1
|
Kaiya H. Anxious-depressive attack and rejection sensitivity-Toward a new approach to treatment-resistant depression. Neuropsychopharmacol Rep 2024; 44:17-28. [PMID: 38059339 PMCID: PMC10932773 DOI: 10.1002/npr2.12399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 10/03/2023] [Accepted: 10/31/2023] [Indexed: 12/08/2023] Open
Abstract
This paper aimed to find clues to treatment-resistant depression (TRD) solutions. Depression comorbid with anxiety is often treatment-resistant where anxious-depressive attack (ADA) often lurks. ADA is a recently proposed clinical idea for just a psychological version of a panic attack. It mostly begins with an abrupt surge of intense anxiety followed by uninterrupted intrusive thoughts; lasting ruminations about regret or worry produced by violent anxiety, agitation, and loneliness. Acting-out behaviors such as deliberate self-injury and over-dose may also be observed during the attack. As the basic psychopathology of ADA, rejection sensitivity (RS) was revealed by a structural equation model. It is said that the presence of RS in depressive disorders implies a poor prognosis. The following biological markers for RS were reviewed in the literature: first, the involvement of the μ-opioid receptor function in RS and, secondly, hypersensitivity of the dopamine D4 receptor (DRD4) in the medial prefrontal cortex. The latter has been suggested in fear-conditioned animal experiments. Manipulation of the μ-opioid receptor function together with the DRD4 function may culminate in a treatment for RS, which could contribute to the development of a treatment for TRD via the improvement of ADA.
Collapse
Affiliation(s)
- Hisanobu Kaiya
- Panic Disorder Research CenterWarakukai Medical CorporationTokyoJapan
| |
Collapse
|
2
|
Alshogran OY, Al-Eitan LN, Altawalbeh SM, Aman HA. Association of DRD4 exon III and 5-HTTLPR VNTR genetic polymorphisms with psychiatric symptoms in hemodialysis patients. PLoS One 2021; 16:e0249284. [PMID: 33784353 PMCID: PMC8009383 DOI: 10.1371/journal.pone.0249284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/15/2021] [Indexed: 01/01/2023] Open
Abstract
Mental illness is prevalent among hemodialysis (HD) patients. Given that the dopaminergic and serotonergic pathways are involved in the etiology of psychiatric disease, this study evaluated the genetic association of dopamine D4 receptor (DRD4) and serotonin transporter (SLC6A4) genes with psychiatric symptom susceptibility among HD patients. Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety and depressive symptoms among patients (n = 265). Genetic polymorphisms of DRD4 (48 bp VNTR) and SLC6A4 (5-HTTLPR VNTR and rs25531) were examined using a conventional polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique, as appropriate. Significant differences were observed in the distribution of 5-HTTLPR genotypes, SLC6A4 tri-allelic-phased genotype, and DRD4-Exon III VNTR genotypes/alleles between patients with anxiety symptoms versus those with normal/borderline conditions (p<0.05). Binary logistic regression analyses showed that the heterozygous 4,5 VNTR genotype of DRD4 was associated with a higher risk of anxiety symptoms after adjusting for other covariates (odds ratio = 4.25, p = 0.028). None of the studied polymorphisms was linked to depression in HD patients. Collectively, the current findings provide genetic clues to psychopathology in HD patients and suggest that the DRD4 exon III VNTR polymorphism is involved in the etiology of anxiety in this patient population.
Collapse
Affiliation(s)
- Osama Y. Alshogran
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Laith N. Al-Eitan
- Department of Applied Biological Sciences, Jordan University of Science and Technology, Irbid, Jordan
- Department of Biotechnology and Genetic Engineering, Jordan University of Science and Technology, Irbid, Jordan
| | - Shoroq M. Altawalbeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Hatem A. Aman
- Department of Applied Biological Sciences, Jordan University of Science and Technology, Irbid, Jordan
| |
Collapse
|
3
|
Trait anxiety, a personality risk factor associated with Alzheimer's Disease. Prog Neuropsychopharmacol Biol Psychiatry 2021; 105:110124. [PMID: 33035604 DOI: 10.1016/j.pnpbp.2020.110124] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 09/24/2020] [Accepted: 10/02/2020] [Indexed: 12/25/2022]
Abstract
Alzheimer's disease (AD) is the most common neurodegenerative disease in elderly population and the leading cause of dementia worldwide. While senile plaques and neurofibrillary tangles have been proposed as the principal histopathologic hallmarks of AD, the exact etiology of this disease is still far from being clearly understood. AD has been recognized as pathological consequences of complex interactions among genetic, aging, medical, life style and psychosocial factors. Recently, the roles of neuroticism personality traits in AD incidence and progression have come into focus. More specifically, increasing evidence has further shown that the trait anxiety, one major component of neuroticism predicting the individual vulnerability in response to stress, is a risk factor for AD and may correlated with various AD pathologies. In this review, we summarized recent literature on the association of trait anxiety with AD. We also discussed the possible neuroendocrinological and neurochemical mechanisms of this association, which may provide clinical implications for AD diagnosis and therapy.
Collapse
|
4
|
Badcock PB, Moore E, Williamson E, Berk M, Williams LJ, Bjerkeset O, Nordahl HM, Patton GC, Olsson CA. Modeling gene‐environment interaction in longitudinal data: Risk for neuroticism due to interaction between maternal care and the Dopamine 4 Receptor gene (DRD4). AUSTRALIAN JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1111/j.1742-9536.2011.00003.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Paul B. Badcock
- Department of Paediatrics, The University of Melbourne, Melbourne
| | - Elya Moore
- Microbiology and Infectious Diseases Department, Royal Women's Hospital, Melbourne
| | - Elizabeth Williamson
- Centre for Molecular, Environmental, Genetic & Analytic Epidemiology, Melbourne School of Population Health Parkville, and the Department of Epidemiology and Preventive Medicine, Monash University, Melbourne
| | - Michael Berk
- Department of Clinical and Biomedical Sciences: Barwon Health, The University of Melbourne, Geelong, Victoria, Australia
| | - Lana J. Williams
- Centre for Molecular, Environmental, Genetic & Analytic Epidemiology, Melbourne School of Population Health Parkville, and the Department of Epidemiology and Preventive Medicine, Monash University, Melbourne
| | - Ottar Bjerkeset
- Department of Neuromedicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim
- Department of Research and Development, Levanger Hospital, Nord‐Trøndelag Health Trust
| | - Hans M. Nordahl
- Department of Psychology, Norwegian University of Science and Technology, Trondheim
- Department of Psychiatry, Levanger Hospital, Nord‐Trøndelag Health Trust, Norway
| | - George C. Patton
- Department of Paediatrics, The University of Melbourne, Melbourne
- Centre for Adolescent Health, Murdoch Childrens Research Institute, Royal Childrens Hospital, Melbourne
| | - Craig A. Olsson
- Department of Paediatrics, The University of Melbourne, Melbourne
- Centre for Adolescent Health, Murdoch Childrens Research Institute, Royal Childrens Hospital, Melbourne
- Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
5
|
Masiak J, Chmielowiec J, Chmielowiec K, Grzywacz A. DRD4, DRD2, DAT1, and ANKK1 Genes Polymorphisms in Patients with Dual Diagnosis of Polysubstance Addictions. J Clin Med 2020; 9:jcm9113593. [PMID: 33171585 PMCID: PMC7695193 DOI: 10.3390/jcm9113593] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/21/2020] [Accepted: 11/05/2020] [Indexed: 12/14/2022] Open
Abstract
Background: Approximately 25–50% of people diagnosed with substance use disorder experience psychiatric disorders, and this percentage is even higher if subclinical psychopathological symptomatology is taken into consideration. ”Dual diagnosis” implies the comorbidity of two disorders (mental disorder and addiction), but in a clinical setting, numerous dual diagnoses involve multiple addictions (polysubstance use means the concurrent use of more than one psychoactive substance). Clinical observations and epidemiological studies showed that the use of stimulants in combination with other substances results in additional risks. Apart from the clinical significance of the specificity of stimulants used in combination with other substances, only non-exhaustive research on the specificity of this comorbidity has been performed to date. The aim of the study was to analyze polymorphisms of the genes (DRD4 VNTR in exon III Ex3, DRD2 rs1076560, rs1800498, rs1079597, rs6276, as well as in the PROM promoter region (rs1799732, ANKK1 Tag1A rs1800497, DAT) in a group of patients diagnosed with polysubstance use disorder, including addiction to stimulants, and the co-occurrence of specific mental disorders in a group of patients diagnosed with polysubstance use disorder, including addiction to stimulants, compared to the group of patients diagnosed with polysubstance use disorder. Methods: The study group consisted of 601 male volunteers with psychoactive substance dependence (n = 300) and non-dependent controls (n = 301). The genomic DNA was extracted from venous blood using standard procedures. Genotyping was conducted with the real-time PCR method. All computations were performed using STATISTICA 13. Results: Psychotic disorders were significantly more common in the group of males with polysubstance addiction, including addiction to stimulants, compared to the group of males with polysubstance addiction without addiction to stimulants. In our own research, different statistical significances were found in the frequency of the DRD4 Ex3 gene polymorphism: s/s was more common in the study group. Psychotic disorders were more common in people addicted to stimulants compared to people addicted to other substances. Conclusions: In our study, psychotic disorders occurred more frequently in the study group of patients with polysubstance addiction, including addiction to stimulants, compared to the control group of patients with polysubstance addiction, but with no addiction to stimulants. Different statistical significances were found in the frequency of the DRD4 Ex3 gene polymorphism: s/s was more common in the study group, while the l/l genotype was less frequent in the study group. In DRD2 PROM rs 1799732, the del allele occurred more often than the ins allele in the study group. In the DRD4 Ex3 gene polymorphism, the s allele was more common in the study group, and the l allele was less frequent. In the DRD4 Ex3 gene polymorphism for the s/s genotype, psychotic disorders and generalized anxiety were more common, while for the s/l and l/l genotype, they were less frequent. The DRD4 Ex3 polymorphism s alleles were more common for depressive episode, dysthymia, and psychotic disorders as well as generalized anxiety disorder. We see a clear genetic aspect here. However, we want to be careful and draw no definite conclusions.
Collapse
Affiliation(s)
- Jolanta Masiak
- Neurophysiological Independent Unit, Department of Psychiatry, Medical University of Lublin, 20-093 Lublin, Poland;
| | - Jolanta Chmielowiec
- Department of Hygiene and Epidemiology, Collegium Medicum, University of Zielona Góra, 65-046 Zielona Góra, Poland; (J.C.); (K.C.)
| | - Krzysztof Chmielowiec
- Department of Hygiene and Epidemiology, Collegium Medicum, University of Zielona Góra, 65-046 Zielona Góra, Poland; (J.C.); (K.C.)
| | - Anna Grzywacz
- Independent Laboratory of Health Promotion, Pomeranian Medical University in Szczecin, 70-204 Szczecin, Poland
- Correspondence: ; Tel.: +48-91441-47-46
| |
Collapse
|
6
|
Modulations in resting state networks of subcortical structures linked to creativity. Neuroimage 2019; 195:311-319. [DOI: 10.1016/j.neuroimage.2019.03.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 02/21/2019] [Accepted: 03/07/2019] [Indexed: 01/21/2023] Open
|
7
|
Aluja A, Balada F, Blanco E, Fibla J, Blanch A. Twenty candidate genes predicting neuroticism and sensation seeking personality traits: A multivariate analysis association approach. PERSONALITY AND INDIVIDUAL DIFFERENCES 2019. [DOI: 10.1016/j.paid.2018.03.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
8
|
McCann SJH. Handedness predicts Conservative-Republican preference and eliminates relations of Big Five personality to political orientation using the 48 contiguous American states as analytical units. Laterality 2018; 24:289-319. [PMID: 30080438 DOI: 10.1080/1357650x.2018.1508214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The two present nomothetic studies focused on the period from 1996 to 2012 to determine relations between handedness and political orientation using the 48 contiguous American states as analytical units. The estimated percentage of left-handers in each state operationally defined handedness. A composite measure of Conservative-Republican preference was created from CBS/New York Times/Gallup polls of state resident conservatism and the percent in each state voting Republican in each presidential election from 1996 to 2012. Study 1 showed that state levels of left-handedness correlated to an extremely high degree with Conservative-Republican preference (r = -.80). As well, with common demographic differences between states reflected in socioeconomic status, White population percent, and urban population percent controlled through multiple regression, handedness still accounted for an additional 37.2% of the variance in Conservative-Republican preference. Study 2 found that each of the Big Five personality variables correlated significantly with handedness and with Conservative-Republican preference, but in the opposite direction. Furthermore, Study 2 demonstrated quite surprisingly that all Big Five personality relations to Conservative-Republican preference were eliminated when handedness was controlled in multiple regression equations. For all regression equations, the global Moran's I test specifically developed for detecting residual spatial autocorrelation indicated no significant spatial autocorrelation.
Collapse
|
9
|
Weger M, Sandi C. High anxiety trait: A vulnerable phenotype for stress-induced depression. Neurosci Biobehav Rev 2018; 87:27-37. [DOI: 10.1016/j.neubiorev.2018.01.012] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/14/2018] [Accepted: 01/21/2018] [Indexed: 11/25/2022]
|
10
|
Gottschalk MG, Domschke K. Genetics of generalized anxiety disorder and related traits. DIALOGUES IN CLINICAL NEUROSCIENCE 2018. [PMID: 28867940 PMCID: PMC5573560 DOI: 10.31887/dcns.2017.19.2/kdomschke] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
This review serves as a systematic guide to the genetics of generalized anxiety disorder (GAD) and further focuses on anxiety-relevant endophenotypes, such as pathological worry fear of uncertainty, and neuroticism. We inspect clinical genetic evidence for the familialityl heritability of GAD and cross-disorder phenotypes based on family and twin studies. Recent advances of linkage studies, genome-wide association studies, and candidate gene studies (eg, 5-HTT, 5-HT1A, MAOA, BDNF) are outlined. Functional and structural neuroimaging and neurophysiological readouts relating to peripheral stress markers and psychophysiology are further integrated, building a multilevel disease framework. We explore etiologic factors in gene-environment interaction approaches investigating childhood trauma, environmental adversity, and stressful life events in relation to selected candidate genes (5-HTT, NPSR1, COMT, MAOA, CRHR1, RGS2), Additionally, the pharmacogenetics of selective serotonin reuptake inhibitor/serotonin-norepinephrine reuptake inhibitor treatment are summarized (5-HTT, 5-HT2A, COMT, CRHR1). Finally, GAD and trait anxiety research challenges and perspectives in the field of genetics, including epigenetics, are discussed.
Collapse
Affiliation(s)
- Michael G Gottschalk
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| |
Collapse
|
11
|
Integrating molecular genetics and evolutionary psychology: Sexual jealousy and the androgen receptor (AR) gene. PERSONALITY AND INDIVIDUAL DIFFERENCES 2018. [DOI: 10.1016/j.paid.2016.11.021] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
12
|
Evolved individual differences: Advancing a condition-dependent model of personality. PERSONALITY AND INDIVIDUAL DIFFERENCES 2015. [DOI: 10.1016/j.paid.2014.10.013] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
13
|
Arbune A, Lin SH, Chen KC, Lee IH, Chen PS, Yang YK. Positive association between neuroticism and working memory in healthy female volunteers. Int J Psychiatry Clin Pract 2015; 19:75-8. [PMID: 24994479 DOI: 10.3109/13651501.2014.940050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Neuroticism is an important personality trait that is often associated with mental disorders. It has been reported that lower levels of neuroticism are associated with better cognitive function later in life; however, the concurrent association is unclear. METHODS A total of 184 healthy participants, 84 males and 100 females, completed the Wechsler Memory Scale-Revised version and the 24-item neuroticism subscale of the Maudsley personality inventory. RESULTS The neuroticism score was found to be positively associated with verbal memory, general memory, and delayed recall, particularly among healthy females, independent of the effect of age. CONCLUSION The mechanisms of this association remain to be elucidated. Clinicians should pay additional attention to this phenomenon.
Collapse
Affiliation(s)
- Anca Arbune
- "Carol Davila" University of Medicine and Pharmacy , Bucharest , Romania
| | | | | | | | | | | |
Collapse
|
14
|
Gene × environment effects of serotonin transporter, dopamine receptor D4, and monoamine oxidase A genes with contextual and parenting risk factors on symptoms of oppositional defiant disorder, anxiety, and depression in a community sample of 4-year-old children. Dev Psychopathol 2013; 25:555-75. [PMID: 23627963 DOI: 10.1017/s0954579412001241] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Genetic factors can play a key role in the multiple level of analyses approach to understanding the development of child psychopathology. The present study examined gene-environment correlations and gene × environment interactions for polymorphisms of three target genes, the serotonin transporter gene, the D4 dopamine receptor gene, and the monoamine oxidase A gene in relation to symptoms of anxiety, depression, and oppositional behavior. Saliva samples were collected from 175 non-Hispanic White, 4-year-old children. Psychosocial risk factors included socioeconomic status, life stress, caretaker depression, parental support, hostility, and scaffolding skills. In comparison with the short forms (s/s, s/l) of the serotonin transporter linked polymorphic repeat, the long form (l/l) was associated with greater increases in symptoms of oppositional defiant disorder in interaction with family stress and with greater increases in symptoms of child depression and anxiety in interaction with caretaker depression, family conflict, and socioeconomic status. In boys, low-activity monoamine oxidase A gene was associated with increases in child anxiety and depression in interaction with caretaker depression, hostility, family conflict, and family stress. The results highlight the important of gene-environment interplay in the development of symptoms of child psychopathology in young children.
Collapse
|
15
|
Aragam N, Wang KS, Anderson JL, Liu X. TMPRSS9 and GRIN2B are associated with neuroticism: a genome-wide association study in a European sample. J Mol Neurosci 2013; 50:250-6. [PMID: 23229837 DOI: 10.1007/s12031-012-9931-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 11/26/2012] [Indexed: 12/31/2022]
Abstract
Major depression disorder (MDD) is a complex and chronic disease that ranks fourth as cause of disability worldwide. About 14 million adults in the USA are believed to have MDD, and an estimated 75 % attempt suicide making MDD a major public health problem. Neuroticism has been recognized as an endophenotype of MDD; however, few genome-wide association (GWA) analyses of neuroticism as a quantitative trait have been reported to date. The aim of this study is to identify genome-wide genetic variants affecting neuroticism using a European sample. A linear regression model was used to analyze the association with neuroticism as a continuous trait in the Netherlands Study of Depression and Anxiety and Netherlands Twin Registry population-based sample of 2,748 individuals with Perlegen 600K single nucleotide polymorphisms (SNPs). In addition, the neuroticism-associated genes/loci of the top 20 SNPs (p < 10⁻⁴) were examined with anti-social personality disorder (ASPD) in an Australian twin family study. Through GWA analysis, 32 neuroticism-associated SNPs (p < 10⁻⁴) were identified. The most significant association was observed with SNP rs4806846 within the TMPRSS9 gene (p = 7.79 × 10⁻⁶) at 19p13.3. The next best signal was in GRIN2B gene (rs220549, p = 1.05 × 10⁻⁵) at 12p12. In addition, several SNPs within GRIN2B showed borderline associations with ASPD in the Australian sample. In conclusion, these results provide a possible genetic basis for the association with neuroticism. Our findings provide a basis for replication in other populations to elucidate the potential role of these genetic variants in neuroticism and MDD along with a possible relationship between ASPD and neuroticism.
Collapse
Affiliation(s)
- Nagesh Aragam
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, PO Box 70259, Lamb Hall, Johnson City, TN 37614-1700, USA
| | | | | | | |
Collapse
|
16
|
Letourneau N, Giesbrecht GF, Bernier FP, Joschko J. How Do Interactions Between Early Caregiving Environment and Genes Influence Health and Behavior? Biol Res Nurs 2012; 16:83-94. [DOI: 10.1177/1099800412463602] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To promote optimal health and behavioral outcomes in children, nurses have long supported parents in providing the best possible care and nurturance to their offspring. A growing body of neuroscience research argues convincingly for the combined influences of genes and early caregiving on producing an individual's unique health and behavioral phenotype. In this article, we systematically review studies that demonstrate the relationship between qualities of early caregiving and genetic propensity to health and behavioral outcomes. From an initial set of 255 articles, 24 articles met our inclusion criteria. The outcomes fall into four distinct groups: hypothalamic-pituitary-adrenal (HPA) response to stress, externalizing behavior, internalizing behavior, and disorganized attachment. In the articles, authors examined genes that code for the 5-hydroxy tryptamine (serotonin) transporter genes linked polymorphic region [5- HTTLPR] serotonin transporter promoter, D4 dopamine receptor, brain-derived neurotrophic factor, and monoamine oxidase A promoter. The reviewed studies suggest that the effect of the early rearing environment on gene expression relates mainly to HPA response to stress, whereas interactions between genes and caregiving mainly relate to behavior and attachment. Findings have implications for nurses focused on advocacy, prevention, and intervention to support the healthy development of children in families faced with adversity.
Collapse
Affiliation(s)
- Nicole Letourneau
- Faculties of Nursing and Medicine (Pediatrics), University of Calgary, Norlien
- Alberta Children’s Hospital Research Foundation Chair in Parent-Infant Mental Health, Calgary, Canada
| | - Gerald F. Giesbrecht
- Department of Pediatrics, Faculty of Medicine, University of Calgary, Calgary, Canada
| | | | - Justin Joschko
- Research Assistant, Faculty of Nursing, University of Calgary, Calgary, Canada
| |
Collapse
|
17
|
Dopamine activation in Neuroticism as measured by spontaneous eye blink rate. Physiol Behav 2012; 105:332-6. [DOI: 10.1016/j.physbeh.2011.08.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Revised: 08/01/2011] [Accepted: 08/06/2011] [Indexed: 11/17/2022]
|
18
|
Park A, Sher KJ, Todorov AA, Heath AC. Interaction between the DRD4 VNTR polymorphism and proximal and distal environments in alcohol dependence during emerging and young adulthood. JOURNAL OF ABNORMAL PSYCHOLOGY 2011; 120:585-95. [PMID: 21381802 DOI: 10.1037/a0022648] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The manifestation of alcohol dependence at different developmental stages may be associated with different genetic and environmental factors. Taking a developmental approach, we characterized interaction between the dopamine receptor 4 variable number tandem repeat (DRD4 VNTR) polymorphism and developmentally specific environmental factors (childhood adversity, college/Greek organization involvement, and delayed adult role transition) on alcohol dependence during emerging and young adulthood. Prospective data were obtained from a cohort of 234 White individuals (56% women, 44% men) who were followed up at ages 18 through 34. A longitudinal hierarchical factor model was estimated to model a traitlike persistent alcohol dependence factor throughout emerging and young adulthood and 2 residual statelike alcohol dependence factors limited to emerging adulthood and young adulthood, respectively. We accounted for those alcohol dependence factors by modeling 3 two-way interaction effects between the DRD4 VNTR polymorphism and the 3 developmentally specific environment factors. Carriers of the DRD4 long allele showed greater susceptibility to environmental effects; they showed more persistent symptoms of alcohol dependence as childhood adversity increased and more alcohol dependence symptoms limited to emerging adulthood as college/Greek organization involvement increased. Alcohol dependence among noncarriers of the long allele, however, did not differ as a function of those environments. Although replication is necessary, these findings highlight the importance of repeated phenotypic assessments across development and modeling both distal and proximal environments and their interaction with genetic susceptibility at specific developmental stages.
Collapse
Affiliation(s)
- Aesoon Park
- Department of Psychological Sciences, University of Missouri, USA
| | | | | | | |
Collapse
|
19
|
DeYoung CG, Cicchetti D, Rogosch FA, Gray JR, Eastman M, Grigorenko EL. Sources of Cognitive Exploration: Genetic Variation in the Prefrontal Dopamine System Predicts Openness/Intellect. JOURNAL OF RESEARCH IN PERSONALITY 2011; 45:364-371. [PMID: 21804655 PMCID: PMC3143482 DOI: 10.1016/j.jrp.2011.04.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The personality trait Openness/Intellect reflects the tendency to be imaginative, curious, perceptive, artistic, and intellectual-all characteristics that involve cognitive exploration. Little is known about the biological basis of Openness/Intellect, but the trait has been linked to cognitive functions of prefrontal cortex, and the neurotransmitter dopamine plays a key role in motivation to explore. The hypothesis that dopamine is involved in Openness/Intellect was supported by examining its association with two genes that are central components of the prefrontal dopaminergic system. In two demographically different samples (children: N = 608; adults: N = 214), variation in the dopamine D4 receptor gene (DRD4) and the catechol-O-methyltransferase gene (COMT) predicted Openness/Intellect, as main effects in the child sample and in interaction in adults.
Collapse
|
20
|
Drago A, De Ronchi D, Serretti A. Incomplete coverage of candidate genes: a poorly considered bias. Curr Genomics 2011; 8:476-83. [PMID: 19412419 PMCID: PMC2647155 DOI: 10.2174/138920207783591681] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2007] [Revised: 10/22/2007] [Accepted: 11/01/2007] [Indexed: 12/31/2022] Open
Abstract
Current genetic investigations are performed both on the basis of a rational and biologically based choice of candidate genes and through genome wide scans. Nonetheless, lack of replication is a common problem in psychiatric genetics as well as in other genetic fields. There are a number of reasons for this inconsistency, among them a well known but poorly considered issue is gene coverage. The aim of the present paper is to focus on this well known and defectively deemed bias, especially when a candidate gene approach is chosen. The rational and the technical feasibility of this proposal are discussed as well as a survey of current investigations. The known consistent methodology to fix this bias is also discussed.
Collapse
Affiliation(s)
- Antonio Drago
- Institute of Psychiatry, University of Bologna, Italy
| | | | | |
Collapse
|
21
|
|
22
|
Bos-Veneman NGP, Minderaa RB, Hoekstra PJ. The DRD4 gene and severity of tics and comorbid symptoms: main effects and interactions with delivery complications. Mov Disord 2010; 25:1470-6. [PMID: 20629147 DOI: 10.1002/mds.23122] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In this study, we investigated the role of the dopamine receptor D4 (DRD4) 48-base pairs (bp) variable number of tandem repeats (VNTR) and perinatal adversities regarding severity of tics and comorbid symptoms in children with tic disorders. We genotyped 110 children with tics with regard to the 48-bp VNTR and assessed presence of prenatal smoking exposure, and pregnancy and delivery complications by parent questionnaires. We examined associations between 2, 3, 4, and 7 repeat (R) alleles and severity of tics and comorbid obsessive-compulsive, depressive, anxious, and autistic symptoms. Through linear regressions, we investigated whether perinatal adversities and the 2R, 3R, 4R, and 7R alleles would interact with severity ratings of tics or comorbid symptoms as outcome. Presence of a 2R allele was related to more severe obsessive-compulsive symptoms, and presence of a 3R allele to increased severity of autistic features. Pregnancy complications were associated with decreased obsessive-compulsive symptom severity, and prenatal smoking exposure to more severe depressive and autistic symptoms. In children without a 3R allele delivery complications were associated with more severe tics, but in children with a 3R variant an inverse relation between delivery complications and tic severity was found. Moreover, the relation between delivery complications and internalizing symptom severity appeared to be most pronounced in children with a 2R allele. In conclusion, this study provides evidence for a role of the 48-bp VNTR in the etiology of tic and associated disorders, and for interactions with delivery complications regarding severity of tics and co-occurring internalizing symptoms.
Collapse
Affiliation(s)
- Netty G P Bos-Veneman
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | | | | |
Collapse
|
23
|
Zhong S, Israel S, Shalev I, Xue H, Ebstein RP, Chew SH. Dopamine D4 receptor gene associated with fairness preference in ultimatum game. PLoS One 2010; 5:e13765. [PMID: 21072167 PMCID: PMC2972208 DOI: 10.1371/journal.pone.0013765] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2010] [Accepted: 07/27/2010] [Indexed: 12/01/2022] Open
Abstract
In experimental economics, the preference for reciprocal fairness has been observed in the controlled and incentivized laboratory setting of the ultimatum game, in which two individuals decide on how to divide a sum of money, with one proposing the share while the second deciding whether to accept. Should the proposal be accepted, the amount is divided accordingly. Otherwise, both would receive no money. A recent twin study has shown that fairness preference inferred from responder behavior is heritable, yet its neurogenetic basis remains unknown. The D4 receptor (DRD4) exon3 is a well-characterized functional polymorphism, which is known to be associated with attention deficit hyperactivity disorder and personality traits including novelty seeking and self-report altruism. Applying a neurogenetic approach, we find that DRD4 is significantly associated with fairness preference. Additionally, the interaction among this gene, season of birth, and gender is highly significant. This is the first result to link preference for reciprocal fairness to a specific gene and suggests that gene × environment interactions contribute to economic decision making.
Collapse
Affiliation(s)
- Songfa Zhong
- Department of Economics, National University of Singapore, Singapore, Singapore
- Department of Economics, Hong Kong University of Science and Technology, Kowloon, Hong Kong
| | - Salomon Israel
- Scheinfeld Center of Human Genetics for Social Sciences, Hebrew University, Jerusalem, Israel
| | - Idan Shalev
- Scheinfeld Center of Human Genetics for Social Sciences, Hebrew University, Jerusalem, Israel
| | - Hong Xue
- Applied Genomics Center, Hong Kong University of Science and Technology, Kowloon, Hong Kong
| | - Richard P. Ebstein
- Scheinfeld Center of Human Genetics for Social Sciences, Hebrew University, Jerusalem, Israel
- Department of Psychology, National University of Singapore, Singapore, Singapore
- * E-mail: (SHC); (RPE)
| | - Soo Hong Chew
- Department of Economics, National University of Singapore, Singapore, Singapore
- Department of Economics, Hong Kong University of Science and Technology, Kowloon, Hong Kong
- Department of Finance, National University of Singapore, Singapore, Singapore
- Center for Experimental Business Research, Hong Kong University of Science and Technology, Kowloon, Hong Kong
- * E-mail: (SHC); (RPE)
| |
Collapse
|
24
|
Abstract
We review recent developments in longitudinal studies of aging, focusing on the Wisconsin Longitudinal Study (WLS) and the Health and Retirement Study (HRS). Both studies are part of a trend toward biosocial surveys in which biological measurement is joined with traditional survey techniques, and a related trend toward greater harmonization across studies. Both studies have collected DNA samples and are working toward genotyping that would allow broadly based association studies. Increased attention to psychological measurement of personality and of cognitive ability using adaptive testing structures has also been shared across the studies. The HRS has expanded its economic measurement to longitudinal studies of consumption and to broader-based measurement of pension and Social Security wealth. It has added biomarkers of cardiovascular risk. The WLS has developed an integrated approach to the study of death and bereavement and an innovative use of high school yearbook photographs to capture information about health in early life of its participants.
Collapse
Affiliation(s)
- Robert M Hauser
- Center for Demography of Health and Aging, University of Wisconsin-Madison, 1180 Observatory Drive, Madison, WI 53706, USA.
| | | |
Collapse
|
25
|
Pauli P, Conzelmann A, Mucha RF, Weyers P, Baehne CG, Fallgatter AJ, Jacob CP, Lesch KP. Affect-modulated startle reflex and dopamine D4 receptor gene variation. Psychophysiology 2010; 47:25-33. [DOI: 10.1111/j.1469-8986.2009.00923.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
26
|
Tsuchimine S, Yasui-Furukori N, Kaneda A, Saito M, Sugawara N, Kaneko S. Minor genetic variants of the dopamine D4 receptor (DRD4) polymorphism are associated with novelty seeking in healthy Japanese subjects. Prog Neuropsychopharmacol Biol Psychiatry 2009; 33:1232-5. [PMID: 19602428 DOI: 10.1016/j.pnpbp.2009.07.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2009] [Revised: 06/23/2009] [Accepted: 07/06/2009] [Indexed: 10/20/2022]
Abstract
Although an association between the dopamine receptor D4 (DRD4) gene and personality traits had been previously investigated, results from previous studies were not conclusive. This may be due to the method of grouping used, which categorized the gene population into two groups based on the length of the variable number of tandem repeats (VNTR) in exon 3. In the present study, we categorized 616 healthy Japanese subjects into more than two groups by further subdividing the DRD4 48-bp VNTR polymorphism, and compared Temperament and Character Inventory (TCI) scores among the groups. A significant difference was found between the DRD4 48-bp VNTR polymorphism and novelty seeking (p=0.016). The novelty-seeking scores in the subjects carrying the 5/5 genotype were significantly higher than in those carrying the 2/2 genotype (p=0.002) or the 4/4 genotype (p=0.005). However, when the conventional method of grouping was used (i.e., short alleles vs. long alleles), there were no significant associations between the DRD4 VNTR polymorphism and any TCI scores. Our results suggest that minor 5-repeat allele is associated with high novelty-seeking scores in healthy Japanese subjects.
Collapse
Affiliation(s)
- Shoko Tsuchimine
- Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
| | | | | | | | | | | |
Collapse
|
27
|
The impact of maternal psychopathology on child-mother attachment. Arch Womens Ment Health 2009; 12:123-34. [PMID: 19337701 DOI: 10.1007/s00737-009-0066-5] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2008] [Accepted: 03/04/2009] [Indexed: 10/20/2022]
Abstract
This review aims to consider evidence for the impact of maternal psychopathology on the child's attachment to the mother, and the role of this in mediating the known transmission of developmental and clinical risk to children. The studies reviewed focus on mothers with depression and psychotic disorder. A number of studies (mainly of mothers with depression) demonstrate an association between insecure/disorganised infant attachments and severe maternal psychopathology, whether chronic or current, in the presence of comorbid disorder, maternal insecure or unresolved attachment state of mind, trauma/loss, or low parenting sensitivity. Whether such effects last into middle childhood, however, is unclear. Our understanding of the role of attachment in determining developmental trajectories in this group is at an early stage. Some evidence suggests that attachment may have a role in mediating the intergenerational transmission of internalizing and other problems in this group, although the presence of co-occurring contextual risk factors may account for the variability in findings. A multifactorial longitudinal approach is needed to elucidate such factors. However, the current literature highlights which subgroups are likely to be vulnerable and provides an evidence-based rationale for taking an attachment-based approach to intervention in this group.
Collapse
|
28
|
Munafò MR, Yalcin B, Willis-Owen SA, Flint J. Association of the dopamine D4 receptor (DRD4) gene and approach-related personality traits: meta-analysis and new data. Biol Psychiatry 2008; 63:197-206. [PMID: 17574217 DOI: 10.1016/j.biopsych.2007.04.006] [Citation(s) in RCA: 221] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2007] [Revised: 03/28/2007] [Accepted: 04/09/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Two variants in the dopamine D4 receptor (DRD4) gene have been reported to be associated with human approach-related traits such as novelty seeking and extraversion. However, the strength of evidence for this association remains uncertain. METHODS We conducted a meta-analysis of published studies of the association between the DRD4 gene variable number of tandem repeats (VNTR) and C-521T polymorphisms and human approach-related personality traits, including novelty seeking, extraversion, and impulsivity, restricted to adult samples recruited from nonpsychiatric populations, and extended on this literature by attempting to confirm any evidence of association in a replication sample (n = 309) selected for extreme scores on the extraversion subscale of the Eysenck Personality Questionnaire from a large (n = 40,090) population-based sample. RESULTS Our initial meta-analysis supported the association of the DRD4 C-521T polymorphism, but not the VNTR polymorphism, with approach-related traits. This conclusion was qualified by evidence of significant publication bias and the failure to detect association in a replication sample comprising individuals at the extremes of the trait distribution. The association of the C-521T polymorphism observed in our initial meta-analysis was robust to the inclusion of these new data, but our revised meta-analysis indicated that the association was present for measures of novelty seeking and impulsivity but not for measures of extraversion. CONCLUSIONS The DRD4 gene may be associated with measures of novelty seeking and impulsivity but not extraversion. The association of the C-521T variant with these measures, if genuine, may account for up to 3% of phenotypic variance.
Collapse
Affiliation(s)
- Marcus R Munafò
- Department of Experimental Psychology, University of Bristol, Bristol, United Kingdom.
| | | | | | | |
Collapse
|
29
|
Abstract
Human anxiety disorders represent one of the most common mental illnesses. They are complex diseases with both genetic and environmental factors affecting their predisposition. Since the basic neuronal mechanisms are shared across mammalian species, the same set of genes may regulate critical aspects of anxiety in humans and in lower species. In this review, we first summarize findings from human molecular genetic approaches to anxiety disorders or anxiety-related personality traits: genome-wide scans and candidate gene studies in large families or case-control cohorts. We then discuss recent studies that have used genome-wide methods in mouse strains to identify genes that regulate anxiety-like behavior. Although it has been difficult to pinpoint specific susceptibility genes for anxiety disorders, ongoing efforts to collect larger study cohorts and to develop new genetic tools should help in this task. Studies in animals have shown that novel quantitative trait locus (QTL) and functional genomics approaches might lead to the identification of regulators of anxiety in mice, and that these genes can be tested for their involvement in human anxiety disorders. Finally, breakthroughs are expected in the fine-mapping of human and mouse genetic linkage regions and in the identification of novel candidate genes using genome-wide methods in mouse models of anxiety.
Collapse
Affiliation(s)
- Iiris Hovatta
- Research Program of Molecular Neurology, Biomedicum, University of Helsinki, Finland.
| | | |
Collapse
|
30
|
Pudrovska T, Carr D. Age at first birth and fathers' subsequent health: evidence from sibling and twin models. Am J Mens Health 2007; 3:104-15. [PMID: 19477723 DOI: 10.1177/1557988307306424] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Using a sample of 540 siblings and twins from the National Survey of Midlife Development in the United States, this study examines the relationship between the age at which men become biological fathers and their subsequent health. The analysis includes both between-family models that treat brothers as independent observations and within-family models that account for unobserved genetic and early-life environmental endowments shared by brothers within families. Findings indicate that age at first birth has a positive, linear effect on men's health, and this relationship is not explained by the confounding influences of unobserved early-life characteristics. However, the effect of age at first birth on fathers' health is explained by men's socioeconomic and family statuses. Whereas most research linking birth timing to specific diseases focuses narrowly on biological mechanisms among mothers, this study demonstrates the importance of reproductive decisions for men's health and well-being.
Collapse
Affiliation(s)
- Tetyana Pudrovska
- Department of Sociology, Center for Demography of Health and Aging, University of Wisconsin-Madison, 53703, USA.
| | | |
Collapse
|
31
|
Gratacòs M, Sahún I, Gallego X, Amador-Arjona A, Estivill X, Dierssen M. Candidate genes for panic disorder: insight from human and mouse genetic studies. GENES BRAIN AND BEHAVIOR 2007; 6 Suppl 1:2-23. [PMID: 17543035 DOI: 10.1111/j.1601-183x.2007.00318.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Panic disorder is a major cause of medical attention with substantial social and health service cost. Based on pharmacological studies, research on its etiopathogenesis has been focused on the possible dysfunction of specific neurotransmitter systems. However, recent work has related the genes involved in development, synaptic plasticity and synaptic remodeling to anxiety disorders. This implies that learning processes and changes in perception, interpretation and behavioral responses to environmental stimuli are essential for development of complex anxiety responses secondary to the building of specific brain neural circuits and to adult plasticity. The focus of this review is on progress achieved in identifying genes that confer increased risk for panic disorder through genetic epidemiology and the use of genetically modified mouse models. The integration of human and animal studies targeting behavioral, systems-level, cellular and molecular levels will most probably help identify new molecules with potential impact on the pathogenetic aspects of the disease.
Collapse
Affiliation(s)
- M Gratacòs
- Genes and Disease Program, Genomic Regulation Center-CRG, Pompeu Fabra University, Barcelona Biomedical Research Park, Barcelona, Catalonia, Spain
| | | | | | | | | | | |
Collapse
|
32
|
Dragan WŁ, Oniszczenko W. An association between dopamine D4 receptor and transporter gene polymorphisms and personality traits, assessed using NEO-FFI in a Polish female population. PERSONALITY AND INDIVIDUAL DIFFERENCES 2007. [DOI: 10.1016/j.paid.2007.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
33
|
Abstract
PURPOSE OF REVIEW The aim of this review is to discuss the current state of research on the concept of neurosis across cultures and to document the advances made in this field over the previous year. RECENT FINDINGS There has been a significant alteration in the concept of neurosis in most cultures, with the relative abandonment of the term 'neurosis' and replacing the concept with that of common mental disorders. The state of research on the aetiopathogenesis of neurosis has moved towards neurobiological, neurophysiological and genetic factors. Neuroticism as a personality trait has retained its role in the development of neurotic disorders. The epidemiological studies on neurotic disorders are equivocal across cultures. Besides, studies on clinical presentation of common mental disorders, somatization and abnormal illness behaviour show some cultural variations. Though there are no significant advances in the management of neurosis equivalents, it seems that the specific serotonin receptor inhibitors may have a role in management of these conditions. SUMMARY The recent literature shows acceptance of common mental disorders across cultures replacing neurotic disorders. Other conceptual equivalents of neurosis are seen in somatoform disorders, somatization and abnormal illness behaviour. Some traditional culture-bound neurotic syndromes and idioms of distress persist.
Collapse
Affiliation(s)
- Santosh Kumar Chaturvedi
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, NIMHANS, Bangalore 560029, India
| | | |
Collapse
|
34
|
|