Increased ratio of 2nd to 4th digit (2D:4D) in schizophrenia

Excess neonatal testosterone causes male-specific social and fear memory deficits in wild-type mice

Neurodevelopmental disorders (ND) disproportionately affect males compared to females, and Autism Spectrum Disorder (ASD) in particular exhibits a 4:1 male bias. The biological mechanisms of this female protection or male susceptibility have not been identified. There is some evidence to suggest that fetal/neonatal gonadal hormones, which play pivotal roles in many aspects of development, may contribute. Here, we investigate the role of testosterone administration during a critical period of development, and its effects on social approach and fear learning in C57BL/6J wildtype mice. Male, but not female mice treated with testosterone on the day of birth (PN0) exhibited deficits in both social behavior and contextual fear conditioning, whereas mice treated with the same dose of testosterone on postnatal day 18 (PN18) did not display such impairments. Testosterone administration did not induce anxiogenic effects or lead to changes in body weight compared to the vehicle-treated group. These impairmeants are relevant to ND and may help identify novel treatment targets.

Are the digit ratio (2D:4D) and hand grip strength related to Parkinson disease in elderly males?

BACKGROUND

Sex hormones affect the pathogenesis of Parkinson patients and it has been suggested that gender is the most important factor in the development and progression of Parkinson's disease. Studies have shown that the second to fourth digit ratio (2D:4D) is affected by the prenatal testosterone and estrogen levels and can predict predisposition to disease. In addition, decreased muscle strength in people with Parkinson's has been repeatedly reported. Hand grip strength (HGS) is a suitable measure to evaluate the musculoskeletal system among the elderly and it is considered as an indicator of the overall strength of the body. This study aimed at investigating the relationship between Parkinson's disease and HGS and 2D:4D ratio.

METHODS

In this study 117 elderly men with Parkinson disease (mean age of 61.66 ± 11.28 years) and 156 healthy control subjects (mean age of 61.86 ± 6.29 years) participated. After determining the level of disability of Parkinson patients by a neurologist (level of disability in the range of 1-4), anthropometric indices (height, weight, length of the second and fourth fingers) and maximum HGS were measured.

RESULTS

Although 2D:4D ratios (right and left hand) of male patients with Parkinson's disease were higher than those of healthy males, this difference was not statistically significant (P = 0.12, P = 0.40; respectively). Conversely, HGS for the right and left hands of Parkinson patients were significantly lower than those of healthy males (P = 0.02, P = 0.03; respectively). The results showed a significant negative relationship between Parkinson disease and the right and left HGS (R = -0.16, P = 0.005; R = -0.17, P = 0.003; respectively). Parkinson disease had no significant relationship with 2D:4D of the right hand, left hand, mean finger ratio and D_R-L 2D:4D (P > 0.05). The regression results showed that the right and left HGS were not able to predict Parkinson disease (P = 0.25, P = 0.16; respectively).

CONCLUSION

We concluded that HGS was negatively associated with the Parkinson disease, but conversely, 2D:4D may not be a valuable biomarker of elevated risk of Parkinson in elderly males.

Second-to-Fourth Digit Ratio (2D:4D) in Psychiatric Disorders: A Systematic Review of Case-control Studies

The second-to-fourth digit ratio (2D:4D) is an indirect, retrospective, non-invasive measure that correlates negatively with intrauterine exposure to testosterone. The present meta-analysis aimed to evaluate if 2D:4D differs between patients with psychiatric disorders and controls. In September 2019, we searched in Web of Knowledge, PsycINFO, Embase, and CINHAL, and retrieved 619 papers. We finally included 43 case-control studies which compared the 2D:4D ratio of patients with autism spectrum disorder (ASD) (n = 16), schizophrenia (n = 8), gender non-conformity (n = 7), addictions (n = 5), attention deficit-hyperactivity disorder (ADHD) (n = 4), mood disorders (n = 2), and intellectual disability (n = 1) to non-clinical controls. Meta-analyses showed that, overall, psychiatric patients had lower 2D:4D than healthy controls (n = 43, overall sample = 9,484, mean difference = -0.0056, 95% confidence interval from -0.0093 to -0.002, I2 = 74%), with more pronounced differences in the right hand, males, and children. Considering psychiatric disorders individually, significant differences were found in the ASD, ADHD, and addictions groups, in which 2D:4D was significantly lower than healthy controls. Conversely, the right hand of males with schizophrenia showed higher 2D:4D than healthy controls. No other significant differences were detected. Although our results need to be cautiously interpreted and find limited applications in clinical practice, they may suggest that 2D:4D is altered in some psychopathological conditions, underlining the role of prenatal exposure to sex steroids in the etiology of psychiatric disorders.

Effects of hand preference on digit lengths and digit ratios among children and adults

BACKGROUND

Prenatal sex hormones may not exclusively determine effects of hand preference on digit ratios. Genetic determination is an alternative possibility.

AIM

To study the likelihood of similar effects of hand preference on digit lengths and digit ratios.

METHODS

We selected similar numbers of left-handers and right-handers in samples of kindergarten children (N = 101, age range: 3.5-7 years) and adults (N = 189, age range: 17-28 years) and measured digit lengths (excluding the thumb) directly on the palmar hand.

RESULTS

Compared to right-handers, left-handers had longer digits and lower third-to-fourth (3D:4D) digit ratios among children, whereas an opposite pattern of handedness differences occurred among adults.

CONCLUSIONS

Effects of hand preference on digit lengths and ratios might be genetically/ontogenetically determined. Also discussed are implications of this set of findings for digit ratio research.

Sexual Dimorphism in Titi Monkeys' Digit (2D:4D) Ratio is Associated with Maternal Urinary Sex Hormones During Pregnancy

The second-to-fourth digit (2D:4D) ratio is a sexually-dimorphic biomarker for prenatal sex hormone exposure. We investigated whether titi monkeys (Plecturocebus cupreus) exhibit sexually-dimorphic 2D:4D ratio, and whether variation in 2D:4D ratio correlates with maternal testosterone and estrogen levels during early pregnancy. Subjects were 61 adult titi monkeys (32 males, 29 females). For 26 subjects, maternal urine samples were collected approximately 15-20 weeks before birth and assayed for testosterone and estrone conjugate (E1 C). Titi monkeys exhibited a human-like pattern of sexual dimorphism in right-hand 2D:4D ratio, with females exhibiting higher 2D:4D ratio than males (β = -0.29, p = 0.023). For left-hand 2D:4D ratio, high levels of maternal E1 C predicted low offspring 2D:4D ratio (β = -0.48, p = 0.009). For right-hand 2D:4D ratio, high levels of testosterone (β = -0.53, p = 0.005) and testosterone-to-E1 C ratio (β = -0.41, p = 0.028) predicted low offspring 2D:4D ratio. For 2D:4D ratio asymmetry (right-hand - left-hand), high levels of testosterone (β = -0.43, p = 0.03) and testosterone-to-E1 C ratio (β = -0.53, p = 0.003) predicted low (right-biased) asymmetry. This is the first report of sexually-dimorphic 2D:4D ratio in New World monkeys, and the results support a growing literature suggesting prenatal sex hormones may modulate offspring 2D:4D ratio.

Biomarkers of fetal conditions: Finger ridge-counts, facial fluctuating asymmetry, and digit ratio (2D:4D)-are they correlated in women?

OBJECTIVES

Fetal environmental conditions are crucial for life-long health. Direct measurements of developmental conditions are limited in humans; thus, several biomarkers of those conditions have been proposed: that is, finger ridge-counts, level of facial fluctuating asymmetry (FA), and digit ratio (2D:4D). Since all of these biomarkers share a similar gestational time of formation, we hypothesize that their values are significantly correlated.

MATERIALS AND METHODS

Data were collected at the Mogielica Human Ecology Study Site in southern Poland among 234 women. Finger ridge-counts, level of facial FA, and 2D:4D have been measured. The two-step analyses included Pearson's correlations of simple values of the biomarkers and correlations of composite variables calculated based on principal component analysis.

RESULTS

We did not find any statistically significant correlations between finger ridge-counts, FA, and 2D:4D in women. Similarly, we did not observe any correlations between three composites created from the biomarkers.

DISCUSSION

Our results indicate that there are no relationships between the biomarkers, suggested as proxies of the quality of prenatal conditions, in a single population. This is the first study analyzing three different markers simultaneously. The lack of correlations may indicate that the tested biomarkers reflect, in fact, different environmental conditions, occurring in separate "critical windows" of development, or that the biomarkers are not valid as proxies of developmental conditions.

Beyond Human Perception: Sexual Dimorphism in Hand and Wrist Radiographs Is Discernible by a Deep Learning Model

Despite the well-established impact of sex and sex hormones on bone structure and density, there has been limited description of sexual dimorphism in the hand and wrist in the literature. We developed a deep convolutional neural network (CNN) model to predict sex based on hand radiographs of children and adults aged between 5 and 70 years. Of the 1531 radiographs tested, the algorithm predicted sex correctly in 95.9% (κ = 0.92) of the cases. Two human radiologists achieved 58% (κ = 0.15) and 46% (κ = − 0.07) accuracy. The class activation maps (CAM) showed that the model mostly focused on the 2nd and 3rd metacarpal base or thumb sesamoid in women, and distal radioulnar joint, distal radial physis and epiphysis, or 3rd metacarpophalangeal joint in men. The radiologists reviewed 70 cases (35 females and 35 males) labeled with sex along with heat maps generated by CAM, but they could not find any patterns that distinguish the two sexes. A small sample of patients (n = 44) with sexual developmental disorders or transgender identity was selected for a preliminary exploration of application of the model. The model prediction agreed with phenotypic sex in only 77.8% (κ = 0.54) of these cases. To the best of our knowledge, this is the first study that demonstrated a machine learning model to perform a task in which human experts could not fulfill.

Evaluation of 2D:4D digit ratio in bipolar 1 disorder patients and its relationship with treatment response

BACKGROUND

The role of sex steroids in bipolar disorder (BD) has been demonstrated in adults. We aimed to evaluate the 2D:4D ratio, which indirectly reflects prenatal sex steroids, in BD. Another purpose of this study was to determine the relationship between clinical features, especially lithium response, and digit ratio.

METHODS

The study included 74 patients with bipolar 1 disorder and 74 healthy individuals matched according to age, gender, and educational status. The digit ratio was calculated by dividing the index finger (2D) length by the ring finger (4D) length in both hands. A lithium response scale was used to evaluate the lithium response history.

RESULTS

There was no difference in 2D:4D ratio between the patients and controls in either right or left hands. The digit ratio was not different between groups with and without suicide attempts. The 2D:4D ratio in the patient group was lower in individuals unresponsive to lithium therapy than in partial and good responders for both right and left hands.

DISCUSSION

According to the results of our study, the 2D:4D ratio in the BD group was not different from healthy controls but was lower in patients unresponsive to lithium. In this respect, the 2D:4D ratio can be considered as a biomarker for lithium response in BD. In large-sample studies, the 2D:4D ratio should be investigated for pathophysiology and treatment response of BD.

Schizophrenia spectrum and other psychotic disorders

Since its earliest conceptualization, schizophrenia has been considered a disorder of "young men." Contemporary research suggests that there are sex differences in schizophrenia that are both transdiagnostic and representative of general sex/gender differences across the psychopathology spectrum. This chapter selectively summarizes representative sex/gender differences in clinical expression, epidemiology, risk factors, treatment, as well as course and outcome in schizophrenia. The consistent sex differences found, such as onset age, generic brain anomalies, and hormonal involvement, are not specific to schizophrenia or necessarily to psychopathology. It is suggested that in working with those diagnosed as meeting the current criteria for schizophrenia, clinicians adopt a transdiagnostic framework informed by sex and gender role processes.

The 2nd to 4th digit ratios (2D:4D) in patients with bipolar disorder

BACKGROUND

The ratio of the index finger to the ring finger (2D:4D) is a reflection of the intrauterine hormonal environment and a lower ratio has been shown to be associated with male gender, impulsive behaviors, substance abuse, and aggression. Bipolar illness is characterized by increased impulsivity and increased rates of co-morbid substance abuse, but the 2D:4D ratios have not been examined in this disorder.

METHODS

We measured digit length of both hands in subjects with bipolar disorder and age- and gender-matched non-bipolar controls (n = 50 in each group). Diagnosis was confirmed with structured diagnostic interviews (MINI) and all subjects also completed Barratt Impulsivity Scale-version 11.

RESULTS

The patients did not vary significantly from the controls in demographic variables. Subjects with bipolar disorder had a higher right hand 2D:4D ratio compared to controls (0.967 ± .029 vs. 0.953 ± .035, t = 2.18, p = .03). Despite clearly higher measures of impulsivity in the bipolar group, no relationship could be documented between digit ratio and measures of impulsivity in either group. However, the right hand 2D:4D ratios and total impulsivity scores predicted bipolar disorder diagnosis status.

LIMITATIONS

The predominantly white racial composition of the study sample may limit generalizability to other groups. Only three patients were diagnosed with bipolar type 2, limiting the generalizability of the findings to all bipolar disorder types.

CONCLUSIONS

The data confirm previous observations of increased measures of impulsivity in euthymic bipolar individuals, and suggest that the mechanism of this increased impulsivity is different than in impulsivity seen in other conditions such as personality disorders.

Sex Differences in Rhesus Monkeys' Digit Ratio (2D:4D Ratio) and Its Association With Maternal Social Dominance Rank

Prenatal androgen exposure (PAE) plays a pivotal role in masculinizing the developing body and brain, and extreme exposure may contribute to autism, anxiety disorder and schizophrenia. One commonly used biomarker for PAE is the pointer-to-ring-finger digit length (2D:4D) ratio. Although this biomarker is widely used in human studies, relatively few studies have investigated 2D:4D ratio in nonhuman primates, particularly rhesus macaques (Macaca mulatta), one of the most commonly used animals in biomedical research. Thus far, data suggest that sexual dimorphism in 2D:4D ratio may be in the opposite direction in some monkey species, when compared to the pattern exhibited by humans and great apes. Using a large sample size, we investigated whether rhesus monkeys' 2D:4D ratio shows the same sex-differentiated pattern present in other Old World monkey species. We also investigated whether individual differences in 2D:4D ratio are associated with the social dominance rank of subjects' mothers during pregnancy, and the social dominance rank the subjects attained as adults. Subjects were 335 rhesus monkeys between 3 years and 24 years of age (M = 6.6). Maternal dominance rank during pregnancy and subjects' adult dominance rank were categorized into tertiles (high, middle and low). Results showed that, across both hands, male rhesus monkeys exhibited higher 2D:4D ratio than females, a pattern consistent with other monkey species and a reversal from the pattern typically observed in humans and apes. This sex difference was modulated by maternal dominance rank, with female offspring of high-ranking and middle-ranking mothers exhibiting masculinized 2D:4D ratio, indicating that maternal dominance rank during pregnancy may influence levels of PAE. There was no association between subjects' 2D:4D ratio and the social dominance rank they attained as adults. These findings show a consistent sex difference in Old World monkeys' 2D:4D ratio that diverges from the pattern observed in apes and humans, and suggest maternal social dominance rank modulates PAE in rhesus monkeys.

Cross-national gender variations of digit ratio (2D:4D) correlate with life expectancy, suicide rate, and other causes of death

The second-to-fourth finger length ratio (2D:4D) is an indication of prenatal sex hormone exposure, and has sex-specifically been associated with several lethal illnesses including ischemic heart disease, diverse cancers, and suicide. Our primary aim was to verify that 2D:4D sex-specifically relates to life expectancy and suicide numbers on a national level (23 countries). We also used a hypothesis-free approach to investigate associations with other causes of death [p value adjustment for multiple hypothesis testing using the false discovery rate procedure (FDR)]. All parameters were normalized to the national mean (of males and females) and analyzed across nations. Normalized male 2D:4D correlated positively with normalized male life expectancy (at birth, r = 0.46, p = 0.029; at the age of 60, r = 0.44, p = 0.038) and negatively with normalized male suicide rates (r = − 0.49, p = 0.017). In the exploratory analyses, the normalized male 2D:4D values were negatively associated with the normalized male deaths rates from communicable, maternal, perinatal, and nutritional conditions [r = − 0.65, p(FDR) = 0.011], respiratory infections [r = − 0.69, p(FDR) = 0.008], asthma [r = − 0.65, p(FDR) = 0.011], neurological conditions [r = − 0.56, p(FDR) = 0.046], and Alzheimer’s disease and other dementias [r = − 0.59, p(FDR) = 0.036]. The normalized female parameters showed the same cross-national correlations. In line with the previous individual level findings, the results suggest that prenatal sex hormone effects are sex-specifically involved in suicide and neurological conditions. Moreover, we provide novel national level evidence that prenatal sex hormone priming may sex-specifically influence life expectancy and death risk from respiratory diseases.

The placenta and neurodevelopment: sex differences in prenatal vulnerability

Prenatal insults, such as maternal stress, are associated with an increased neurodevelopmental disease risk and impact males significantly more than females, including increased rates of autism, mental retardation, stuttering, dyslexia, and attention deficit/hyperactivity disorder (ADHD). Sex differences in the placenta, which begin with sex chromosomes, are likely to produce sex-specific transplacental signals to the developing brain. Our studies and others have identified X-linked genes that are expressed at higher levels in the female placenta. Through a genome-wide screen after maternal stress in mice, we identified the X-linked gene O-linked N-acetylglucosamine transferase (OGT) and demonstrated its causality in neurodevelopmental programming producing a male-specific stress phenotype. Elucidating the sex-specific molecular mechanisms involved in transplacental signals that impact brain development is key to understanding the sex bias in neurodevelopmental disorders and is expected to yield novel insight into disease risk and resilience.

The relationship between second-to-fourth digit (2D:4D) ratios and problematic and pathological Internet use among Turkish university students

Background and aims The ratio of the second and fourth fingers (2D:4D ratio) is a sexually dimorphic trait, with men tending to have lower values than women. This ratio has been related to prenatal testosterone concentrations and addictive behaviors including problematic video-gaming. We aimed to investigate the possible association between 2D:4D ratios and Internet addiction and whether such a relationship would be independent of impulsivity. Methods A total of 652 university students (369 women, 283 men), aged 17-27 years, were enrolled in the study. Problematic and pathological Internet use (PPIU) was assessed using the Internet Addiction Test (IAT). The participants also completed the Barratt Impulsiveness Scale (version 11; BIS-11) and had their 2D:4D ratios measured. Results 2D:4D ratios were not significantly different in women with PPIU and in those with adaptive Internet use (AIU). Men with PPIU exhibited lower 2D:4D ratios on both hands when compared with those with AIU. Correlation analysis revealed that 2D:4D ratios on both hands were negatively correlated with IAT scores among men, but not among women. The multiple linear regression analysis revealed that age, duration of weekly Internet use, impulsiveness, and 2D:4D ratios on the right hand were independently associated with IAT scores among men, and impulsivity did not mediate the relationship between 2D:4D ratios and PPIU. Conclusions For men, 2D:4D ratios on the right hand were inversely correlated with Internet addiction severity even after controlling for individual differences in impulsivity. These findings suggest that high prenatal testosterone levels may contribute to the occurrence of PPIU among men.

The 2D:4D Marker and Different Forms of Internet Use Disorder

Internet use disorder (IUD) presents a growing problem worldwide. Among others, it manifests in loss of control over Internet usage and social problems due to problematic Internet use. Although IUD currently is not an official diagnosis in DSM-5 or ICD-10, mounting evidence suggests that IUD indeed could be categorized as a behavioral addiction. On a systemic neuroscientific level, IUD is well characterized and dysfunctions in the fronto-striatal-limbic loop have been observed in persons being afflicted with IUD. On a molecular level underlying these neural dysfunctions less is known. Therefore, the present research investigates the influence of prenatal testosterone as measured via the 2D:4D marker of the hand on IUD. Testosterone represents an interesting hormonal marker, because sex differences in IUD have been observed, e.g., males show higher tendencies toward Internet gaming disorder (IGD) or females toward overusage of online social networks (both compared to the contrary sex). In N = 217 participants associations between the 2D:4D marker of the hand and both unspecified IUD and specific forms of IUD were investigated. It appeared that more female hands (right side; characterized by higher digit ratio of the index to the ring finger, i.e., >1, meaning lower prenatal testosterone) were associated with lower IGD (rho = -0.17, p = 0.01, N = 211). This effect was driven by the facet of loss of control of Internet Gaming in the whole sample (rho = -0.20, p < 0.01, N = 211) and the female subsample (rho = -0.20, p = 0.02, N(f) = 137). Aside from this, a negative association appeared between the facet of loss of control of generalized IUD and the right digit ratio in males underlining earlier work. In sum, the present work demonstrates that the 2D:4D marker is an interesting marker for Internet addiction and can be easily included as a biomarker to understand the biological underpinnings of Internet (over-)usage.

Digit ratio (2D:4D) in a Chinese population with schizophrenia

BACKGROUND

Prenatal gonadal hormones may play a major role in pathogenesis of schizophrenia. It has been reported that second to fourth digit ratio (2D:4D) was influenced by the levels of exposure to prenatal testosterone and estrogen. So, 2D:4D may help to predict the disease susceptibility to schizophrenia.

AIMS

The aim of this study was to investigate the relationship between the digit ratio (2D:4D) and schizophrenia in Chinese population.

METHODS

We recruited 178 schizophrenics (males: 76; females: 102) and 365 controls (males: 218; females: 147) in this study. Photocopies of both hands were collected and left hand, right hand, mean hand and left minus right hand (DL-R) 2D:4D were analyzed.

RESULTS

The right and mean hand 2D:4D ratios were significantly higher in schizophrenics compared to that of controls in both males and females. The left hand 2D:4D ratio in female schizophrenics was also significantly higher than in controls. Compared to controls, the DL-R 2D:4D in male schizophrenics was obviously higher. There was a weakly (but not significantly) negative correlation between the mean hand 2D:4D ratio and the age of onset.

CONCLUSIONS

The 2D:4D ratio may correlate with the schizophrenia in Chinese population, and it may be an indicator of schizophrenia.

The Ratio of 2nd to 4th Digit Length in Korean Alcohol-dependent Patients

Objective

The ratio of 2nd to 4th digit length (2D:4D) is a sexually dimorphic trait. Men have a relatively shorter second digit than fourth digit. This ratio is thought to be influenced by higher prenatal testosterone level or greater sensitivity to androgen. The purpose of this study is to investigate the relationship between alcohol dependence and 2D:4D in a Korean sample and whether 2D:4D can be a biologic marker in alcohol dependence.

Methods

In this study, we recruited 87 male patients with alcohol dependence from the alcohol center of one psychiatric hospital and 52 healthy male volunteers who were all employees in the same hospital as controls. We captured images of the right and left hands of patients and controls using a scanner and extracted data with a graphics program. We measured the 2D:4D of each hand and compared the alcohol dependence group with the control group. We analyzed these ratios using an independent-samples t-test.

Results

The mean 2D:4D of patients was 0.934 (right hand) and 0.942 (left hand), while the mean 2D:4D of controls was 0.956 (right hand) and 0.958 (left hand). Values for both hands were significantly lower for patients than controls (p<0.001, right hand; p=0.004, left hand).

Conclusion

Patients who are alcohol dependent have a significantly lower 2D:4D than controls, similar to the results of previous studies, which suggest that a higher prenatal testosterone level in the gonadal period is related to alcoholism. Furthermore, 2D:4D is a possible predictive marker of alcohol dependence.

Sex/gender differences in the brain and cognition in schizophrenia

The early conceptualizations of schizophrenia have noted some sex/gender differences in epidemiology and clinical expression of the disorder. Over the past few decades, the interest in differences between male and female patients has expanded to encompass brain morphology and neurocognitive function. Despite some variability and methodological shortcomings, a few patterns emerge from the available literature. Most studies of gross neuroanatomy show more enlarged ventricles and smaller frontal lobes in men than in women with schizophrenia; finding reflecting normal sexual dimorphism. In comparison, studies of brain asymmetry and specific corticolimbic structures, suggest a disturbance in normal sexual dimorphism. The neurocognitive findings are somewhat consistent with this picture. Studies of cognitive functions mediated by the lateral frontal network tend to show sex differences in patients which are in the same direction as those observed in the general population, whereas studies of processes mediated by the corticolimbic system more frequently reveal reversal of normal sexual dimorphisms. These trends are faint and future research would need to delineate neurocognitive differences between men and women with various subtypes of schizophrenia (e.g., early versus late onset), while taking into consideration hormonal status and gender of tested participants.

The ratios of 2nd to 4th digit may be a predictor of schizophrenia in male patients

The production of androgens (mostly testosterone) during the early fetal stage is essential for the differentiation of the male brain. Some authors have suggested a relationship between androgen exposure during the prenatal period and schizophrenia. These two separate relationships suggest that digit length ratios are associated with schizophrenia in males. The study was performed in a university hospital between October 2012 and May 2013. One hundred and three male patients diagnosed with schizophrenia according to DSM-IV using SCID-I, and 100 matched healthy males, were admitted to the study. Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms (SANS) and Brief Psychiatric Rating Scale (BPRS) were used to assess schizophrenia symptoms. The second digit (2D) and fourth digit (4D) asymmetry index (AI), and the right- and left-hand 2D:4D ratios were calculated. All parametric data in the groups were compared using an independent t-test. The predictive power of the AI was estimated by receiver operating characteristics analysis. The 2D:4D AI was statistically significantly lower in the patient group than the healthy control comparison group. There were significant differences between the schizophrenia and the control groups in respect of left 2D:4D and right 2D:4D. There was no correlation between AI, left, or right 2D:4D, BPRS, or SAPS in the schizophrenia group. However, there was a negative correlation between left 2nd digit (L2D):4D and the SANS score. Our findings support the view that the 2D:4D AI can be used as a moderate indicator of schizophrenia. Even more simply, the right or left 2D:4D can be used as an indicator. L2D:4D could indicate the severity of negative symptoms.

Oxytocin, testosterone, and human social cognition

I describe an integrative social-evolutionary model for the adaptive significance of the human oxytocinergic system. The model is based on a role for this hormone in the generation and maintenance of social familiarity and affiliation across five homologous, functionally similar, and sequentially co-opted contexts: mothers with offspring, female and male mates, kin groups, individuals with reciprocity partners, and individuals within cooperating and competing social groups defined by culture. In each situation, oxytocin motivates, mediates and rewards the cognitive and behavioural processes that underlie the formation and dynamics of a more or less stable social group, and promotes a relationship between two or more individuals. Such relationships may be positive (eliciting neurological reward, reducing anxiety and thus indicating fitness-enhancing effects), or negative (increasing anxiety and distress, and thus motivating attempts to alleviate a problematic, fitness-reducing social situation). I also present evidence that testosterone exhibits opposite effects from oxytocin on diverse aspects of cognition and behaviour, most generally by favouring self-oriented, asocial and antisocial behaviours. I apply this model for effects of oxytocin and testosterone to understanding human psychological disorders centrally involving social behaviour. Reduced oxytocin and higher testosterone levels have been associated with under-developed social cognition, especially in autism. By contrast, some combination of oxytocin increased above normal levels, and lower testosterone, has been reported in a notable number of studies of schizophrenia, bipolar disorder and depression, and, in some cases, higher oxytocin involves maladaptively 'hyper-developed' social cognition in these conditions. This pattern of findings suggests that human social cognition and behaviour are structured, in part, by joint and opposing effects of oxytocin and testosterone, and that extremes of such joint effects partially mediate risks and phenotypes of autism and psychotic-affective conditions. These considerations have direct implications for the development of therapies for alleviating disorders of social cognition, and for understanding how such disorders are associated with the evolution of human cognitive-affective architecture.

The 2D:4D ratio of the hand and schizotypal personality traits in schizophrenia patients and healthy control persons

Prenatal estrogen/testosterone exposure is known to be involved in early brain development. In this context, the ratio of the index finger to ring finger length (2D:4D) has been put forward as an indicator of the intrauterine sex hormonal level. A previous study by Collinson et al. (2010) examined 2D:4D ratios in Asian patients with schizophrenia and found an increased 2D:4D pattern in male patients compared to male healthy controls. In the current study, we tried to replicate the result of this study on the 2D:4D ratio in schizophrenia patients and controls in a Chinese sample. Moreover, we investigated the link between 2D:4D ratios and schizotypal personality traits in the participants of the study. No significant difference between cases and controls in 2D:4D ratios for both hands could be observed. However, a positive association between right 2D:4D ratio and schizotypal personality traits was found in healthy controls (both in the male and female subsamples) suggesting that a high 2D:4D ratio could represent a vulnerability factor for schizophrenia in healthy males and females. Same results were observed for the digit ratio of the left hand and the SPQ in the healthy total and healthy female subsample. Therefore, the inclusion of personality measures to study the link between the digit ratio and schizophrenia might help to provide insights in a potential continuum from healthy to schizophrenic behavior.

Gender identity disorder and schizophrenia: neurodevelopmental disorders with common causal mechanisms?

Gender identity disorder (GID), recently renamed gender dysphoria (GD), is a rare condition characterized by an incongruity between gender identity and biological sex. Clinical evidence suggests that schizophrenia occurs in patients with GID at rates higher than in the general population and that patients with GID may have schizophrenia-like personality traits. Conversely, patients with schizophrenia may experience alterations in gender identity and gender role perception. Neurobiological research, including brain imaging and studies of finger length ratio and handedness, suggests that both these disorders are associated with altered cerebral sexual dimorphism and changes in cerebral lateralization. Various mechanisms, such as Toxoplasma infection, reduced levels of brain-derived neurotrophic factor (BDNF), early childhood adversity, and links with autism spectrum disorders, may account for some of this overlap. The implications of this association for further research are discussed.

Minor physical anomalies in patients with schizophrenia in a Chinese population

Studies have shown that minor physical anomalies (MPAs) may be associated with schizophrenia. However, it remains unclear whether any items of MPAs are more associated with schizophrenia than the others. We aimed to examine which specific MPAs are more associated with schizophrenia than others. A total of 154 patients with schizophrenia and 152 healthy controls were assessed using candidate MPAs items along with items from the Waldrop scale. Significant differences were found between the patients and controls in inner canthal distance, epicanthus, adherent ear lobe, cuspidal ear and length difference from section index to ring finger (2D:4D length difference) as well as gap between the first and the second toes. These six items were selected by the logistic regression model, which correctly classified 89.0% of patients with schizophrenia (sensitivity) and 96.7% of healthy controls (specificity). The overall classification success rate was 92.8%. MPAs are associated with neurodevelopment, especially 2D:4D associated with cerebral lateralisation. Hence, our present findings support that it is necessary to evaluate MPAs beyond the Waldrop scale, as some item, such as 2D:4D length difference may reflect the more detailed aberrant neurodevelopment of schizophrenia.

Family history correlates of digit ratio abnormalities in schizophrenia

BACKGROUND

The differences in digit ratio are proposed to arise due to differential effects of sex steroids on the growth of finger bones. In this study, we sought to examine the sex differences and the influence of family history of psychosis on digit ratio in patients with schizophrenia compared to matched healthy controls (HCs).

MATERIALS AND METHODS

Digit ratio (2D: 4D) was examined for a large sample of schizophrenia patients (n=200) and HC (n=177) to evaluate the potential effects of family history.

RESULTS

The right hand 2D: 4D digit ratio was lesser in schizophrenia patients compared to HC (0.97±0.05 vs 0.98±0.04, t=2.2, P=0.02). There was a significant difference in the right hand 2D: 4D digit ratio of female patients with schizophrenia when compared to female HCs (0.96±0.05 vs 0.98±0.03, t=2.1, P=0.03) while males showed no such difference on either hands. On the contrary, family history‑positive males showed a significantly greater digit ratio for the left hand (FH present (0.99±0.04) vs HC (0.97±0.04), t=2.15, P=0.03), while there was no difference between family history‑positive females and HC.

CONCLUSION

Overall, in patients, reversal of expected "directionality" in digit ratio was observed in our study with greater left 2D: 4D in male patients having a family history of schizophrenia being a novel finding. Reversal of sexual dimorphism has been linked to the pathogenesis of schizophrenia. It is possible that such reversal might have a putative genetic basis, perhaps only in men with schizophrenia.

Sex steroids and schizophrenia

The peak in incidence for schizophrenia is during late adolescence for both sexes, but within this time frame the peak is both earlier and steeper for males. Additionally, women have a second peak in incidence following menopause. Two meta-analyses have reported that men have an overall ∼40% greater chance of developing schizophrenia than do women (Aleman et al., 2003; McGrath et al., 2004). These and other findings have led to the suggestion that ovarian hormones may be protective against schizophrenia. Less explored is the potential role of testosterone in schizophrenia, although disruptions in steroid levels have also been reported in men with the illness. The relationship between increased gonadal hormone release per se and peri-adolescent vulnerability for psychiatric illness is difficult to tease apart from other potentially contributory factors in clinical studies, as adolescence is a turbulent period characterized by many social and biological changes. Despite the obvious opportunity provided by animal research, surprisingly little basic science effort has been devoted to this important issue. On the other hand, the animal work offers an understanding of the many ways in which gonadal steroids exert a powerful impact on the brain, both shaping its development and modifying its function during adulthood. Recently, investigators using preclinical models have described a greater male vulnerability to neurodevelopmental insults that are associated with schizophrenia; such studies may provide clinically relevant insights into the role of gonadal steroids in psychiatric illness.

Gray matter volumetric abnormalities associated with the onset of psychosis

Patients with psychosis display structural brain abnormalities in multiple brain regions. The disorder is characterized by a putative prodromal period called ultra-high-risk (UHR) status, which precedes the onset of full-blown psychotic symptoms. Recent studies on psychosis have focused on this period. Neuroimaging studies of UHR individuals for psychosis have revealed that the structural brain changes observed during the established phases of the disorder are already evident prior to the onset of the illness. Moreover, certain brain regions show extremely dynamic changes during the transition to psychosis. These neurobiological features may be used as prognostic and predictive biomarkers for psychosis. With advances in neuroimaging techniques, neuroimaging studies focusing on gray matter abnormalities provide new insights into the pathophysiology of psychosis, as well as new treatment strategies. Some of these novel approaches involve antioxidants administration, because it is suggested that this treatment may delay the progression of UHR to a full-blown psychosis and prevent progressive structural changes. The present review includes an update on the most recent developments in early intervention strategies for psychosis and potential therapeutic treatments for schizophrenia. First, we provide the basic knowledge of the brain regions associated with structural abnormalities in individuals at UHR. Next, we discuss the feasibility on the use of magnetic resonance imaging (MRI)-biomarkers in clinical practice. Then, we describe potential etiopathological mechanisms underlying structural brain abnormalities in prodromal psychosis. Finally, we discuss the potentials and limitations related to neuroimaging studies in individuals at UHR.

Minor physical anomalies in patients with schizophrenia, unaffected first-degree relatives, and healthy controls: a meta-analysis

BACKGROUND

Minor physical anomalies (MPAs) have been found to be more prevalent in schizophrenia than control participants in numerous studies and may index a potential endophenotype for schizophrenia.

AIM

To quantitatively define the magnitude of the difference in total MPA scores between patients with schizophrenia and healthy controls; to determine the degree of manifestation in unaffected first-degree relatives compared to patients and controls; and to investigate the degree of sensitivity among individual MPA items.

METHODS

A systematic search was conducted on the literature pertaining to MPAs in patients with schizophrenia and unaffected relatives. Effect sizes (Cohen's d and odds ratios) and corresponding confidence intervals were combined using the Comprehensive Meta-Analysis software package.

RESULTS

A large difference was found when examining 14 studies comprising 1207 patients with schizophrenia and 1007 healthy controls (d = 0.95, 95% CI = 0.63, 1.27). Six studies involving relatives of individuals with schizophrenia showed a medium effect size (d = 0.45, 95% CI = 0.29,0.62) between patients and relatives, but a small and non-significant effect size (d = 0.32, 95% CI = -0.08, 0.73) between relatives and controls. The majority of MPAs items showed significant odds ratios (1.26-9.86) in comparing patients and controls.

CONCLUSIONS

The findings indicate that medium effect size of MPAs have been demonstrated in patients with schizophrenia as compared to healthy controls, and to a lesser extent in unaffected relatives. These findings are consistent with the idea that MPAs may represent a putative endophenotype for schizophrenia. However, more research including first-degree family members is warranted.

Neuroendocrine markers of high risk for psychosis: salivary testosterone in adolescent boys with prodromal symptoms

BACKGROUND

The peak in age of onset of psychotic disorders such as schizophrenia during puberty and early adulthood suggests a relationship between the expression of psychopathology and the changes in the brain and body that take place during this dynamic maturational period, including a dramatic increase in circulating oestrogens and androgens. This study examined levels of salivary testosterone and oestradiol in adolescents with prepsychotic, prodromal symptoms, as this may mediate risk for psychosis by having an impact on brain development.

METHOD

In 21 male adolescents with prodromal symptoms and 21 male non-clinical controls levels of testosterone and oestradiol were measured in saliva. Tanner pubertal stage and prodromal symptoms were also assessed.

RESULTS

Levels of testosterone were significantly lower in adolescents with prodromal symptoms as compared with non-clinical controls. No group differences in oestradiol were found. In the total sample, level of testosterone was significantly correlated with age and Tanner pubertal stage.

CONCLUSIONS

Our observations are in line with current hypotheses stressing the role of neuroendocrine factors during adolescence in the expression of psychotic symptoms. From a developmental perspective, susceptibility to psychotic disorders increases during adolescence. Our data suggest that testosterone might, in part, mediate this increased vulnerability. Further research is needed to assess the mediating, neural, mechanisms through which testosterone may have an impact on the development of psychotic symptoms. In the search for early risk markers for psychosis, studying neuroendocrine factors might increase our understanding of 'at-risk' developmental pathways.

Schizotypy and altered digit ratios: a second look

Alterations in the ratio between the 2nd and 4th finger digits have been posited as a potential indicator of increased liability for neurodevelopmental disorders such as autism and schizophrenia. We compared digit ratios in two groups of psychometrically-identified schizotypes, namely, those characterized by positive schizotypy (perceptual aberrations and magical ideation; n=76) and those characterized by negative schizotypy (social anhedonia; n=64), to a control group (n=110). The groups were also compared in terms of their performance on a measure of Theory of Mind, namely, the Reading the Mind in the Eyes Test (RMET) and trait affect, as measured by the PANAS. Our results indicate that neither negative schizotypy nor positive schizotypy is associated with altered digit ratios. Similarly, the groups showed no significant differences on the RMET. However, we observed a small but significant inverse association between Theory of Mind performance and negative affect. The findings are considered in light of the extant literature. These results call into question the viability of altered digit ratios to serve as an indicator of increased risk for schizophrenia-spectrum disorders.