- Institute of Psychiatric Phenomics and Genomics, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Laura Flatau-Nagel
- Institute of Psychiatric Phenomics and Genomics, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Markus Reitt
- Department of Psychiatry and Psychotherapy, University Medical Center Gottingen, Gottingen, Germany
| | - Silke Quast
- Department of Psychiatry and Psychotherapy, University Medical Center Gottingen, Gottingen, Germany
| | - Sophia Stegmaier
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Milena Meyers
- Department of Psychiatry, Ruhr University Bochum, LWL University Hospital, Bochum, Germany
| | - Barbara Emons
- Department of Psychiatry, Ruhr University Bochum, LWL University Hospital, Bochum, Germany
| | - Ida Sybille Haußleiter
- Department of Psychiatry, Ruhr University Bochum, LWL University Hospital, Bochum, Germany
| | - Georg Juckel
- Department of Psychiatry, Ruhr University Bochum, LWL University Hospital, Bochum, Germany
| | - Vanessa Nieratschker
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Udo Dannlowski
- Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany
| | - Tomoya Yoshida
- Department of Physiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Max Schmauß
- Department of Psychiatry and Psychotherapy, Bezirkskrankenhaus Augsburg, Augsburg, Germany
| | - Jörg Zimmermann
- Psychiatrieverbund Oldenburger Land gGmbH, Karl-Jaspers-Klinik, Bad Zwischenahn, Germany
| | - Jens Reimer
- Department of Psychiatry, Klinikum Bremen-Ost, Bremen, Germany,Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy, University Medical Center Gottingen, Gottingen, Germany,German Center for Neurodegenerative Diseases (DZNE), Gottingen, Germany,Institute of BioMedicine (iBiMED), Medical Sciences Department, University of Aveiro, Aveiro, Portugal
| | - Eva Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Research Unit for Bipolar Affective Disorder, Medical University of Graz, Graz, Austria
| | | | - Volker Arolt
- Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany
| | - Bernhard T. Baune
- Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany,Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia,The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Carsten Konrad
- Department of Psychiatry and Psychotherapy, Agaplesion Diakonieklinikum, Rotenburg, Germany
| | - Andreas Thiel
- Department of Psychiatry and Psychotherapy, Agaplesion Diakonieklinikum, Rotenburg, Germany
| | - Andreas J. Fallgatter
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Christian Figge
- Karl-Jaspers Clinic, European Medical School Oldenburg-Groningen, Oldenburg, Germany
| | - Martin von Hagen
- Clinic for Psychiatry and Psychotherapy, Clinical Center Werra-Meißner, Eschwege, Germany
| | | | - Fabian U. Lang
- Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Günzburg, Germany
| | - Moritz E. Wigand
- Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Günzburg, Germany
| | - Thomas Becker
- Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Günzburg, Germany
| | - Markus Jäger
- Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Günzburg, Germany
| | - Detlef E. Dietrich
- AMEOS Clinical Center Hildesheim, Hildesheim, Germany,Center for Systems Neuroscience, Hannover, Germany,Burghof-Klinik Rinteln, Rinteln, Germany
| | | | - Carsten Spitzer
- Department of Psychosomatics and Psychotherapeutic Medicine, University Medical Center Rostock, Rostock, Germany
| | - Here Folkerts
- Department of Psychiatry, Psychotherapy and Psychosomatics, Clinical Center Wilhelmshaven, Wilhelmshaven, Germany
| | - Stephanie H. Witt
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Franziska Degenhardt
- Institute of Human Genetics, University Hospital Bonn, Bonn, Germany,Department of Genomics, Life and Brain Center, University of Bonn, Bonn, Germany
| | - Andreas J. Forstner
- Institute of Human Genetics, University Hospital Bonn, Bonn, Germany,Department of Genomics, Life and Brain Center, University of Bonn, Bonn, Germany,Human Genomics Research Group, Department of Biomedicine, University of Basel, Basel, Switzerland,Centre for Human Genetics, University of Marburg, Marburg, Germany
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Markus M. Nöthen
- Institute of Human Genetics, University Hospital Bonn, Bonn, Germany,Department of Genomics, Life and Brain Center, University of Bonn, Bonn, Germany
| | - Nikola Mueller
- Institute of Computational Biology, Helmholtz Zentrum Munich, Oberschleißheim, Germany
| | - Sergi Papiol
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany,Institute of Psychiatric Phenomics and Genomics, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Urs Heilbronner
- Institute of Psychiatric Phenomics and Genomics, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Thomas G. Schulze
- Institute of Psychiatric Phenomics and Genomics, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany,International Max-Planck Research School for Translational Psychiatry, Max-Planck Institute of Psychiatry, Munich, Germany
| |
Collapse
|
20
|
Mallet J, Le Strat Y, Dubertret C, Gorwood P. Polygenic Risk Scores Shed Light on the Relationship between Schizophrenia and Cognitive Functioning: Review and Meta-Analysis. J Clin Med 2020; 9:E341. [PMID: 31991840 PMCID: PMC7074036 DOI: 10.3390/jcm9020341] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 01/14/2020] [Accepted: 01/23/2020] [Indexed: 12/26/2022] Open
Abstract
Schizophrenia is a multifactorial disease associated with widespread cognitive impairment. Although cognitive deficits are one of the factors most strongly associated with functional impairment in schizophrenia (SZ), current treatment strategies hardly tackle these impairments. To develop more efficient treatment strategies in patients, a better understanding of their pathogenesis is needed. Recent progress in genetics, driven by large genome-wide association studies (GWAS) and the use of polygenic risk scores (PRS), has provided new insights about the genetic architecture of complex human traits, including cognition and SZ. Here, we review the recent findings examining the genetic links between SZ and cognitive functions in population-based samples as well as in participants with SZ. The performed meta-analysis showed a negative correlation between the polygenetic risk score of schizophrenia and global cognition (p < 0.001) when the samples rely on general and healthy participants, while no significant correlation was detected when the three studies devoted to schizophrenia patients were meta-analysed (p > 0.05). Our review and meta-analysis therefore argues against universal pleiotropy for schizophrenia alleles and cognition, since cognition in SZ patients would be underpinned by the same genetic factors than in the general population, and substantially independent of common variant liability to the disorder.
Collapse
Affiliation(s)
- Jasmina Mallet
- APHP; Department of Psychiatry, Universitary Hospital Louis Mourier, 92700 Colombes, France; (Y.L.S.); (C.D.)
- Université de Paris, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, F-75014 Paris, France
| | - Yann Le Strat
- APHP; Department of Psychiatry, Universitary Hospital Louis Mourier, 92700 Colombes, France; (Y.L.S.); (C.D.)
- Université de Paris, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, F-75014 Paris, France
| | - Caroline Dubertret
- APHP; Department of Psychiatry, Universitary Hospital Louis Mourier, 92700 Colombes, France; (Y.L.S.); (C.D.)
- Université de Paris, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, F-75014 Paris, France
| | - Philip Gorwood
- Université de Paris, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, F-75014 Paris, France
- GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, F-75014 Paris, France
| |
Collapse
|
21
|
Hjorthøj C, Uddin MJ, Hougaard DM, Sørensen HJ, Nordentoft M. Polygenic risk for psychiatric disorder and singleness in patients with severe mental illness and controls. J Psychiatr Res 2019; 119:60-66. [PMID: 31563858 DOI: 10.1016/j.jpsychires.2019.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 09/17/2019] [Accepted: 09/23/2019] [Indexed: 11/25/2022]
Abstract
We aimed to investigate whether the polygenic risk score (PRS) for schizophrenia influences time in couple relationships for patients with severe mental illness and controls. We combined the nationwide Danish registers with genetic information from dried neonatal blood spots. We included 2,599 individuals with schizophrenia, 1,446 with bipolar disorder, 20,315 with depression, and 6,963 controls. PRS for schizophrenia, depression, and bipolar disorder were estimated using data from the Psychiatric Genetics Consortium and analyzed both as a scale-predictor and as highest versus other deciles. The main outcome was number of days in couple relationships. Patients with schizophrenia had markedly fewer days/year in couple relationships: 64 (95% CI; 61-69) than patients with depression: 119 (95% CI; 117-121), bipolar disorder: 103 (95% CI 97-110), and controls: 136 (95% CI 133-139). PRS for schizophrenia was associated with fewer days in couple relationships in patients with schizophrenia (scale-PRS: IRR = 0.95 (0.93-0.97)) or depression (highest decile: IRR = 0.93 (0.87-0.98)). PRS for bipolar disorder (as scale) was also associated with fewer days in couple relationships in patients with depression (IRR = 0.99 (0.99-1.00)) or bipolar disorder (IRR = 0.96 (0.94-0.99)) and controls (IRR = 0.99 (0.97-1.00), and IRR = 0.89 (0.81-0.98) for the highest decile). Due to the number of statistical tests, however, it cannot be concluded definitely that some of these may not be spurious findings. In conclusion, our findings implicate high genetic loading for schizophrenia as a predisposing factor to singleness in patients with schizophrenia or depression, and genetic loading for bipolar disorder a similar predisposing factor in patients with depression, bipolar disorder or controls.
Collapse
Affiliation(s)
- Carsten Hjorthøj
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Copenhagen and Aarhus, Denmark; University of Copenhagen, Section of Epidemiology, Department of Public Health, Copenhagen, Denmark.
| | - Md Jamal Uddin
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Copenhagen and Aarhus, Denmark; University of Copenhagen, Section of Biostatistics, Copenhagen, Denmark
| | - David Michael Hougaard
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Copenhagen and Aarhus, Denmark; Center for Neonatal Screening, Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | - Holger J Sørensen
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Copenhagen and Aarhus, Denmark
| | - Merete Nordentoft
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Copenhagen and Aarhus, Denmark
| |
Collapse
|
22
|
Horsdal HT, Agerbo E, McGrath JJ, Vilhjálmsson BJ, Antonsen S, Closter AM, Timmermann A, Grove J, Mok PLH, Webb RT, Sabel CE, Hertel O, Sigsgaard T, Erikstrup C, Hougaard DM, Werge T, Nordentoft M, Børglum AD, Mors O, Mortensen PB, Brandt J, Geels C, Pedersen CB. Association of Childhood Exposure to Nitrogen Dioxide and Polygenic Risk Score for Schizophrenia With the Risk of Developing Schizophrenia. JAMA Netw Open 2019; 2:e1914401. [PMID: 31675084 PMCID: PMC6827271 DOI: 10.1001/jamanetworkopen.2019.14401] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
IMPORTANCE Schizophrenia is a highly heritable psychiatric disorder, and recent studies have suggested that exposure to nitrogen dioxide (NO2) during childhood is associated with an elevated risk of subsequently developing schizophrenia. However, it is not known whether the increased risk associated with NO2 exposure is owing to a greater genetic liability among those exposed to highest NO2 levels. OBJECTIVE To examine the associations between childhood NO2 exposure and genetic liability for schizophrenia (as measured by a polygenic risk score), and risk of developing schizophrenia. DESIGN, SETTING, AND PARTICIPANTS Population-based cohort study including individuals with schizophrenia (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code F20) and a randomly selected subcohort. Using national registry data, all individuals born in Denmark between May 1, 1981, and December 31, 2002, were followed up from their 10th birthday until the first occurrence of schizophrenia, emigration, death, or December 31, 2012, whichever came first. Statistical analyses were conducted between October 24, 2018, and June 17, 2019. EXPOSURES Individual exposure to NO2 during childhood estimated as mean daily exposure to NO2 at residential addresses from birth to the 10th birthday. Polygenic risk scores were calculated as the weighted sum of risk alleles at selected single-nucleotide polymorphisms based on genetic material obtained from dried blood spot samples from the Danish Newborn Screening Biobank and on the Psychiatric Genomics Consortium genome-wide association study summary statistics file. MAIN OUTCOMES AND MEASURES The main outcome was schizophrenia. Weighted Cox proportional hazards regression models were fitted to estimate adjusted hazard ratios (AHRs) for schizophrenia with 95% CIs according to the exposures. RESULTS Of a total of 23 355 individuals, 11 976 (51.3%) were male and all had Danish-born parents. During the period of the study, 3531 were diagnosed with schizophrenia. Higher polygenic risk scores were correlated with higher childhood NO2 exposure (ρ = 0.0782; 95% CI, 0.065-0.091; P < .001). A 10-μg/m3 increase in childhood daily NO2 exposure (AHR, 1.23; 95% CI, 1.15-1.32) and a 1-SD increase in polygenic risk score (AHR, 1.29; 95% CI, 1.23-1.35) were independently associated with increased schizophrenia risk. CONCLUSIONS AND RELEVANCE These findings suggest that the apparent association between NO2 exposure and schizophrenia is only slightly confounded by a higher polygenic risk score for schizophrenia among individuals living in areas with greater NO2. The findings demonstrate the utility of including polygenic risk scores in epidemiologic studies.
Collapse
Affiliation(s)
- Henriette Thisted Horsdal
- Department of Economics and Business Economics, National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Big Data Centre for Environment and Health (BERTHA), Aarhus University, Roskilde, Denmark
| | - Esben Agerbo
- Department of Economics and Business Economics, National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Centre for Integrated Register-based Research, CIRRAU, Aarhus University, Aarhus, Denmark
| | - John Joseph McGrath
- Department of Economics and Business Economics, National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- Queensland Brain Institute, The University of Queensland, St Lucia, Queensland, Australia
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Queensland, Australia
| | - Bjarni Jóhann Vilhjálmsson
- Department of Economics and Business Economics, National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
| | - Sussie Antonsen
- Department of Economics and Business Economics, National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- Centre for Integrated Register-based Research, CIRRAU, Aarhus University, Aarhus, Denmark
| | - Ane Marie Closter
- Department of Economics and Business Economics, National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- Big Data Centre for Environment and Health (BERTHA), Aarhus University, Roskilde, Denmark
- Centre for Integrated Register-based Research, CIRRAU, Aarhus University, Aarhus, Denmark
| | - Allan Timmermann
- Department of Economics and Business Economics, National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- Big Data Centre for Environment and Health (BERTHA), Aarhus University, Roskilde, Denmark
- Centre for Integrated Register-based Research, CIRRAU, Aarhus University, Aarhus, Denmark
| | - Jakob Grove
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Department of Biomedicine and Center for Integrative Sequencing, iSEQ, Aarhus University, Aarhus, Denmark
- Center for Genomics and Personalized Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Pearl L. H. Mok
- Centre for Mental Health and Safety, Division of Psychology and Mental Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom
| | - Roger T. Webb
- Centre for Mental Health and Safety, Division of Psychology and Mental Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom
| | - Clive Eric Sabel
- Big Data Centre for Environment and Health (BERTHA), Aarhus University, Roskilde, Denmark
- Department of Environmental Science, Aarhus University, Aarhus, Denmark
| | - Ole Hertel
- Big Data Centre for Environment and Health (BERTHA), Aarhus University, Roskilde, Denmark
- Department of Environmental Science, Aarhus University, Aarhus, Denmark
| | - Torben Sigsgaard
- Big Data Centre for Environment and Health (BERTHA), Aarhus University, Roskilde, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Christian Erikstrup
- Big Data Centre for Environment and Health (BERTHA), Aarhus University, Roskilde, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - David Michael Hougaard
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | - Thomas Werge
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Institute of Biological Psychiatry, Copenhagen Mental Health Services, Copenhagen, Denmark
| | - Merete Nordentoft
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Mental Health Centre Copenhagen, Capital Region of Denmark, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anders Dupont Børglum
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Department of Biomedicine and Center for Integrative Sequencing, iSEQ, Aarhus University, Aarhus, Denmark
- Center for Genomics and Personalized Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Ole Mors
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Psychosis Research Unit, Aarhus University Hospital Psychiatry, Aarhus, Denmark
| | - Preben Bo Mortensen
- Department of Economics and Business Economics, National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Centre for Integrated Register-based Research, CIRRAU, Aarhus University, Aarhus, Denmark
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Aarhus, Denmark
| | - Camilla Geels
- Department of Environmental Science, Aarhus University, Aarhus, Denmark
| | - Carsten Bøcker Pedersen
- Department of Economics and Business Economics, National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Big Data Centre for Environment and Health (BERTHA), Aarhus University, Roskilde, Denmark
- Centre for Integrated Register-based Research, CIRRAU, Aarhus University, Aarhus, Denmark
| |
Collapse
|
23
|
Horsdal HT, Agerbo E, McGrath JJ, Vilhjálmsson BJ, Antonsen S, Closter AM, Timmermann A, Grove J, Mok PLH, Webb RT, Sabel CE, Hertel O, Sigsgaard T, Erikstrup C, Hougaard DM, Werge T, Nordentoft M, Børglum AD, Mors O, Mortensen PB, Brandt J, Geels C, Pedersen CB. Association of Childhood Exposure to Nitrogen Dioxide and Polygenic Risk Score for Schizophrenia With the Risk of Developing Schizophrenia. JAMA Netw Open 2019; 2:e1914401. [PMID: 31675084 DOI: 10.1001/jamanetworkopen.201914401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2023] Open
Abstract
IMPORTANCE Schizophrenia is a highly heritable psychiatric disorder, and recent studies have suggested that exposure to nitrogen dioxide (NO2) during childhood is associated with an elevated risk of subsequently developing schizophrenia. However, it is not known whether the increased risk associated with NO2 exposure is owing to a greater genetic liability among those exposed to highest NO2 levels. OBJECTIVE To examine the associations between childhood NO2 exposure and genetic liability for schizophrenia (as measured by a polygenic risk score), and risk of developing schizophrenia. DESIGN, SETTING, AND PARTICIPANTS Population-based cohort study including individuals with schizophrenia (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code F20) and a randomly selected subcohort. Using national registry data, all individuals born in Denmark between May 1, 1981, and December 31, 2002, were followed up from their 10th birthday until the first occurrence of schizophrenia, emigration, death, or December 31, 2012, whichever came first. Statistical analyses were conducted between October 24, 2018, and June 17, 2019. EXPOSURES Individual exposure to NO2 during childhood estimated as mean daily exposure to NO2 at residential addresses from birth to the 10th birthday. Polygenic risk scores were calculated as the weighted sum of risk alleles at selected single-nucleotide polymorphisms based on genetic material obtained from dried blood spot samples from the Danish Newborn Screening Biobank and on the Psychiatric Genomics Consortium genome-wide association study summary statistics file. MAIN OUTCOMES AND MEASURES The main outcome was schizophrenia. Weighted Cox proportional hazards regression models were fitted to estimate adjusted hazard ratios (AHRs) for schizophrenia with 95% CIs according to the exposures. RESULTS Of a total of 23 355 individuals, 11 976 (51.3%) were male and all had Danish-born parents. During the period of the study, 3531 were diagnosed with schizophrenia. Higher polygenic risk scores were correlated with higher childhood NO2 exposure (ρ = 0.0782; 95% CI, 0.065-0.091; P < .001). A 10-μg/m3 increase in childhood daily NO2 exposure (AHR, 1.23; 95% CI, 1.15-1.32) and a 1-SD increase in polygenic risk score (AHR, 1.29; 95% CI, 1.23-1.35) were independently associated with increased schizophrenia risk. CONCLUSIONS AND RELEVANCE These findings suggest that the apparent association between NO2 exposure and schizophrenia is only slightly confounded by a higher polygenic risk score for schizophrenia among individuals living in areas with greater NO2. The findings demonstrate the utility of including polygenic risk scores in epidemiologic studies.
Collapse
Affiliation(s)
- Henriette Thisted Horsdal
- Department of Economics and Business Economics, National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Big Data Centre for Environment and Health (BERTHA), Aarhus University, Roskilde, Denmark
| | - Esben Agerbo
- Department of Economics and Business Economics, National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Centre for Integrated Register-based Research, CIRRAU, Aarhus University, Aarhus, Denmark
| | - John Joseph McGrath
- Department of Economics and Business Economics, National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- Queensland Brain Institute, The University of Queensland, St Lucia, Queensland, Australia
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Queensland, Australia
| | - Bjarni Jóhann Vilhjálmsson
- Department of Economics and Business Economics, National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
| | - Sussie Antonsen
- Department of Economics and Business Economics, National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- Centre for Integrated Register-based Research, CIRRAU, Aarhus University, Aarhus, Denmark
| | - Ane Marie Closter
- Department of Economics and Business Economics, National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- Big Data Centre for Environment and Health (BERTHA), Aarhus University, Roskilde, Denmark
- Centre for Integrated Register-based Research, CIRRAU, Aarhus University, Aarhus, Denmark
| | - Allan Timmermann
- Department of Economics and Business Economics, National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- Big Data Centre for Environment and Health (BERTHA), Aarhus University, Roskilde, Denmark
- Centre for Integrated Register-based Research, CIRRAU, Aarhus University, Aarhus, Denmark
| | - Jakob Grove
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Department of Biomedicine and Center for Integrative Sequencing, iSEQ, Aarhus University, Aarhus, Denmark
- Center for Genomics and Personalized Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Pearl L H Mok
- Centre for Mental Health and Safety, Division of Psychology and Mental Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom
| | - Roger T Webb
- Centre for Mental Health and Safety, Division of Psychology and Mental Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom
| | - Clive Eric Sabel
- Big Data Centre for Environment and Health (BERTHA), Aarhus University, Roskilde, Denmark
- Department of Environmental Science, Aarhus University, Aarhus, Denmark
| | - Ole Hertel
- Big Data Centre for Environment and Health (BERTHA), Aarhus University, Roskilde, Denmark
- Department of Environmental Science, Aarhus University, Aarhus, Denmark
| | - Torben Sigsgaard
- Big Data Centre for Environment and Health (BERTHA), Aarhus University, Roskilde, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Christian Erikstrup
- Big Data Centre for Environment and Health (BERTHA), Aarhus University, Roskilde, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - David Michael Hougaard
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | - Thomas Werge
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Institute of Biological Psychiatry, Copenhagen Mental Health Services, Copenhagen, Denmark
| | - Merete Nordentoft
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Mental Health Centre Copenhagen, Capital Region of Denmark, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anders Dupont Børglum
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Department of Biomedicine and Center for Integrative Sequencing, iSEQ, Aarhus University, Aarhus, Denmark
- Center for Genomics and Personalized Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Ole Mors
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Psychosis Research Unit, Aarhus University Hospital Psychiatry, Aarhus, Denmark
| | - Preben Bo Mortensen
- Department of Economics and Business Economics, National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Centre for Integrated Register-based Research, CIRRAU, Aarhus University, Aarhus, Denmark
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Aarhus, Denmark
| | - Camilla Geels
- Department of Environmental Science, Aarhus University, Aarhus, Denmark
| | - Carsten Bøcker Pedersen
- Department of Economics and Business Economics, National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Big Data Centre for Environment and Health (BERTHA), Aarhus University, Roskilde, Denmark
- Centre for Integrated Register-based Research, CIRRAU, Aarhus University, Aarhus, Denmark
| |
Collapse
|
24
|
Comes AL, Senner F, Budde M, Adorjan K, Anderson-Schmidt H, Andlauer TFM, Gade K, Hake M, Heilbronner U, Kalman JL, Reich-Erkelenz D, Klöhn-Saghatolislam F, Schaupp SK, Schulte EC, Juckel G, Dannlowski U, Schmauß M, Zimmermann J, Reimer J, Reininghaus E, Anghelescu IG, Arolt V, Baune BT, Konrad C, Thiel A, Fallgatter AJ, Nieratschker V, Figge C, von Hagen M, Koller M, Becker T, Wigand ME, Jäger M, Dietrich DE, Stierl S, Scherk H, Spitzer C, Folkerts H, Witt SH, Degenhardt F, Forstner AJ, Rietschel M, Nöthen MM, Wiltfang J, Falkai P, Schulze TG, Papiol S. The genetic relationship between educational attainment and cognitive performance in major psychiatric disorders. Transl Psychiatry 2019; 9:210. [PMID: 31462630 PMCID: PMC6713703 DOI: 10.1038/s41398-019-0547-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 06/03/2019] [Accepted: 07/17/2019] [Indexed: 11/13/2022] Open
Abstract
Cognitive deficits are a core feature of psychiatric disorders like schizophrenia and bipolar disorder. Evidence supports a genome-wide polygenic score (GPS) for educational attainment (GPSEDU) can be used to explain variability in cognitive performance. We aimed to identify different cognitive domains associated with GPSEDU in a transdiagnostic clinical cohort of chronic psychiatric patients with known cognitive deficits. Bipolar and schizophrenia patients from the PsyCourse cohort (N = 730; 43% female) were used. Likewise, we tested whether GPSs for schizophrenia (GPSSZ) and bipolar disorder (GPSBD) were associated with cognitive outcomes. GPSEDU explained 1.5% of variance in the backward verbal digit span, 1.9% in the number of correctly recalled words of the Verbal Learning and Memory Test, and 1.1% in crystallized intelligence. These effects were robust to the influences of treatment and diagnosis. No significant associations between GPSSZ or GPSBD with cognitive outcomes were found. Furthermore, these risk scores did not confound the effect of GPSEDU on cognitive outcomes. GPSEDU explains a small fraction of cognitive performance in adults with psychiatric disorders, specifically for domains related to linguistic learning and working memory. Investigating such a proxy-phenotype longitudinally, could give intriguing insight into the disease course, highlighting at what time genes play a more influential role on cognitive performance. Better understanding the origin of these deficits might help identify those patients at risk for lower levels of functioning and poor social outcomes. Polygenic estimates may in the future be part of predictive models for more personalized interventions.
Collapse
Affiliation(s)
- Ashley L Comes
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Munich, 80336, Germany.
- International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, 80804, Germany.
| | - Fanny Senner
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Munich, 80336, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, 80336, Germany
| | - Monika Budde
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Munich, 80336, Germany
| | - Kristina Adorjan
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Munich, 80336, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, 80336, Germany
| | - Heike Anderson-Schmidt
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Munich, 80336, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, 37075, Germany
| | - Till F M Andlauer
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, 81675, Germany
| | - Katrin Gade
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, 37075, Germany
| | - Maria Hake
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Munich, 80336, Germany
| | - Urs Heilbronner
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Munich, 80336, Germany
| | - Janos L Kalman
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Munich, 80336, Germany
- International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, 80804, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, 80336, Germany
| | - Daniela Reich-Erkelenz
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Munich, 80336, Germany
| | - Farah Klöhn-Saghatolislam
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Munich, 80336, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, 80336, Germany
| | - Sabrina K Schaupp
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Munich, 80336, Germany
| | - Eva C Schulte
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Munich, 80336, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, 80336, Germany
| | - Georg Juckel
- Department of Psychiatry, Ruhr University Bochum, LWL University Hospital, Bochum, 44791, Germany
| | - Udo Dannlowski
- Department of Psychiatry, University of Münster, Münster, 48149, Germany
| | - Max Schmauß
- Department of Psychiatry and Psychotherapy, Bezirkskrankenhaus Augsburg, Augsburg, 86156, Germany
| | - Jörg Zimmermann
- Psychiatrieverbund Oldenburger Land gGmbH, Karl-Jaspers-Klinik, Bad Zwischenahn, 26160, Germany
| | - Jens Reimer
- Department of Psychiatry and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, Hamburg, 20246, Germany
| | - Eva Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Research Unit for Bipolar Affective Disorder, Medical University of Graz, Graz, 8036, Austria
| | | | - Volker Arolt
- Department of Psychiatry, University of Münster, Münster, 48149, Germany
| | - Bernhard T Baune
- Department of Psychiatry, University of Münster, Münster, 48149, Germany
- Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Carsten Konrad
- Department of Psychiatry and Psychotherapy, Agaplesion Diakonieklinikum, Rotenburg, 27356, Germany
| | - Andreas Thiel
- Department of Psychiatry and Psychotherapy, Agaplesion Diakonieklinikum, Rotenburg, 27356, Germany
| | - Andreas J Fallgatter
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, 72076, Germany
| | - Vanessa Nieratschker
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, 72076, Germany
| | - Christian Figge
- Karl-Jaspers Clinic, European Medical School Oldenburg-Groningen, Oldenburg, 26160, Germany
| | - Martin von Hagen
- Clinic for Psychiatry and Psychotherapy, Clinical Center Werra-Meißner, Eschwege, 37269, Germany
| | - Manfred Koller
- Asklepios Specialized Hospital, Göttingen, 37081, Germany
| | - Thomas Becker
- Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Günzburg, 89312, Germany
| | - Moritz E Wigand
- Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Günzburg, 89312, Germany
| | - Markus Jäger
- Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Günzburg, 89312, Germany
| | - Detlef E Dietrich
- AMEOS Clinical Center Hildesheim, Hildesheim, 31135, Germany
- Center für Systems Neuroscience (ZSN) Hannover, Hannover, 30559, Germany
- Dept. of Psychiatry, Medical School of Hannover, Hannover, 30625, Germany
| | | | - Harald Scherk
- AMEOS Clinical Center Osnabrück, Osnabrück, 49088, Germany
| | - Carsten Spitzer
- ASKLEPIOS Specialized Hospital Tiefenbrunn, Rosdorf, 37124, Germany
- Department of Psychosomatic Medicine, University Medicine Rostock, Rostock, 18051, Germany
| | - Here Folkerts
- Department of Psychiatry, Psychotherapy and Psychosomatics, Clinical Center Wilhelmshaven, Wilhelmshaven, 26389, Germany
| | - Stephanie H Witt
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, 68159, Germany
| | - Franziska Degenhardt
- Institute of Human Genetics, University of Bonn School of Medicine & University Hospital Bonn, Bonn, 53127, Germany
| | - Andreas J Forstner
- Institute of Human Genetics, University of Bonn School of Medicine & University Hospital Bonn, Bonn, 53127, Germany
- Center for Human Genetics, University of Marburg, Marburg, 35033, Germany
- Department of Biomedicine, University of Basel, Basel, 4031, Switzerland
- Department of Psychiatry (UPK), University of Basel, Basel, 4002, Switzerland
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, 68159, Germany
| | - Markus M Nöthen
- Institute of Human Genetics, University of Bonn School of Medicine & University Hospital Bonn, Bonn, 53127, Germany
| | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, 37075, Germany
- German Center for Neurodegenerative Diseases (DZNE), Göttingen, 37075, Germany
- iBiMED, Medical Sciences Department, University of Aveiro, Aveiro, 3810-193, Portugal
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, 80336, Germany
| | - Thomas G Schulze
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Munich, 80336, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, 80336, Germany
| | - Sergi Papiol
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Munich, 80336, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, 80336, Germany
| |
Collapse
|
25
|
Guloksuz S, Pries LK, Delespaul P, Kenis G, Luykx JJ, Lin BD, Richards AL, Akdede B, Binbay T, Altınyazar V, Yalınçetin B, Gümüş-Akay G, Cihan B, Soygür H, Ulaş H, Cankurtaran E, Kaymak SU, Mihaljevic MM, Petrovic SA, Mirjanic T, Bernardo M, Cabrera B, Bobes J, Saiz PA, García-Portilla MP, Sanjuan J, Aguilar EJ, Santos JL, Jiménez-López E, Arrojo M, Carracedo A, López G, González-Peñas J, Parellada M, Maric NP, Atbaşog Lu C, Ucok A, Alptekin K, Saka MC, Arango C, O'Donovan M, Rutten BPF, van Os J. Examining the independent and joint effects of molecular genetic liability and environmental exposures in schizophrenia: results from the EUGEI study. World Psychiatry 2019; 18:173-182. [PMID: 31059627 PMCID: PMC6502485 DOI: 10.1002/wps.20629] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Schizophrenia is a heritable complex phenotype associated with a background risk involving multiple common genetic variants of small effect and a multitude of environmental exposures. Early twin and family studies using proxy-genetic liability measures suggest gene-environment interaction in the etiology of schizophrenia spectrum disorders, but the molecular evidence is scarce. Here, by analyzing the main and joint associations of polygenic risk score for schizophrenia (PRS-SCZ) and environmental exposures in 1,699 patients with a diagnosis of schizophrenia spectrum disorders and 1,542 unrelated controls with no lifetime history of a diagnosis of those disorders, we provide further evidence for gene-environment interaction in schizophrenia. Evidence was found for additive interaction of molecular genetic risk state for schizophrenia (binary mode of PRS-SCZ above 75% of the control distribution) with the presence of lifetime regular cannabis use and exposure to early-life adversities (sexual abuse, emotional abuse, emotional neglect, and bullying), but not with the presence of hearing impairment, season of birth (winter birth), and exposure to physical abuse or physical neglect in childhood. The sensitivity analyses replacing the a priori PRS-SCZ at 75% with alternative cut-points (50% and 25%) confirmed the additive interaction. Our results suggest that the etiopathogenesis of schizophrenia involves genetic underpinnings that act by making individuals more sensitive to the effects of some environmental exposures.
Collapse
Affiliation(s)
- Sinan Guloksuz
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Lotta-Katrin Pries
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Philippe Delespaul
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Gunter Kenis
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jurjen J Luykx
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- GGNet Mental Health, Apeldoorn, The Netherlands
| | - Bochao D Lin
- Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Alexander L Richards
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Berna Akdede
- Department of Psychiatry, Dokuz Eylül University School of Medicine, Izmir, Turkey
| | - Tolga Binbay
- Department of Psychiatry, Dokuz Eylül University School of Medicine, Izmir, Turkey
| | - Vesile Altınyazar
- Department of Psychiatry, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey
| | - Berna Yalınçetin
- Department of Neuroscience, Health Sciences Institute, Dokuz Eylül University, Izmir, Turkey
| | | | - Burçin Cihan
- Department of Psychology, Middle East Technical University, Ankara, Turkey
| | - Haldun Soygür
- Turkish Federation of Schizophrenia Associations, Ankara, Turkey
| | - Halis Ulaş
- Department of Psychiatry, School of Medicine, Dokuz Eylül University (discharged by decree 701 on July 8, 2018 because of signing "Peace Petition")
| | | | | | - Marina M Mihaljevic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Psychiatry CCS, Belgrade, Serbia
| | | | - Tijana Mirjanic
- Special Hospital for Psychiatric Disorders Kovin, Kovin, Serbia
| | - Miguel Bernardo
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
| | - Bibiana Cabrera
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
| | - Julio Bobes
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
- Department of Psychiatry, School of Medicine, University of Oviedo, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
- Mental Health Services of Principado de Asturias, Oviedo, Spain
| | - Pilar A Saiz
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
- Department of Psychiatry, School of Medicine, University of Oviedo, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
- Mental Health Services of Principado de Asturias, Oviedo, Spain
| | - María Paz García-Portilla
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
- Department of Psychiatry, School of Medicine, University of Oviedo, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
- Mental Health Services of Principado de Asturias, Oviedo, Spain
| | - Julio Sanjuan
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
- Department of Psychiatry, Hospital Clínico Universitario de Valencia, School of Medicine, Universidad de Valencia, Valencia, Spain
| | - Eduardo J Aguilar
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
- Department of Psychiatry, Hospital Clínico Universitario de Valencia, School of Medicine, Universidad de Valencia, Valencia, Spain
| | - José Luis Santos
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
- Department of Psychiatry, Hospital Virgen de la Luz, Cuenca, Spain
| | - Estela Jiménez-López
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Manuel Arrojo
- Department of Psychiatry, Instituto de Investigación Sanitaria, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Angel Carracedo
- Fundación Publica Galega de Medicina Xenómica, Universidad de Santiago de Compostela, Santiago de Compostela, Spain
| | - Gonzalo López
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - Javier González-Peñas
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - Mara Parellada
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - Nadja P Maric
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Psychiatry CCS, Belgrade, Serbia
| | - Cem Atbaşog Lu
- Department of Psychiatry, School of Medicine, Ankara University, Ankara, Turkey
| | - Alp Ucok
- Department of Psychiatry, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Köksal Alptekin
- Department of Psychiatry, Dokuz Eylül University School of Medicine, Izmir, Turkey
| | - Meram Can Saka
- Department of Psychiatry, School of Medicine, Ankara University, Ankara, Turkey
| | - Celso Arango
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - Michael O'Donovan
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Bart P F Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jim van Os
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, London, UK
| |
Collapse
|
26
|
Chen J, Wu JS, Mize T, Shui D, Chen X. Prediction of Schizophrenia Diagnosis by Integration of Genetically Correlated Conditions and Traits. J Neuroimmune Pharmacol 2018; 13:532-540. [PMID: 30276764 DOI: 10.1007/s11481-018-9811-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 09/12/2018] [Indexed: 01/03/2023]
Abstract
Schizophrenia is genetically heterogeneous and comorbid with many conditions. In this study, we explored polygenic scores (PGSs) from genetically related conditions and traits to predict schizophrenia diagnosis using both logistic regression and deep neural network (DNN) models. We used the combined Molecular Genetics of Schizophrenia and Swedish Schizophrenia Case Control Study (MGS + SSCCS) data for training and testing the models, and used the Clinical Antipsychotic Trials for Intervention Effectiveness (CATIE) data as independent validation. We screened 28 conditions and traits comorbid with schizophrenia to identify traits as potential predictors and used LASSO regression to select predictors for model construction. We investigated how PGS calculation influenced model performance. We found that the inclusion of comorbid traits improved model performance and PGSs calculated from two traits were more generalizable in independent validation. With a DNN model using 19 PGS predictors, we accomplished a prediction accuracy of 0.813 and an AUC of 0.905 in the MGS + SSCCS data. When this model was validated with the CATIE data, it achieved an accuracy of 0.721 and AUC of 0.747. Our results indicate that PGSs alone may not be sufficient to predict schizophrenia accurately and the inclusion of behavioral and clinical data may be necessary for more accurate prediction model.
Collapse
Affiliation(s)
- Jingchun Chen
- Nevada institute of personalized medicine, University of Nevada Las Vegas, Las Vegas, NV, 89154-4009, USA
| | - Jian-Shing Wu
- Nevada institute of personalized medicine, University of Nevada Las Vegas, Las Vegas, NV, 89154-4009, USA
| | - Travis Mize
- Department of Psychology, University of Nevada Las Vegas, 4505 S. Maryland Parkway, Las Vegas, NV, 89154-4009, USA
| | - Dandan Shui
- Nevada institute of personalized medicine, University of Nevada Las Vegas, Las Vegas, NV, 89154-4009, USA
| | - Xiangning Chen
- Nevada institute of personalized medicine, University of Nevada Las Vegas, Las Vegas, NV, 89154-4009, USA. .,Department of Psychology, University of Nevada Las Vegas, 4505 S. Maryland Parkway, Las Vegas, NV, 89154-4009, USA.
| |
Collapse
|