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Moradi H, Bunnell HT, Price BS, Khodaverdi M, Vest MT, Porterfield JZ, Anzalone AJ, Santangelo SL, Kimble W, Harper J, Hillegass WB, Hodder SL. Assessing the effects of therapeutic combinations on SARS-CoV-2 infected patient outcomes: A big data approach. PLoS One 2023; 18:e0282587. [PMID: 36893086 PMCID: PMC9997963 DOI: 10.1371/journal.pone.0282587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 02/18/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has demonstrated the need for efficient and comprehensive, simultaneous assessment of multiple combined novel therapies for viral infection across the range of illness severity. Randomized Controlled Trials (RCT) are the gold standard by which efficacy of therapeutic agents is demonstrated. However, they rarely are designed to assess treatment combinations across all relevant subgroups. A big data approach to analyzing real-world impacts of therapies may confirm or supplement RCT evidence to further assess effectiveness of therapeutic options for rapidly evolving diseases such as COVID-19. METHODS Gradient Boosted Decision Tree, Deep and Convolutional Neural Network classifiers were implemented and trained on the National COVID Cohort Collaborative (N3C) data repository to predict the patients' outcome of death or discharge. Models leveraged the patients' characteristics, the severity of COVID-19 at diagnosis, and the calculated proportion of days on different treatment combinations after diagnosis as features to predict the outcome. Then, the most accurate model is utilized by eXplainable Artificial Intelligence (XAI) algorithms to provide insights about the learned treatment combination impacts on the model's final outcome prediction. RESULTS Gradient Boosted Decision Tree classifiers present the highest prediction accuracy in identifying patient outcomes with area under the receiver operator characteristic curve of 0.90 and accuracy of 0.81 for the outcomes of death or sufficient improvement to be discharged. The resulting model predicts the treatment combinations of anticoagulants and steroids are associated with the highest probability of improvement, followed by combined anticoagulants and targeted antivirals. In contrast, monotherapies of single drugs, including use of anticoagulants without steroid or antivirals are associated with poorer outcomes. CONCLUSIONS This machine learning model by accurately predicting the mortality provides insights about the treatment combinations associated with clinical improvement in COVID-19 patients. Analysis of the model's components suggests benefit to treatment with combination of steroids, antivirals, and anticoagulant medication. The approach also provides a framework for simultaneously evaluating multiple real-world therapeutic combinations in future research studies.
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Affiliation(s)
- Hamidreza Moradi
- University of Mississippi Medical Center, Jackson, MS, United States of America
| | | | - Bradley S. Price
- West Virginia University, Morgantown, WV, United States of America
| | - Maryam Khodaverdi
- West Virginia Clinical and Translational Science Institute, Morgantown, WV, United States of America
| | - Michael T. Vest
- Christiana Care Health System, Newark, DE, United States of America
| | | | - Alfred J. Anzalone
- University of Nebraska Medical Center, Omaha, NE, United States of America
| | | | - Wesley Kimble
- West Virginia Clinical and Translational Science Institute, Morgantown, WV, United States of America
| | - Jeremy Harper
- Owl Health Works LLC, Indianapolis, IN, United States of America
| | | | - Sally L. Hodder
- West Virginia Clinical and Translational Science Institute, Morgantown, WV, United States of America
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Baran B, Trang Huong Nguyen Q, Mylonas D, Santangelo SL, Manoach DS. Increased resting-state thalamocortical functional connectivity in children and young adults with autism spectrum disorder. Autism Res 2023; 16:271-279. [PMID: 36546577 PMCID: PMC10619334 DOI: 10.1002/aur.2875] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022]
Abstract
There is converging evidence that abnormal thalamocortical interactions contribute to attention deficits and sensory sensitivities in autism spectrum disorder (ASD). However, previous functional MRI studies of thalamocortical connectivity in ASD have produced inconsistent findings in terms of both the direction (hyper vs. hypoconnectivity) and location of group differences. This may reflect, in part, the confounding effects of head motion during scans. In the present study, we investigated resting-state thalamocortical functional connectivity in 8-25 year-olds with ASD and their typically developing (TD) peers. We used pre-scan training, on-line motion correction, and rigorous data quality assurance protocols to minimize motion confounds. ASD participants showed increased thalamic connectivity with temporal cortex relative to TD. Both groups showed similar age-related decreases in thalamic connectivity with occipital cortex, consistent with a process of circuit refinement. Findings of thalamocortical hyperconnectivity in ASD are consistent with other evidence that decreased thalamic inhibition leads to increase and less filtered sensory information reaching the cortex where it disrupts attention and contributes to sensory sensitivity. This literature motivates studies of mechanisms, functional consequences, and treatment of thalamocortical circuit dysfunction in ASD.
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Affiliation(s)
- Bengi Baran
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA
| | | | - Dimitrios Mylonas
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Susan L. Santangelo
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Maine Medical Center Research Institute, Scarborough, ME
- Tufts University School of Medicine, Department of Psychiatry, Boston, MA
| | - Dara S. Manoach
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Anzalone AJ, Sun J, Vinson AJ, Beasley WH, Hillegass WB, Murray K, Hendricks BM, Haendel M, Geary CR, Bailey KL, Hanson CK, Miele L, Horswell R, McMurry JA, Porterfield JZ, Vest MT, Bunnell HT, Harper JR, Price BS, Santangelo SL, Rosen CJ, McClay JC, Hodder SL. Community risks for SARS-CoV-2 infection among fully vaccinated US adults by rurality: A retrospective cohort study from the National COVID Cohort Collaborative. PLoS One 2023; 18:e0279968. [PMID: 36603014 DOI: 10.1371/journal.pone.0279968] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 12/19/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND While COVID-19 vaccines reduce adverse outcomes, post-vaccination SARS-CoV-2 infection remains problematic. We sought to identify community factors impacting risk for breakthrough infections (BTI) among fully vaccinated persons by rurality. METHODS We conducted a retrospective cohort study of US adults sampled between January 1 and December 20, 2021, from the National COVID Cohort Collaborative (N3C). Using Kaplan-Meier and Cox-Proportional Hazards models adjusted for demographic differences and comorbid conditions, we assessed impact of rurality, county vaccine hesitancy, and county vaccination rates on risk of BTI over 180 days following two mRNA COVID-19 vaccinations between January 1 and September 21, 2021. Additionally, Cox Proportional Hazards models assessed the risk of infection among adults without documented vaccinations. We secondarily assessed the odds of hospitalization and adverse COVID-19 events based on vaccination status using multivariable logistic regression during the study period. RESULTS Our study population included 566,128 vaccinated and 1,724,546 adults without documented vaccination. Among vaccinated persons, rurality was associated with an increased risk of BTI (adjusted hazard ratio [aHR] 1.53, 95% confidence interval [CI] 1.42-1.64, for urban-adjacent rural and 1.65, 1.42-1.91, for nonurban-adjacent rural) compared to urban dwellers. Compared to low vaccine-hesitant counties, higher risks of BTI were associated with medium (1.07, 1.02-1.12) and high (1.33, 1.23-1.43) vaccine-hesitant counties. Compared to counties with high vaccination rates, a higher risk of BTI was associated with dwelling in counties with low vaccination rates (1.34, 1.27-1.43) but not medium vaccination rates (1.00, 0.95-1.07). Community factors were also associated with higher odds of SARS-CoV-2 infection among persons without a documented vaccination. Vaccinated persons with SARS-CoV-2 infection during the study period had significantly lower odds of hospitalization and adverse events across all geographic areas and community exposures. CONCLUSIONS Our findings suggest that community factors are associated with an increased risk of BTI, particularly in rural areas and counties with high vaccine hesitancy. Communities, such as those in rural and disproportionately vaccine hesitant areas, and certain groups at high risk for adverse breakthrough events, including immunosuppressed/compromised persons, should continue to receive public health focus, targeted interventions, and consistent guidance to help manage community spread as vaccination protection wanes.
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Affiliation(s)
| | - Jing Sun
- Johns Hopkins University, Baltimore, Maryland, United States of America
| | | | | | - William B Hillegass
- University of Mississippi Medical Center, Jackson, Mississippi, United States of America
| | - Kimberly Murray
- Maine Health Institute for Research, Portland, Maine, United States of America
| | - Brian M Hendricks
- West Virginia University, Morgantown, West Virginia, United States of America
| | - Melissa Haendel
- University of Colorado Anschutz Medical School, Aurora, CO, United States of America
| | - Carol Reynolds Geary
- University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Kristina L Bailey
- University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Corrine K Hanson
- University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Lucio Miele
- Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Ronald Horswell
- Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Julie A McMurry
- Oregon State University, Corvallis, Oregon, United States of America
| | | | - Michael T Vest
- Christiana Care Health System, Newark, Delaware, United States of America
| | - H Timothy Bunnell
- Nemours Children's Health, Wilmington, Delaware, United States of America
| | - Jeremy R Harper
- Owl Health Networks, Indianapolis, Indiana, United States of America
| | - Bradley S Price
- West Virginia University, Morgantown, West Virginia, United States of America
| | - Susan L Santangelo
- Maine Health Institute for Research, Portland, Maine, United States of America
- Tufts University School of Medicine, Boston, Massachusetts, United States of America
| | - Clifford J Rosen
- Maine Health Institute for Research, Portland, Maine, United States of America
| | - James C McClay
- University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Sally L Hodder
- West Virginia University, Morgantown, West Virginia, United States of America
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Anzalone AJ, Horswell R, Hendricks BM, Chu S, Hillegass WB, Beasley WH, Harper JR, Kimble W, Rosen CJ, Miele L, McClay JC, Santangelo SL, Hodder SL. Higher hospitalization and mortality rates among SARS-CoV-2-infected persons in rural America. J Rural Health 2023; 39:39-54. [PMID: 35758856 PMCID: PMC9349606 DOI: 10.1111/jrh.12689] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE Rural communities are among the most underserved and resource-scarce populations in the United States. However, there are limited data on COVID-19 outcomes in rural America. This study aims to compare hospitalization rates and inpatient mortality among SARS-CoV-2-infected persons stratified by residential rurality. METHODS This retrospective cohort study from the National COVID Cohort Collaborative (N3C) assesses 1,033,229 patients from 44 US hospital systems diagnosed with SARS-CoV-2 infection between January 2020 and June 2021. Primary outcomes were hospitalization and all-cause inpatient mortality. Secondary outcomes were utilization of supplemental oxygen, invasive mechanical ventilation, vasopressor support, extracorporeal membrane oxygenation, and incidence of major adverse cardiovascular events or hospital readmission. The analytic approach estimates 90-day survival in hospitalized patients and associations between rurality, hospitalization, and inpatient adverse events while controlling for major risk factors using Kaplan-Meier survival estimates and mixed-effects logistic regression. FINDINGS Of 1,033,229 diagnosed COVID-19 patients included, 186,882 required hospitalization. After adjusting for demographic differences and comorbidities, urban-adjacent and nonurban-adjacent rural dwellers with COVID-19 were more likely to be hospitalized (adjusted odds ratio [aOR] 1.18, 95% confidence interval [CI], 1.16-1.21 and aOR 1.29, CI 1.24-1.1.34) and to die or be transferred to hospice (aOR 1.36, CI 1.29-1.43 and 1.37, CI 1.26-1.50), respectively. All secondary outcomes were more likely among rural patients. CONCLUSIONS Hospitalization, inpatient mortality, and other adverse outcomes are higher among rural persons with COVID-19, even after adjusting for demographic differences and comorbidities. Further research is needed to understand the factors that drive health disparities in rural populations.
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Affiliation(s)
- Alfred Jerrod Anzalone
- University of Nebraska Medical Center, Omaha, Nebraska, USA
- Great Plains IDeA-CTR, Omaha, Nebraska, USA
| | - Ronald Horswell
- Pennington Biomedical Research Centre, Baton Rouge, Louisiana, USA
- LA CaTS Center, Baton Rouge, Louisiana, USA
| | - Brian M. Hendricks
- West Virginia University, Morgantown, West Virginia, USA
- West Virginia Clinical and Translational Sciences Institute, Morgantown, West Virginia, USA
| | - San Chu
- Pennington Biomedical Research Centre, Baton Rouge, Louisiana, USA
- LA CaTS Center, Baton Rouge, Louisiana, USA
| | - William B. Hillegass
- University of Mississippi Medical Center, Jackson, Mississippi, USA
- Mississippi Center for Clinical and Translational Research, Jackson, Mississippi, USA
| | - William H. Beasley
- University of Oklahoma, Norman, Oklahoma, USA
- Oklahoma Clinical and Translational Science Institute, Oklahoma City, Oklahoma, USA
| | | | - Wesley Kimble
- West Virginia University, Morgantown, West Virginia, USA
- West Virginia Clinical and Translational Sciences Institute, Morgantown, West Virginia, USA
| | - Clifford J. Rosen
- Maine Medical Center Research Institute, Scarborough, Maine, USA
- Northern New England Clinical & Translational Research Network, Burlington, Vermont, USA
| | - Lucio Miele
- LA CaTS Center, Baton Rouge, Louisiana, USA
- Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - James C. McClay
- University of Nebraska Medical Center, Omaha, Nebraska, USA
- Great Plains IDeA-CTR, Omaha, Nebraska, USA
| | - Susan L. Santangelo
- Maine Medical Center Research Institute, Scarborough, Maine, USA
- Northern New England Clinical & Translational Research Network, Burlington, Vermont, USA
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Sally L. Hodder
- West Virginia University, Morgantown, West Virginia, USA
- West Virginia Clinical and Translational Sciences Institute, Morgantown, West Virginia, USA
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Khodaverdi M, Price BS, Porterfield JZ, Bunnell HT, Vest MT, Anzalone AJ, Harper J, Kimble WD, Moradi H, Hendricks B, Santangelo SL, Hodder SL. An ordinal severity scale for COVID-19 retrospective studies using Electronic Health Record data. JAMIA Open 2022; 5:ooac066. [PMID: 35911666 PMCID: PMC9278199 DOI: 10.1093/jamiaopen/ooac066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/24/2022] [Accepted: 07/07/2022] [Indexed: 12/02/2022] Open
Abstract
Objectives Although the World Health Organization (WHO) Clinical Progression Scale for COVID-19 is useful in prospective clinical trials, it cannot be effectively used with retrospective Electronic Health Record (EHR) datasets. Modifying the existing WHO Clinical Progression Scale, we developed an ordinal severity scale (OS) and assessed its usefulness in the analyses of COVID-19 patient outcomes using retrospective EHR data. Materials and Methods An OS was developed to assign COVID-19 disease severity using the Observational Medical Outcomes Partnership common data model within the National COVID Cohort Collaborative (N3C) data enclave. We then evaluated usefulness of the developed OS using heterogenous EHR data from January 2020 to October 2021 submitted to N3C by 63 healthcare organizations across the United States. Principal component analysis (PCA) was employed to characterize changes in disease severity among patients during the 28-day period following COVID-19 diagnosis. Results The data set used in this analysis consists of 2 880 456 patients. PCA of the day-to-day variation in OS levels over the totality of the 28-day period revealed contrasting patterns of variation in disease severity within the first and second 14 days and illustrated the importance of evaluation over the full 28-day period. Discussion An OS with well-defined, robust features, based on discrete EHR data elements, is useful for assessments of COVID-19 patient outcomes, providing insights on the progression of COVID-19 disease severity over time. Conclusions The OS provides a framework that can facilitate better understanding of the course of acute COVID-19, informing clinical decision-making and resource allocation.
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Affiliation(s)
- Maryam Khodaverdi
- West Virginia Clinical and Translational Sciences Institute, Morgantown, West Virginia, USA
| | - Bradley S Price
- West Virginia Clinical and Translational Sciences Institute, Morgantown, West Virginia, USA
- Department of Management Information Systems, West Virginia University, Morgantown, West Virginia, USA
| | | | - H Timothy Bunnell
- Biomedical Research Informatics Center, Nemours Children's Health, Wilmington, Delaware, USA
| | - Michael T Vest
- Section of Pulmonary and Critical Care Medicine, Christiana Care Health System, Newark, Delaware, USA
- Department of Medicine, Sidney Kimmel College of Medicine, Philadelphia, Pennsylvania, USA
| | - Alfred Jerrod Anzalone
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | | | - Wes D Kimble
- West Virginia Clinical and Translational Sciences Institute, Morgantown, West Virginia, USA
| | - Hamidreza Moradi
- Department of Data Science, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Brian Hendricks
- Department of Epidemiology, West Virginia University, Morgantown, West Virginia, USA
| | - Susan L Santangelo
- Center for Psychiatric Research, Maine Medical Center Research Institute, and Maine Medical Center, Portland, Maine, USA
- Department of Psychiatry, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Sally L Hodder
- West Virginia Clinical and Translational Sciences Institute, Morgantown, West Virginia, USA
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Sheikh TI, Harripaul R, Vasli N, Ghadami M, Santangelo SL, Ayub M, Sasanfar R, Vincent JB. Heterozygous De Novo Truncating Mutation of Nucleolin in an ASD Individual Disrupts Its Nucleolar Localization. Genes (Basel) 2021; 13:51. [PMID: 35052391 PMCID: PMC8774667 DOI: 10.3390/genes13010051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/10/2021] [Accepted: 12/14/2021] [Indexed: 11/16/2022] Open
Abstract
Nucleolin (NCL/C23; OMIM: 164035) is a major nucleolar protein that plays a critical role in multiple processes, including ribosome assembly and maturation, chromatin decondensation, and pre-rRNA transcription. Due to its diverse functions, nucleolin has frequently been implicated in pathological processes, including cancer and viral infection. We recently identified a de novo frameshifting indel mutation of NCL, p.Gly664Glufs*70, through whole-exome sequencing of autism spectrum disorder trios. Through the transfection of constructs encoding either a wild-type human nucleolin or a mutant nucleolin with the same C-terminal sequence predicted for the autism proband, and by using co-localization with the nucleophosmin (NPM; B23) protein, we have shown that the nucleolin mutation leads to mislocalization of the NCL protein from the nucleolus to the nucleoplasm. Moreover, a construct with a nonsense mutation at the same residue, p.Gly664*, shows a very similar effect on the location of the NCL protein, thus confirming the presence of a predicted nucleolar location signal in this region of the NCL protein. Real-time fluorescence recovery experiments show significant changes in the kinetics and mobility of mutant NCL protein in the nucleoplasm of HEK293Tcells. Several other studies also report de novoNCL mutations in ASD or neurodevelopmental disorders. The altered mislocalization and dynamics of mutant NCL (p.G664Glufs*70/p.G664*) may have relevance to the etiopathlogy of NCL-related ASD and other neurodevelopmental phenotypes.
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Affiliation(s)
- Taimoor I. Sheikh
- Molecular Neuropsychiatry & Development (MiND) Lab, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M5T 1R8, Canada; (T.I.S.); (R.H.)
| | - Ricardo Harripaul
- Molecular Neuropsychiatry & Development (MiND) Lab, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M5T 1R8, Canada; (T.I.S.); (R.H.)
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Nasim Vasli
- Department of Pediatric Laboratory Medicine, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada;
| | - Majid Ghadami
- Department of Educational Sciences, Farhangian University, Tehran 19989-63341, Iran;
| | - Susan L. Santangelo
- Center for Psychiatric Research, Maine Medical Center Research Institute, Portland, ME 04101, USA;
- Department of Psychiatry, Tufts University School of Medicine, Boston, MA 02110, USA
- Department of Psychiatry, Maine Medical Center, Portland, ME 04102, USA
| | - Muhammad Ayub
- Department of Psychiatry, Queen’s University, Kingston, ON K7L 7X3, Canada;
- Department of Academic Psychiatry, University College London, London WC1E 6BT, UK
| | - Roksana Sasanfar
- Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA;
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA 02114, USA
| | - John B. Vincent
- Molecular Neuropsychiatry & Development (MiND) Lab, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M5T 1R8, Canada; (T.I.S.); (R.H.)
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
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Khodaverdi M, Price BS, Santangelo SL, Anzalone A(J, Kimble W, Porterfield JZ, Vest MT, Hodder SL, Hendricks B, Rosen CJ, Bunnell HTI, Moradi H. 447. An Ordinal Scale Assessing SARS-CoV-2 Infected Patient Outcomes Using Electronic Health Records. Open Forum Infect Dis 2021. [PMCID: PMC8643916 DOI: 10.1093/ofid/ofab466.646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background A major challenge to identifying effective treatments for COVID-19 has been the conflicting results offered by small, often underpowered clinical trials. The World Health Organization (WHO) Ordinal Scale (OS) has been used to measure clinical improvement among clinical trial participants and has the benefit of measuring effect across the spectrum of clinical illness. We modified the WHO OS to enable assessment of COVID-19 patient outcomes using electronic health record (EHR) data. Methods Employing the National COVID Cohort Collaborative (N3C) database of EHR data from 50 sites in the United States, we assessed patient outcomes, April 1,2020 to March 31, 2021, among those with a SARS-CoV-2 diagnosis, using the following modification of the WHO OS: 1=Outpatient, 3=Hospitalized, 5=Required Oxygen (any), 7=Mechanical Ventilation, 9=Organ Support (pressors; ECMO), 11=Death. OS is defined over 4 weeks beginning at first diagnosis and recalculated each week using the patient’s maximum OS value in the corresponding 7-day period. Modified OS distributions were compared across time using a Pearson Chi-Squared test. Results The study sample included 1,446,831 patients, 54.7% women, 14.7% Black, 14.6% Hispanic/Latinx. Pearson Chi-Sq P< 0.0001 was obtained comparing the distribution of 2nd Quarter 2020 OS with the distribution of later time points for Week 4. Table 1. OS at week 1 and 4 by quarter ![]()
The study sample included 1,446,831 patients, 54.7% women, 14.7% Black, 14.6% Hispanic/Latinx. Pearson Chi-Sq P< 0.0001 was obtained comparing the distribution of 2nd Quarter 2020 OS with the distribution of later time points for Week 4. Conclusion All Week 4 OS distributions significantly improved from the initial period (April-June 2020) compared with subsequent months, suggesting improved management. Further work is needed to determine which elements of care are driving the improved outcomes. Time series analyses must be included when assessing impact of therapeutic modalities across the COVID pandemic time frame. Disclosures Sally L. Hodder, M.D., Gilead (Advisor or Review Panel member)Merck (Grant/Research Support, Advisor or Review Panel member)Viiv Healthcare (Grant/Research Support, Advisor or Review Panel member)
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Affiliation(s)
| | | | | | | | | | | | | | - Sally L Hodder
- West Virginia University School of Medicine, Morgantown, West Virginia
| | | | | | - H TImothy Bunnell
- Nemours Children’s Health System & University of Delaware, Wilmington, Delaware
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Schwind JS, Norman SA, Brown R, Frances RH, Koss E, Karmacharya D, Santangelo SL. Association Between Earthquake Exposures and Mental Health Outcomes in Phulpingdanda Village After the 2015 Nepal Earthquakes. Community Ment Health J 2019; 55:1103-1113. [PMID: 31102165 DOI: 10.1007/s10597-019-00404-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 05/06/2019] [Indexed: 12/24/2022]
Abstract
In 2015, two strong earthquakes, as well as continuous, high magnitude aftershocks, struck Nepal. Phulpingdanda village was greatly impacted due to its lack of infrastructure and environmental remoteness. Adults from sampled households were surveyed 1-year later to examine the association between earthquake exposures and indicators of depression, post-traumatic stress disorder (PTSD), and resilience. Results showed 33% of surveyed residents screened positive for depression, 9% screened positive for severe PTSD, and 46% displayed moderate to high resilience. Additionally, participants experienced resource loss (100%), damaged home and goods (99%), and exposure to the grotesque (82%). Traumatic earthquake experiences related to personal harm were associated with symptoms of depression and PTSD and resource loss was associated with depressive symptoms. Earthquake experiences associated with less damage to home and goods, but greater exposure to the grotesque were associated with increased resilience. This research adds to our knowledge of the relationship between traumatic exposures and indicators of psychological distress and resilience following a disaster.
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Affiliation(s)
- Jessica S Schwind
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, P.O. Box 8015, Statesboro, GA, 30460, USA. .,Department of Biostatistics and Epidemiology, Medical College of Georgia, Augusta University, Augusta, GA, USA.
| | - Stephanie A Norman
- Department of Biostatistics and Epidemiology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | | | - Rebecca Hoffmann Frances
- Maine Behavioral Healthcare, Portland, ME, USA.,Tufts University School of Medicine, Department of Psychiatry, Boston, MA, USA
| | | | | | - Susan L Santangelo
- Tufts University School of Medicine, Department of Psychiatry, Boston, MA, USA.,Maine Medical Center Research Institute, Center for Psychiatric Research, Portland, ME, USA
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9
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Schwind JS, Formby CB, Santangelo SL, Norman SA, Brown R, Hoffman Frances R, Koss E, Karmacharya D. Earthquake exposures and mental health outcomes in children and adolescents from Phulpingdanda village, Nepal: a cross-sectional study. Child Adolesc Psychiatry Ment Health 2018; 12:54. [PMID: 30598695 PMCID: PMC6300918 DOI: 10.1186/s13034-018-0257-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 12/06/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mental health issues can reach epidemic proportions in developed countries after natural disasters, but research is needed to better understand the impact on children and adolescents in developing nations. METHODS A cross-sectional study was performed to examine the relationship between earthquake exposures and depression, PTSD, and resilience among children and adolescents in Phulpingdanda village in Nepal, 1 year after the 2015 earthquakes, using the Depression Self-Rating Scale for Children, Child PTSD Symptom Scale, and the Child and Youth Resilience Measure, respectively. To quantify exposure, a basic demographic and household questionnaire, including an earthquake exposure assessment tool for children and adolescents, was created. RESULTS Of the 62 respondents interviewed, 3.23% and 4.84% displayed symptomatology of depression and PTSD. A large number of respondents interviewed scored high for resiliency (80.65%). All 62 respondents were displaced from their household and witnessed severe damage of both their homes and village. The number of earthquake exposures had a strong, positive correlation with PTSD symptomatology. CONCLUSIONS Although the number of respondents who showed signs of depression and PTSD symptomatology was lower than anticipated, resilience scores were considerably higher. Future research should explore which protective factors may contribute to high resiliency in Nepali children and adolescents.
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Affiliation(s)
- Jessica S. Schwind
- 0000 0001 0657 525Xgrid.256302.0Department of Biostatistics, Epidemiology, and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, P.O. Box 8015, Statesboro, Georgia 30460 USA ,0000 0001 2284 9329grid.410427.4Medical College of Georgia, Augusta University, 1120 15th Street, Augusta, GA 30912 USA
| | - Clara B. Formby
- 0000 0001 2284 9329grid.410427.4Medical College of Georgia, Augusta University, 1120 15th Street, Augusta, GA 30912 USA
| | - Susan L. Santangelo
- 0000 0004 0433 3945grid.416311.0Maine Medical Research Institute, 509 Forest Ave, Suite 200B, Portland, ME 04101 USA ,0000 0000 8934 4045grid.67033.31Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111 USA
| | - Stephanie A. Norman
- 0000 0001 2284 9329grid.410427.4Medical College of Georgia, Augusta University, 1120 15th Street, Augusta, GA 30912 USA
| | - Rebecca Brown
- St. Joseph’s College of Maine, 278 Whites Bridge Road, Standish, ME 04084 USA
| | - Rebecca Hoffman Frances
- 0000 0000 8934 4045grid.67033.31Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111 USA ,Maine Behavioral Healthcare, 165 Lancaster Street, Portland, ME 04101 USA
| | | | - Dibesh Karmacharya
- grid.428196.0Center for Molecular Dynamics Nepal, GPO Box 21049, Kathmandu, Nepal
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10
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Karahanoğlu FI, Baran B, Nguyen QTH, Meskaldji DE, Yendiki A, Vangel M, Santangelo SL, Manoach DS. Diffusion-weighted imaging evidence of altered white matter development from late childhood to early adulthood in Autism Spectrum Disorder. Neuroimage Clin 2018; 19:840-847. [PMID: 29946509 PMCID: PMC6008282 DOI: 10.1016/j.nicl.2018.06.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 05/18/2018] [Accepted: 06/03/2018] [Indexed: 12/01/2022]
Abstract
Autism Spectrum Disorder (ASD) is thought to reflect disrupted development of brain connectivity characterized by white matter abnormalities and dyscoordination of activity across brain regions that give rise to core features. But there is little consensus about the nature, timing and location of white matter abnormalities as quantified with diffusion-weighted MRI. Inconsistent findings likely reflect small sample sizes, motion confounds and sample heterogeneity, particularly different age ranges across studies. We examined the microstructural integrity of major white matter tracts in relation to age in 38 high functioning ASD and 35 typically developing (TD) participants, aged 8-25, whose diffusion-weighted scans met strict data-quality criteria and survived group matching for motion. While there were no overall group differences in diffusion measures, the groups showed different relations with age. Only the TD group showed the expected positive correlations of fractional anisotropy with age. In parallel, axial diffusivity was unrelated to age in TD, but showed inverse correlations with age in ASD. Younger participants with ASD tended to have higher fractional anisotropy and axial diffusivity than their TD peers, while the opposite was true for older participants. Most of the affected tracts - cingulum bundle, inferior and superior longitudinal fasciculi - are association bundles related to cognitive, social and emotional functions that are abnormal in ASD. The manifestations of abnormal white matter development in ASD as measured by diffusion-weighted MRI depend on age and this may contribute to inconsistent findings across studies. We conclude that ASD is characterized by altered white matter development from childhood to early adulthood that may underlie abnormal brain function and contribute to core features.
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Affiliation(s)
- Fikret Işık Karahanoğlu
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States; Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, United States.
| | - Bengi Baran
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States; Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, United States
| | - Quynh Trang Huong Nguyen
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States; Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, United States
| | - Djalel-Eddine Meskaldji
- Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Anastasia Yendiki
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, United States; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Mark Vangel
- Department of Biostatistics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Susan L Santangelo
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States; Maine Medical Center Research Institute, Scarborough, ME, United States; Tufts University School of Medicine, Department of Psychiatry, Boston, MA, United States
| | - Dara S Manoach
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States; Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, United States
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11
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Pedersen KA, Santangelo SL, Gabriels RL, Righi G, Erard M, Siegel M. Behavioral Outcomes of Specialized Psychiatric Hospitalization in the Autism Inpatient Collection (AIC): A Multisite Comparison. J Autism Dev Disord 2017; 48:3658-3667. [PMID: 29170939 DOI: 10.1007/s10803-017-3366-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Psychiatric hospitalization of children with autism spectrum disorder (ASD) is relatively common and occurs at a higher rate than in non-ASD youth. This study compared changes in the severity of serious problem behaviors in 350 youth with ASD enrolled in the autism inpatient collection during and after hospitalization in six specialized child psychiatry units. There was a significant reduction in serious problem behaviors from admission (aberrant behavior checklist-irritability subscale M = 29.7, SD 9.6) to discharge (M = 15.0, SD 10.3) and 2-month follow-up (M = 19.3, SD 10.3). Between discharge and 2-month follow-up, tantrum-like behaviors but not self-injurious behaviors increased slightly. Improvement in the severity of problem behaviors was not uniform across sites, even after controlling for measured site differences.
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Affiliation(s)
- Kahsi A Pedersen
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, 509 Forest Avenue, Portland, ME, 04101, USA. .,Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02110, USA.
| | - Susan L Santangelo
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, 509 Forest Avenue, Portland, ME, 04101, USA.,Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02110, USA.,Department of Psychiatry, Maine Medical Center, 22 Bramhall Road, Portland, ME, 04102, USA
| | - Robin L Gabriels
- University of Colorado Anschutz Medical Campus, 13123 E. 16th Ave, Aurora, CO, 80045, USA
| | - Giulia Righi
- Emma Pendleton Bradley Hospital, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Michael Erard
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, 509 Forest Avenue, Portland, ME, 04101, USA
| | - Matthew Siegel
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, 509 Forest Avenue, Portland, ME, 04101, USA.,Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02110, USA.,Developmental Disorders Program, Spring Harbor Hospital, 123 Andover Road, Westbrook, ME, 04092, USA
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12
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Siegel M, Smith KA, Mazefsky C, Gabriels RL, Erickson C, Kaplan D, Morrow EM, Wink L, Santangelo SL. The autism inpatient collection: methods and preliminary sample description. Mol Autism 2015; 6:61. [PMID: 26557975 PMCID: PMC4640153 DOI: 10.1186/s13229-015-0054-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 10/26/2015] [Indexed: 12/03/2022] Open
Abstract
Background Individuals severely affected by autism spectrum disorder (ASD), including those with intellectual disability, expressive language impairment, and/or self-injurious behavior (SIB), are underrepresented in the ASD literature and extant collections of phenotypic and biological data. An understanding of ASD’s etiology and subtypes can only be as complete as the studied samples are representative. Methods The Autism Inpatient Collection (AIC) is a multi-site study enrolling children and adolescents with ASD aged 4–20 years admitted to six specialized inpatient psychiatry units. Enrollment began March, 2014, and continues at a rate of over 400 children annually. Measures characterizing adaptive and cognitive functioning, communication, externalizing behaviors, emotion regulation, psychiatric co-morbidity, self-injurious behavior, parent stress, and parent self-efficacy are collected. ASD diagnosis is confirmed by the Autism Diagnostic Observation Schedule – 2 (ADOS-2) and extensive inpatient observation. Biological samples from probands and their biological parents are banked and processed for DNA extraction and creation of lymphoblastoid cell lines. Results Sixty-one percent of eligible subjects were enrolled. The first 147 subjects were an average of 12.6 years old (SD 3.42, range 4–20); 26.5 % female; 74.8 % Caucasian, and 81.6 % non-Hispanic/non-Latino. Mean non-verbal intelligence quotient IQ = 70.9 (SD 29.16, range 30–137) and mean adaptive behavior composite score = 55.6 (SD 12.9, range 27–96). A majority of subjects (52.4 %) were non- or minimally verbal. The average Aberrant Behavior Checklist - Irritability Subscale score was 28.6, well above the typical threshold for clinically concerning externalizing behaviors, and 26.5 % of the sample engaged in SIB. Females had more frequent and severe SIB than males. Conclusions Preliminary data indicate that the AIC has a rich representation of the portion of the autism spectrum that is understudied and underrepresented in extant data collections. More than half of the sample is non- or minimally verbal, over 40 % have intellectual disability, and over one quarter exhibit SIB. The AIC is a substantial new resource for study of the full autism spectrum, which will augment existing data on higher-functioning cohorts and facilitate the identification of genetic subtypes and novel treatment targets. The AIC investigators welcome collaborations with other investigators, and access to the AIC phenotypic data and biosamples may be requested through the Simons Foundation (www.sfari.org).
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Affiliation(s)
- Matthew Siegel
- Maine Medical Center Research Institute, Spring Harbor Hospital, Tufts University School of Medicine, 123 Andover Road, Westbrook, ME 04092 USA
| | - Kahsi A Smith
- Maine Medical Center Research Institute, Tufts University School of Medicine, 509 Forest Avenue, Portland, ME 04101 USA
| | - Carla Mazefsky
- University of Pittsburgh School of Medicine, 3811 O'Hara St, Pittsburgh, PA 15213 USA
| | - Robin L Gabriels
- University of Colorado School of Medicine, Children's Hospital Colorado, 13123 E. 16th Avenue, Aurora, CO 80045 USA
| | - Craig Erickson
- University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 4002, Cincinnati, OH 45229 USA
| | - Desmond Kaplan
- University of Maryland School of Medicine, Sheppard Pratt Health System, 6501 N. Charles Street, Baltimore, MD 21204 USA
| | - Eric M Morrow
- Brown University, Lab for Molecular Medicine, 70 Ship Street, Providence, RI USA ; Rhode Island Consortium of Autism Research and Treatment (RI-CART), Developmental Disorders Genetics Research Program, Emma Pendleton Bradley Hospital and Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 1011 Veteran Memorial Pkwy, East Providence, RI 02915 USA
| | - Logan Wink
- University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 4002, Cincinnati, OH 45229 USA
| | - Susan L Santangelo
- Maine Medical Center and Maine Medical Center Research Institute, Tufts University School of Medicine, 66 Bramhall Street, Portland, ME 04102 USA
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13
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Abstract
IMPORTANCE Although autism spectrum disorder (ASD) is known to be heritable, patterns of inheritance of subclinical autistic traits in nonclinical samples are poorly understood. OBJECTIVE To examine the familiality of Social Responsiveness Scale (SRS) scores of individuals with and without ASD. DESIGN, SETTING, AND PARTICIPANTS We performed a nested case-control study (pilot study: July 1, 2007, through June 30, 2009; full-scale study: September 15, 2008, through September 14, 2012) within a population-based longitudinal cohort. Participants were drawn from the Nurses' Health Study II, a cohort of 116,430 female nurses recruited in 1989. Case participants were index children with reported ASD; control participants were frequency matched by year of birth of case participants among those not reporting ASD. Of 3161 eligible participants, 2144 nurses (67.8%) returned SRS forms for a child and at least 1 parent and were included in these analyses. EXPOSURE The SRS scores, as reported by nurse mothers and their spouses, were examined in association with risk of ASD using crude and adjusted logistic regression analyses. The SRS scores of the children were examined in association with SRS scores of the parents using crude and adjusted linear regression analyses stratified by case status. MAIN OUTCOMES AND MEASURES Autism spectrum disorder, assessed by maternal report, validated in a subgroup with the Autism Diagnostic Interview-Revised. RESULTS A total of 1649 individuals were included in these analyses, including 256 ASD case participants, 1393 control participants, 1233 mothers, and 1614 fathers. Risk of ASD was increased by 85.0% among children whose parents had concordantly elevated SRS scores (odds ratio [OR], 1.85; 95% CI, 1.08-3.16) and by 52.0% when the score of either parent was elevated (OR, 1.52; 95% CI, 1.11-2.06). Elevated scores of the father significantly increased the risk of ASD in the child (OR, 1.94; 95% CI, 1.38-2.71), but no association was seen with elevated scores of the mother. Elevated parent scores significantly increased child scores in controls, corresponding to an increase in 23 points (P < .001). CONCLUSIONS AND RELEVANCE These findings support the role of additive genetic influences in concentrating inherited ASD susceptibility in successive generations and the potential role of preferential mating, and suggest that typical variation in parental social functioning can produce clinically significant differences in offspring social traits.
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Affiliation(s)
- Kristen Lyall
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA,Department of Public Health Sciences, University of California, Davis, Davis, CA
| | | | - Marc G. Weisskopf
- Department of Epidemiology, Harvard School of Public Health,Department of Environmental Health, Harvard School of Public Health, Boston, MA
| | - Andrea L. Roberts
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston MA
| | - Alberto Ascherio
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA,Department of Epidemiology, Harvard School of Public Health,Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Susan L. Santangelo
- Department of Epidemiology, Harvard School of Public Health,Department of Psychiatry, Maine Medical Center/Maine Medical Center Research Institute, Portland, ME
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14
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Chang SC, Pauls DL, Lange C, Sasanfar R, Santangelo SL. Sex-specific association of a common variant of the XG gene with autism spectrum disorders. Am J Med Genet B Neuropsychiatr Genet 2013; 162B:742-50. [PMID: 24132906 DOI: 10.1002/ajmg.b.32165] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 03/26/2013] [Indexed: 11/11/2022]
Abstract
Autism spectrum disorders (ASD) are much more common in males than in females. Studies using both linkage and candidate gene association approaches have identified genetic variants specific to families in which all affected cases were male, suggesting that sex may interact with or otherwise influence the expression of specific genes in association with ASD. In this study, we specifically evaluated the sex-specific genetic effects of ASD with a family-based genome-wide association study approach using the data from the Autism Genetic Resource Exchange repository. We evaluated the male-specific genetic effects of ASD in 374 multiplex families of European ancestry in which all affected were male (male-only; MO) and identified a novel genome-wide significant association in the pseudoautosomal boundary on chromosome Xp22.33/Yp11.31 in the MO families of predominantly paternal origin (rs2535443, p = 3.8 × 10(-8) ). Five markers that reside within a 550 kb intergenic region on chromosome 13q33.3, between the MYO16 and IRS2 genes, also showed suggestive association with ASD in the MO families (p = 3.3 × 10(-5) to 5.3 × 10(-7) ). In contrast, none of these markers appeared to be associated with ASD in the families containing any affected females. Our results suggest that the pseudoautosomal boundary on Xp22.33/Yp11.31 may harbor male-specific genetic variants for ASD.
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Affiliation(s)
- Shun-Chiao Chang
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts; Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts
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15
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Abstract
Our goal in this study was to determine whether maternal fat intake before or during pregnancy was associated with risk of autism spectrum disorder (ASD) in the offspring. Our primary analysis included 317 mothers who reported a child with ASD and 17,728 comparison mothers from the Nurses' Health Study II (index births in 1991-2007). Dietary information was collected prospectively through a validated food frequency questionnaire. Binomial regression was used to estimate crude and adjusted risk ratios. Maternal intake of linoleic acid was significantly inversely associated with ASD risk in offspring, corresponding to a 34% reduction in risk in the highest versus lowest quartiles of intake. Mothers in the lowest 5% of ω-3 fatty acid intake had a significant increase in offspring ASD risk as compared with the remaining distribution (risk ratio = 1.53, 95% confidence interval: 1.00, 2.32); this association was also seen in the subgroup of women (86 cases and 5,798 noncases) for whom dietary information during pregnancy was available (risk ratio = 2.42, 95% confidence interval: 1.19, 4.91). Thus, variations in intake of polyunsaturated fats within the range commonly observed among US women could affect fetal brain development and ASD risk. Because the number of women with diet assessed during pregnancy was small, however, these results should be interpreted cautiously.
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Affiliation(s)
- Kristen Lyall
- Harvard School of Public Health, 655 Huntington Avenue, Building II 3rd Floor, Boston MA 02115, USA.
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16
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Karmacharya D, Yu D, Dixit S, Rajbhandari R, Subedi B, Shrestha S, Manandhar S, Santangelo SL. A study of the prevalence and risk factors leading to HIV infection among a sample of street children and youth of Kathmandu. AIDS Res Ther 2012; 9:25. [PMID: 22929124 PMCID: PMC3472290 DOI: 10.1186/1742-6405-9-25] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 08/14/2012] [Indexed: 11/10/2022] Open
Abstract
Background The true prevalence of HIV and other sexually transmitted diseases among street children in Nepal is virtually unknown while information on related behavioural risk factors in this population is non-existent. The risk of HIV infection among street children and adolescents may be especially high due to their marginalized social and economic conditions. This study was conducted to determine the prevalence of HIV infection among a sample of street children and youth of Kathmandu and to identify risk factors associated with HIV infection in this group. A sample of street children and youth was recruited based on the purposive sampling of ten streets in Kathmandu, Nepal, known to have a high density of street children and youth. A total of 251 street children (aged 11–16 years) and youth (aged 17–24 years) were enrolled, with informed consent, from November, 2008 through June, 2009. Most of the participants (95%) were male. Case status was determined by serological assessment of HIV status; data on risk factors were obtained using structured survey interviews. HIV prevalence and rates of a number of behavioural risk factors suspected to play a role in HIV transmission among street children and youth were determined, including unprotected sex, intravenous drug use, and other risky sex and substance use behaviours. Results Among the 251 children and youth, we found an overall HIV prevalence of 7.6%. As the sample size of females was small (n = 13) and the behavioural risk factors are likely to be quite different for boys and girls, we conducted separate analyses by gender. As our small sample of females is unlikely to be representative and lacks power for statistical testing, our report focuses on the results for the males surveyed.The strongest behavioural risk factor to emerge from this study was intravenous drug use; 30% of the male subjects were injecting drug users and 20% of those were HIV positive. Furthermore, frequency of drug injection was a highly significant predictor with a dose–response relationship; males reporting occasional injection drug use were nearly 9 times more likely to be HIV positive than never users, while weekly drug injectors had over 46 times the risk of non-users, controlling for exposure to group sex, the only other significant risk factor in the multivariate model. Conclusions This sample of street children and youth of Kathmandu has a nearly 20-fold higher prevalence of HIV infection than the general population of Nepal (0.39%). The children and youth engage in number of high risk behaviours, including intravenous drug use, putting them at significant risk of contracting HIV and other sexually transmitted infections.
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17
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Robinson EB, Munir K, McCormick MC, Koenen KC, Santangelo SL. Brief report: no association between parental age and extreme social-communicative autistic traits in the general population. J Autism Dev Disord 2012; 41:1733-7. [PMID: 21350918 DOI: 10.1007/s10803-011-1202-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This is the first investigation of the relationship between parental age and extreme social-communicative autistic traits in the general population. The parents of 5,246 children in the Avon Longitudinal Study of Parents and Children (ALSPAC) completed the Social and Communication Disorders Checklist (SCDC). The association between parental age and SCDC scores was assessed in the full sample and among high scoring individuals (e.g. top 5%, 1%). There was no association between parental age and social-communicative autistic traits in the general population. Neither maternal nor paternal age was associated with extreme scores. These findings suggest that advanced parental age does not confer increased risk for extreme social and communication impairment assessed quantitatively.
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Affiliation(s)
- Elise B Robinson
- Department of Epidemiology, Harvard School of Public Health, Simches Research Building, Boston, MA 02114, USA.
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18
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Abstract
BACKGROUND An increasing number of women are utilizing fertility treatments, but little is known about their relation to autism spectrum disorders (ASD). METHODS To determine the association between maternal fertility therapy use and risk of having a child with ASD, we conducted a nested case-control study within the Nurses' Health Study II (n = 116,430). Maternally reported diagnoses of ASD were confirmed through a supplementary questionnaire and, in a subgroup, the Autism Diagnostic Interview-Revised. Controls were randomly selected by frequency matching to case children's year of birth. Associations were examined by self-reported infertility and type of therapy using conditional logistic regression. RESULTS In all, 9% of the 507 cases and 7% of 2,529 controls indicated fertility therapy use for the index pregnancy. No significant associations with self-reported fertility therapies or history of infertility were seen in primary analyses. In subgroup analyses of women with maternal age ≥ 35 years (n = 1,020), artificial insemination was significantly associated with ASD; ovulation inducing drug (OID) use was significantly associated in crude but not adjusted analyses (odds ratio 1.81, 95% CI 0.96-3.42). Results were similar by diagnostic subgroup, though within the advanced maternal age group, OID and artificial insemination were significantly associated with Asperger syndrome and pervasive developmental disorder not-otherwise specified, but not autistic disorder. CONCLUSION [corrected] Assisted reproductive therapy and history of infertility did not increase risk of having a child with ASD in this study. However, the associations observed with OID and artificial insemination among older mothers, for whom these exposures are more common, warrant further investigation.
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Affiliation(s)
- Kristen Lyall
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA.
| | - David L. Pauls
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA,Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Donna Spiegelman
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA,Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA
| | - Susan L. Santangelo
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA,Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Alberto Ascherio
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA,Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA,Department of Medicine, Channing Laboratory, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
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19
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Lyall K, Pauls DL, Spiegelman D, Ascherio A, Santangelo SL. Pregnancy complications and obstetric suboptimality in association with autism spectrum disorders in children of the Nurses' Health Study II. Autism Res 2011; 5:21-30. [PMID: 21972225 DOI: 10.1002/aur.228] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2010] [Accepted: 07/20/2011] [Indexed: 11/07/2022]
Abstract
The authors examined pregnancy and obstetric complications in association with autism spectrum disorders (ASD) in children of participants from the Nurses' Health Study II, a prospective national cohort with information collected through biennial mailed questionnaires since 1989. Logistic regression was used to obtain crude and adjusted odds ratios for ASD, and by diagnostic subgroup. Seven hundred and ninety-three cases were reported among 66,445 pregnancies. Pregnancy complications and obstetric suboptimality factors were assessed by maternal report of occurrence in first birth and, in secondary analyses, in any birth. Complications and a suboptimality score were significantly associated with having a child with ASD (OR 1.49, 95% CI 1.26, 1.77, P<0.0001 for pregnancy complications in first birth and 2.76, 95% CI 2.04, 3.74, P<0.0001 comparing individuals with four or more obstetric suboptimality factors in first birth to those with none; results similar when assessed in any birth). In particular, gestational diabetes was associated with a significantly increased risk of ASD in results of primary and sensitivity analyses (OR in primary analysis = 1.76, 95% CI 1.34, 2.32, P<0.0001); suboptimal parity and suboptimal age-at-first-birth were also individual factors associated with ASD. Associations were similar by diagnostic subgroup, suggesting autism, Asperger syndrome, and other Pervasive Developmental Disorders are all associated with pregnancy complications. Consistent with previous research, the general class of pregnancy complications was associated with ASD as a whole. Additional work will be required to more fully assess the role of gestational diabetes.
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Affiliation(s)
- Kristen Lyall
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts 02115, USA.
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20
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Lyall K, Pauls DL, Santangelo SL, Santangelo S, Spiegelman D, Ascherio A. Maternal early life factors associated with hormone levels and the risk of having a child with an autism spectrum disorder in the nurses health study II. J Autism Dev Disord 2011; 41:618-27. [PMID: 20700638 DOI: 10.1007/s10803-010-1079-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
It is not known whether reproductive factors early in the mother's life influence risk of autism spectrum disorders (ASD). We assessed maternal age at menarche, menstrual cycle characteristics during adolescence, oral contraceptive use prior to first birth, body shape, and body mass index (BMI) in association with ASD using binomial regression in a cohort study of 61,596 women, including 743 cases. Overall, early life factors were not associated with ASD, though early age at menarche (RR for age 10 or less = 1.54, 95% CI 1.18, 2.02, p = 0.0002) and BMI at age 18 of ≥30 (RR 2.03, 95% CI 1.34, 3.08, p = 0.0008) were significantly associated with increased risk of ASD. Further work should investigate the potential influence of these factors.
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Affiliation(s)
- Kristen Lyall
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
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21
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Chang SC, Pauls DL, Lange C, Sasanfar R, Santangelo SL. Common genetic variation in the GAD1 gene and the entire family of DLX homeobox genes and autism spectrum disorders. Am J Med Genet B Neuropsychiatr Genet 2011; 156:233-9. [PMID: 21302352 PMCID: PMC3088769 DOI: 10.1002/ajmg.b.31148] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Accepted: 10/26/2010] [Indexed: 12/13/2022]
Abstract
Biological and positional evidence supports the involvement of the GAD1 and distal-less homeobox genes (DLXs) in the etiology of autism. We investigated 42 single nucleotide polymorphisms in these genes as risk factors for autism spectrum disorders (ASD) in a large family-based association study of 715 nuclear families. No single marker showed significant association after correction for multiple testing. A rare haplotype in the DLX1 promoter was associated with ASD (P-value = 0.001). Given the importance of rare variants to the etiology of autism revealed in recent studies, the observed rare haplotype may be relevant to future investigations. Our observations, when taken together with previous findings, suggest that common genetic variation in the GAD1 and DLX genes is unlikely to play a critical role in ASD susceptibility.
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Affiliation(s)
- Shun-Chiao Chang
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
| | - David L. Pauls
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA, Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, Massachusetts General Hospital, Boston, Massachusetts, USA, Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Christoph Lange
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA, Channing Laboratories, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Roksana Sasanfar
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, Massachusetts General Hospital, Boston, Massachusetts, USA, Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Susan L. Santangelo
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA, Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, Massachusetts General Hospital, Boston, Massachusetts, USA, Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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Sasanfar R, Haddad SA, Tolouei A, Ghadami M, Yu D, Santangelo SL. Paternal age increases the risk for autism in an Iranian population sample. Mol Autism 2010; 1:2. [PMID: 20678245 PMCID: PMC2907564 DOI: 10.1186/2040-2392-1-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Accepted: 02/22/2010] [Indexed: 11/10/2022] Open
Abstract
Background Autism is a neurodevelopmental disorder which is known to have a strong genetic component and is most likely oligogenic. However, the necessary role of environmental factors has been well documented. Prior research suggests that parental characteristics, such as age and level of education, may be associated with a risk of autism. Parental age has been shown to be associated with many disorders, such as schizophrenia, childhood cancer and fetal death. However, results from studies of parental age and autism are inconsistent. Methods In the present study, we investigated the association of autism with parental age in 179 autism cases and 1611 matched cohort children from Iran. Each case was matched with nine cohort controls on parental education, sex, order of birth, consanguineous marriage, urbanism and province of residence. The Cox regression model was used to carry out conditional logistic regression on the matched data. Results There was a significant association between higher paternal age, but not maternal age, and an increasing risk of autism. An analysis of the combined effect of parental age and education also revealed that parents with higher education had an increased risk of having autistic children, with a dose-response effect of parental age. Conclusions This study, which is the first epidemiological study of autism in Iran, provides evidence of the association of paternal age and risk of autism.
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Affiliation(s)
- Roksana Sasanfar
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
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Craddock N, Kendler K, Neale M, Nurnberger J, Purcell S, Rietschel M, Perlis R, Santangelo SL, Schulze TG, Schulze T, Smoller JW, Thapar A. Dissecting the phenotype in genome-wide association studies of psychiatric illness. Br J Psychiatry 2009; 195:97-9. [PMID: 19648536 PMCID: PMC4739810 DOI: 10.1192/bjp.bp.108.063156] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Over the past 2 years genome-wide association studies have made major contributions to understanding the genetic architecture of many common human diseases. This editorial outlines the development of such studies in psychiatry and highlights the opportunities for advancing understanding of the biological underpinnings and nosological structure of psychiatric disorders.
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Abstract
BACKGROUND Age-related macular degeneration (AMD) is the leading cause of visual impairment and blindness among older adults in the United States and throughout the developed world. Etiological research implicates both genetic and environmental components. Our prior genome scan in 511 affected sib-pairs and other relative pairs identified significant or suggestive linkage signals on chromosomes 1, 2, 3, 6, 8, 10, 12, 16, and 22. PURPOSE To search for genetic loci for AMD using the extremely discordant sib-pair (EDSP) method of linkage analysis, which until now has never been applied to the study of AMD. METHODS The EDSP method is a more powerful approach than standard methods which rely on relative pairs selected at random or pairs concordant for the phenotype. The EDSP approach has also been characterized as the only design that is uniformly powerful in nearly all genetic situations. Thus, substantial reductions in sample size can be achieved. STUDY POPULATION The study sample for analysis included 110 EDSPs from 40 families that comprise a subset of the 158 families studied in a prior genome-wide scan using affected relative pairs. RESULTS Evidence for linkage was found on chromosomes 1q, 2q, 6q, 19p, and 20q. The regions identified on chromosomes 1q and 2q were the same regions identified in our prior analysis, whereas the identified region on 6q was approximately 80 cM distal to our previous signal. DISCUSSION Within this study population, we have narrowed the focus to chromosomes 1q, 2q, 6q, 19p, and 20q in our search for AMD loci. However, given the fact that a gene was recently identified on chromosome 1q, future family- and population-based analyses should concentrate on testing for associations with candidate gene variants in the other identified chromosomal regions in searches for additional AMD loci.
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MESH Headings
- Chromosome Mapping
- Chromosomes, Human/genetics
- Chromosomes, Human, Pair 1/genetics
- Chromosomes, Human, Pair 19/genetics
- Chromosomes, Human, Pair 2/genetics
- Chromosomes, Human, Pair 20/genetics
- Chromosomes, Human, Pair 6/genetics
- Genetic Linkage
- Genetic Predisposition to Disease
- Genotype
- Humans
- Intraocular Pressure
- Lod Score
- Macular Degeneration/genetics
- Microsatellite Repeats
- Siblings
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Affiliation(s)
- Susan L Santangelo
- Psychiatric & Neurodevelopmental Genetics Unit, Center for Human Genetic Research, Massachusetts General Hospital, 149 13th Street, Charlestown, MA, USA.
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Abstract
The serotonin transporter gene (5-HTT) plays a crucial role in serotonergic neurotransmission and has been found to be associated, with varying degrees of significance, with many diseases, including autism. Prior association studies of autism have yielded conflicting results regarding the association between two common 5-HTT polymorphisms, the promoter insertion/deletion (5-HTTLPR) and the intron 2 VNTR (STin2 VNTR). We conducted a systematic review and meta-analysis to test the following hypotheses: (i) there is an association between autism and either or both of the 5-HTTLPR and STin2 VNTR polymorphisms, and (ii) the S allele of 5-HTTLPR and/or the STin2.12 allele of the VNTR are the specific risk alleles for autism. All published family-based and population based studies were examined to determine the overall strength of association between 5-HTT polymorphisms and autism. After exclusion of studies with overlapping samples and studies whose data did not allow for calculation of an odds ratio, 16 studies were included for final analyses, all but two of which used a family-based design. The meta-analysis failed to find a significant overall association between either of the 5-HTT polymorphisms examined and autism. Further, no allelic transmission distortion was found when studies of simplex (11 studies) and multiplex (3 studies) family samples were analyzed separately. However, there was significant heterogeneity by ethnicity; family based studies of US mixed population samples showed preferential transmission of the S allele of 5-HTTLPR (S allele:L allele = 247:183), while there was no allelic distortion among the family-based studies of European and Asian samples.
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Affiliation(s)
- Christine H Huang
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
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Weiss LA, Shen Y, Korn JM, Arking DE, Miller DT, Fossdal R, Saemundsen E, Stefansson H, Ferreira MAR, Green T, Platt OS, Ruderfer DM, Walsh CA, Altshuler D, Chakravarti A, Tanzi RE, Stefansson K, Santangelo SL, Gusella JF, Sklar P, Wu BL, Daly MJ. Association between microdeletion and microduplication at 16p11.2 and autism. N Engl J Med 2008; 358:667-75. [PMID: 18184952 DOI: 10.1056/nejmoa075974] [Citation(s) in RCA: 1162] [Impact Index Per Article: 72.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Autism spectrum disorder is a heritable developmental disorder in which chromosomal abnormalities are thought to play a role. METHODS As a first component of a genomewide association study of families from the Autism Genetic Resource Exchange (AGRE), we used two novel algorithms to search for recurrent copy-number variations in genotype data from 751 multiplex families with autism. Specific recurrent de novo events were further evaluated in clinical-testing data from Children's Hospital Boston and in a large population study in Iceland. RESULTS Among the AGRE families, we observed five instances of a de novo deletion of 593 kb on chromosome 16p11.2. Using comparative genomic hybridization, we observed the identical deletion in 5 of 512 children referred to Children's Hospital Boston for developmental delay, mental retardation, or suspected autism spectrum disorder, as well as in 3 of 299 persons with autism in an Icelandic population; the deletion was also carried by 2 of 18,834 unscreened Icelandic control subjects. The reciprocal duplication of this region occurred in 7 affected persons in AGRE families and 4 of the 512 children from Children's Hospital Boston. The duplication also appeared to be a high-penetrance risk factor. CONCLUSIONS We have identified a novel, recurrent microdeletion and a reciprocal microduplication that carry substantial susceptibility to autism and appear to account for approximately 1% of cases. We did not identify other regions with similar aggregations of large de novo mutations.
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Abstract
Age-related macular degeneration (AMD) is the leading cause of vision loss and blindness among older adults in the USA and throughout the developed world. Etiological research suggests that AMD is a complex disease, caused by the actions and interactions of multiple genes and environmental factors. Familial aggregation studies, twin studies, and segregation analyses have provided strong evidence for the heritability of AMD, and linkage and association studies have been conducted to localize the disease-causing genes. Whole genome linkage scans have implicated nearly every chromosome in the human genome, with the most replicated signals residing on 1q25-31 and 10q26. Association studies have identified a major risk variant within the complement factor H gene (CFH), and recent reports suggest that PLEKHA1/LOC387715 and the BF/C2 regions may be major risk loci for AMD as well. Several other genes have had at least one positive association finding and deserve further exploration. Among these, apolipoprotein E (APOE) may be a minor risk locus. Additional genes will likely be identified, and future studies should explore the potential interactions of these genes with other genes as well as environmental factors.
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Affiliation(s)
- Stephen Haddad
- Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, 02114, USA
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Fisher SA, Abecasis GR, Yashar BM, Zareparsi S, Swaroop A, Iyengar SK, Klein BEK, Klein R, Lee KE, Majewski J, Schultz DW, Klein ML, Seddon JM, Santangelo SL, Weeks DE, Conley YP, Mah TS, Schmidt S, Haines JL, Pericak-Vance MA, Gorin MB, Schulz HL, Pardi F, Lewis CM, Weber BHF. Meta-analysis of genome scans of age-related macular degeneration. Hum Mol Genet 2005; 14:2257-64. [PMID: 15987700 DOI: 10.1093/hmg/ddi230] [Citation(s) in RCA: 167] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
A genetic contribution to the development of age-related macular degeneration (AMD) is well established. Several genome-wide linkage studies have identified a number of putative susceptibility loci for AMD but only a few of these regions have been replicated in independent studies. Here, we perform a meta-analysis of six AMD genome screens using the genome-scan meta-analysis method, which allows linkage results from several studies to be combined, providing greater power to identify regions that show only weak evidence for linkage in individual studies. Results from non-parametric analysis for a broad AMD clinical phenotype (including two studies with quantitative traits) were extracted. For each study, 120 genomic bins of approximately 30 cM were defined and ranked according to maximum evidence for linkage within each bin. Bin ranks were weighted according to study size and summed across all studies; the summed rank (SR) for each bin was assessed empirically for significance using permutation methods. A high SR indicates a region with consistent evidence for linkage across studies. The strongest evidence for an AMD susceptibility locus was found on chromosome 10q26 where genome-wide significant linkage was observed (P=0.00025). Several other regions met the empirical significance criteria for bins likely to contain linked loci including adjacent pairs of bins on chromosomes 1q, 2p, 3p and 16. Several of the regions identified here showed only weak evidence for linkage in the individual studies. These results will help prioritize regions for future positional and functional candidate gene studies in AMD.
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Affiliation(s)
- Sheila A Fisher
- Department of Medical and Molecular Genetics, Guy's, King's and St Thomas' School of Medicine, King's College London, London SE1 9RT, UK.
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Abstract
Autism is a neurodevelopmental disorder of genetic origins, with a heritability of about 90%. Autistic disorder is classed within the broad domain of pervasive developmental disorders (PDD) that also includes Rett syndrome, childhood disintegrative disorder, Asperger syndrome, and PDD not otherwise specified (PDD-NOS). Prevalence estimates suggest a rate of 0.1-0.2% for autism and 0.6% for the range of PDD disorders. There is considerable phenotypic heterogeneity within this class of disorders as well as continued debate regarding their clinical boundaries. Autism is the prototypical PDD, and is characterized by impairments in three core domains: social interaction, language development, and patterns of behavior (restricted and stereotyped). Clinical pattern and severity of impairment vary along these dimensions, and the level of cognitive functioning of individuals with autism spans the entire range, from profound mental retardation to superior intellect. There is no single biological or clinical marker for autism, nor is it expected that a single gene is responsible for its expression; as many as 15+ genes may be involved. However, environmental influences are also important, as concordance in monozygotic twins is less than 100% and the phenotypic expression of the disorder varies widely, even within monozygotic twins. Multiple susceptibility factors are being explored using varied methodologies, including genome-wide linkage studies, and family- and case-control candidate gene association studies. This paper reviews what is currently known about the genetic and environmental risk factors, neuropathology, and psychopharmacology of autism. Discussion of genetic factors focuses on the findings from linkage and association studies, the results of which have implicated the involvement of nearly every chromosome in the human genome. However, the most consistently replicated linkage findings have been on chromosome 7q, 2q, and 15q. The positive associations from candidate gene studies are largely unreplicated, with the possible exceptions of the GABRB3 and serotonin transporter genes. No single region of the brain or pathophysiological mechanism has yet been identified as being associated with autism. Postmortem findings, animal models, and neuroimaging studies have focused on the cerebellum, frontal cortex, hippocampus, and especially the amygdala. The cerebello-thalamo-cortical circuit may also be influential in autism. There is evidence that overall brain size is increased in some individuals with autism. Presently there are no drugs that produce major improvements in the core social or pragmatic language deficits in autism, although several have limited effects on associated behavioral features. The application of new techniques in autism research is being proposed, including the investigation of abnormal regulation of gene expression, proteomics, and the use of MRI and postmortem analysis of the brain.
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Affiliation(s)
- Susan L Santangelo
- Psychiatric & Neurodevelopmental Genetics Unit, Center for Human Genetic Research, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA.
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Hutcheson HB, Olson LM, Bradford Y, Folstein SE, Santangelo SL, Sutcliffe JS, Haines JL. Examination of NRCAM, LRRN3, KIAA0716, and LAMB1 as autism candidate genes. BMC Med Genet 2004; 5:12. [PMID: 15128462 PMCID: PMC420465 DOI: 10.1186/1471-2350-5-12] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2003] [Accepted: 05/05/2004] [Indexed: 11/10/2022]
Abstract
BACKGROUND A substantial body of research supports a genetic involvement in autism. Furthermore, results from various genomic screens implicate a region on chromosome 7q31 as harboring an autism susceptibility variant. We previously narrowed this 34 cM region to a 3 cM critical region (located between D7S496 and D7S2418) using the Collaborative Linkage Study of Autism (CLSA) chromosome 7 linked families. This interval encompasses about 4.5 Mb of genomic DNA and encodes over fifty known and predicted genes. Four candidate genes (NRCAM, LRRN3, KIAA0716, and LAMB1) in this region were chosen for examination based on their proximity to the marker most consistently cosegregating with autism in these families (D7S1817), their tissue expression patterns, and likely biological relevance to autism. METHODS Thirty-six intronic and exonic single nucleotide polymorphisms (SNPs) and one microsatellite marker within and around these four candidate genes were genotyped in 30 chromosome 7q31 linked families. Multiple SNPs were used to provide as complete coverage as possible since linkage disequilibrium can vary dramatically across even very short distances within a gene. Analyses of these data used the Pedigree Disequilibrium Test for single markers and a multilocus likelihood ratio test. RESULTS As expected, linkage disequilibrium occurred within each of these genes but we did not observe significant LD across genes. None of the polymorphisms in NRCAM, LRRN3, or KIAA0716 gave p < 0.05 suggesting that none of these genes is associated with autism susceptibility in this subset of chromosome 7-linked families. However, with LAMB1, the allelic association analysis revealed suggestive evidence for a positive association, including one individual SNP (p = 0.02) and three separate two-SNP haplotypes across the gene (p = 0.007, 0.012, and 0.012). CONCLUSIONS NRCAM, LRRN3, KIAA0716 are unlikely to be involved in autism. There is some evidence that variation in or near the LAMB1 gene may be involved in autism.
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Affiliation(s)
- Holli B Hutcheson
- Center for Human Genetics Research and Department of Molecular Physiology and Biophysics, Vanderbilt University Medical Center, Nashville, TN, 37027, U.S.A
- Laboratory of Genomic Diversity, National Cancer Institute, Frederick Cancer Research and Development Center, Frederick, MD, 21702, U.S.A
| | - Lana M Olson
- Center for Human Genetics Research and Department of Molecular Physiology and Biophysics, Vanderbilt University Medical Center, Nashville, TN, 37027, U.S.A
| | - Yuki Bradford
- Center for Human Genetics Research and Department of Molecular Physiology and Biophysics, Vanderbilt University Medical Center, Nashville, TN, 37027, U.S.A
| | - Susan E Folstein
- Department of Psychiatry, New England Medical Center/Tufts University School of Medicine, Boston, MA, 02111, U.S.A
| | - Susan L Santangelo
- Psychiatric & Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, MA, 02129, U.S.A
| | - James S Sutcliffe
- Center for Human Genetics Research and Department of Molecular Physiology and Biophysics, Vanderbilt University Medical Center, Nashville, TN, 37027, U.S.A
| | - Jonathan L Haines
- Center for Human Genetics Research and Department of Molecular Physiology and Biophysics, Vanderbilt University Medical Center, Nashville, TN, 37027, U.S.A
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Abstract
BACKGROUND Because high blood pressure, altered lipid levels, obesity, and diabetes so frequently occur together, they are sometimes collectively referred to as the metabolic syndrome. While there have been many studies of each metabolic syndrome trait separately, few studies have attempted to analyze them combined, i.e., as one composite variable, in quantitative trait linkage or association analysis. We used genotype and phenotype data from the Framingham Heart Study to perform a full-genome scan for quantitative trait loci underlying the metabolic syndrome. RESULTS Heritability estimates for all of the covariate-adjusted and age- and gender-standardized individual traits, and the composite metabolic syndrome trait, were all fairly high (0.39-0.62), and the composite trait was among the highest at 0.61. The composite trait yielded no regions with suggestive linkage by Lander and Kruglyak's criteria, although there were several noteworthy regions for individual traits, some of which were also observed for the composite variable. CONCLUSION Despite its high heritability, the composite metabolic syndrome trait variable did not increase the power to detect or localize linkage peaks in this sample. However, this strategy and related methods of combining correlated individual traits deserve further investigation, particularly in settings with complex causal pathways.
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Affiliation(s)
- Matthew B McQueen
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Lars Bertram
- Genetics and Aging Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
| | - Eric B Rimm
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Deborah Blacker
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
- Gerontology Research Unit, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
| | - Susan L Santangelo
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
- Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
- Center for Human Genetics Research, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
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Shenassa ED, McCaffery JM, Swan GE, Khroyan TV, Shakib S, Lerman C, Lyons M, Mouttapa M, Niaura RS, Buka SL, Leslie F, Santangelo SL. Intergenerational transmission of tobacco use and dependence: A transdisciplinary perspective. Nicotine Tob Res 2003; 5 Suppl 1:S55-69. [PMID: 14668087 DOI: 10.1080/14622200310001625500] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Numerous questions remain regarding the intergenerational transmission of tobacco use and dependence, and some of these questions are best approached from a transdisciplinary perspective. For example, considering both genetic and environmental influences on cigarette smoking promises to be a fruitful venue for future investigations. In this paper, we consider the evidence regarding intergenerational influences on the transmission of tobacco use and nicotine dependence in both humans and animal models; our focus will be on genetic influences, in utero exposure to nicotine, and some postnatal influences. Research gaps that exist between scientific disciplines are highlighted, and some directions for future research are suggested.
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Affiliation(s)
- Edmond D Shenassa
- Brown Medical School, Centers for Behavioral & Preventive Medicine, Providence, RI 02903, USA.
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Seddon JM, Santangelo SL, Book K, Chong S, Cote J. A genomewide scan for age-related macular degeneration provides evidence for linkage to several chromosomal regions. Am J Hum Genet 2003; 73:780-90. [PMID: 12945014 PMCID: PMC1180601 DOI: 10.1086/378505] [Citation(s) in RCA: 165] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2003] [Accepted: 07/08/2003] [Indexed: 11/04/2022] Open
Abstract
We report the results of a genomewide scan for age-related macular degeneration (AMD) in 158 multiplex families. AMD classification was based on fundus photography and was assigned a grade ranging from 1 (no disease) to 5 (exudative disease). Genotyping was performed by the National Heart, Lung, and Blood Institute Mammalian Genotyping Service at Marshfield (404 short tandem repeat markers). The sample included 158 families with two or more siblings with AMD, 490 affected individuals, 101 unaffected individuals, and 38 whose affection status was unknown. Relative pairs included 511 affected sibling, 28 avuncular, 53 cousin, 7 grandparent-grandchild, and 9 grand-avuncular pairs. Two-point parametric and multipoint parametric and nonparametric analyses were performed. Maximum two-point LOD scores of 1.0-2.0 were found for markers on chromosomes 1, 2, 8, 10, 14, 15, and 22. Multipoint analyses were consistent with the two-point results for chromosomes 1, 2, 8, 10, and 22 and provided evidence for additional linkage regions on chromosomes 3, 6, 8, 12, 16, and X. Our signals on chromosomes 1q, 6p, and 10q are consistent with some other previously published results. Significant linkage to AMD was found for one marker on chromosome 2, two adjacent markers on chromosome 3, two adjacent markers on chromosome 6, and seven contiguous markers on chromosome 8, with empirical P values of .00001. The consistency of many of the other signals across both two-point and multipoint, as well as parametric and nonparametric, analyses indicate several other regions worthy of follow-up.
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Affiliation(s)
- Johanna M Seddon
- Ophthalmology/Epidemiology Unit, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA.
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Hutcheson HB, Bradford Y, Folstein SE, Gardiner MB, Santangelo SL, Sutcliffe JS, Haines JL. Defining the autism minimum candidate gene region on chromosome 7. Am J Med Genet B Neuropsychiatr Genet 2003; 117B:90-6. [PMID: 12555242 DOI: 10.1002/ajmg.b.10033] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Previous genetic and cytogenetic studies provide evidence that points to one or more autism susceptibility genes residing on chromosome 7q (AUTS1, 115-149 cM on the Marshfield map). However, further localization using linkage analysis has proven difficult. To overcome this problem, we examined the Collaborative Linkage Study of Autism (CLSA) data-set to identify only the families potentially linked to chromosome 7. Out of 94, 47 families were identified and 17 markers were used to generate chromosomal haplotypes. We performed recombination breakpoint analysis to determine if any portion of the chromosome was predominately shared across families. The most commonly shared region spanned a 6 cM interval between D7S501 and D7S2847. Additional markers at 1 cM intervals within this region were genotyped and association and recombination breakpoint analysis was again performed. Although no significant allelic association was found, the recombination breakpoint data points to a shared region between D7S496-D7S2418 (120-123 cM) encompassing about 4.5 Mb of genomic DNA containing over 50 genes.
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Affiliation(s)
- Holli B Hutcheson
- Department of Molecular Physiology and Biophysics, Program in Human Genetics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
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Van Eerdewegh P, Dowd M, Dupuis J, Falls K, Hayward B, Santangelo SL. On the detection of linkage in multiple data sets: a comparison of various statistical approaches. Genet Epidemiol 2002; 21 Suppl 1:S67-72. [PMID: 11793760 DOI: 10.1002/gepi.2001.21.s1.s67] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We contrast the pooling of multiple data sets with the compound HLOD (HLOD-C) and the posterior probability of linkage (PPL), two approaches that have been shown to have more power in the presence of genetic heterogeneity. We also propose and evaluate several multipoint extensions.
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Affiliation(s)
- P Van Eerdewegh
- Genome Therapeutics Corporation, 100 Beaver Street, Waltham, MA 02453, USA
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Nurmi EL, Bradford Y, Chen Y, Hall J, Arnone B, Gardiner MB, Hutcheson HB, Gilbert JR, Pericak-Vance MA, Copeland-Yates SA, Michaelis RC, Wassink TH, Santangelo SL, Sheffield VC, Piven J, Folstein SE, Haines JL, Sutcliffe JS. Linkage disequilibrium at the Angelman syndrome gene UBE3A in autism families. Genomics 2001; 77:105-13. [PMID: 11543639 DOI: 10.1006/geno.2001.6617] [Citation(s) in RCA: 110] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Autistic disorder is a neurodevelopmental disorder with a complex genetic etiology. Observations of maternal duplications affecting chromosome 15q11-q13 in patients with autism and evidence for linkage and linkage disequilibrium to markers in this region in chromosomally normal autism families indicate the existence of a susceptibility locus. We have screened the families of the Collaborative Linkage Study of Autism for several markers spanning a candidate region covering approximately 2 Mb and including the Angelman syndrome gene (UBE3A) and a cluster of gamma-aminobutyric acid (GABA(A)) receptor subunit genes (GABRB3, GABRA5, and GABRG3). We found significant evidence for linkage disequilibrium at marker D15S122, located at the 5' end of UBE3A. This is the first report, to our knowledge, of linkage disequilibrium at UBE3A in autism families. Characterization of null alleles detected at D15S822 in the course of genetic studies of this region showed a small (approximately 5-kb) genomic deletion, which was present at somewhat higher frequencies in autism families than in controls.
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Affiliation(s)
- E L Nurmi
- Program in Human Genetics, Department of Molecular Physiology & Biophysics, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA
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Abstract
We explored the utility of probabilistic weighting of fringe phenotypes in linkage analysis of bipolar disorder for the GAW10 chromosome 18 data. Four liability classes were assigned probabilistic weights based on the estimated probability that the case was a true bipolar. The weights were incorporated in parametric and nonparametric, single and multipoint analyses.
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Affiliation(s)
- P Van Eerdewegh
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
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Mick E, Santangelo SL, Wypij D, Biederman J. Impact of maternal depression on ratings of comorbid depression in adolescents with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 2000; 39:314-9. [PMID: 10714051 DOI: 10.1097/00004583-200003000-00013] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the degree to which indirect maternal reports of comorbid major depression (MD) in adolescents with and without attention-deficit/hyperactivity disorder (ADHD) were influenced by the mother's personal history of MD. METHOD Bivariate regression was used to model the impact of maternal depression on the direct and indirect report of MD in ADHD (n = 150) and non-ADHD (n = 123) subjects. The dependent variable (i.e., risk for MD) was modeled as a function of the main effect of ADHD, the main effect of reporter, their interaction, and higher-order interactions with maternal depression. RESULTS There was a significant interaction between maternal depression and the effect of reporter exclusively in non-ADHD control subjects. ADHD continued to be a significant risk factor for MD independent of maternal reporting or maternal depression. CONCLUSIONS The potential distortion of indirect interviews by depressed mothers may be stronger in community than in clinical settings and does not account for the increased risk for MD in referred adolescents with ADHD.
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Affiliation(s)
- E Mick
- Department of Epidemiology, Harvard School of Public Health, Boston, USA.
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Van Eerdewegh P, Dupuis J, Santangelo SL, Hayward LB, Blacker D. The importance of watching our weights: how the choice of weights for non-independent sib pairs can dramatically alter results. Genet Epidemiol 1999; 17 Suppl 1:S373-8. [PMID: 10597465 DOI: 10.1002/gepi.1370170763] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Handling non-independent sib pairs in families with multiple affected sibs presents a problem in likelihood-based nonparametric linkage analyses. We contrast the more stable partial-likelihood solution in MAPMAKER/SIBS with the extremely variable partial-likelihood approach used in ASPEX, and the potential inflation of lods when the problem is ignored as in BETA.
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Affiliation(s)
- P Van Eerdewegh
- Genome Therapeutics Corporation, Waltham, Massachusetts 02453, USA
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40
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Barrett S, Beck JC, Bernier R, Bisson E, Braun TA, Casavant TL, Childress D, Folstein SE, Garcia M, Gardiner MB, Gilman S, Haines JL, Hopkins K, Landa R, Meyer NH, Mullane JA, Nishimura DY, Palmer P, Piven J, Purdy J, Santangelo SL, Searby C, Sheffield V, Singleton J, Slager S. An autosomal genomic screen for autism. Collaborative linkage study of autism. Am J Med Genet 1999; 88:609-15. [PMID: 10581478 DOI: 10.1002/(sici)1096-8628(19991215)88:6<609::aid-ajmg7>3.3.co;2-c] [Citation(s) in RCA: 97] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Autism is a severe neurodevelopmental disorder defined by social and communication deficits and ritualistic-repetitive behaviors that are detectable in early childhood. The etiology of idiopathic autism is strongly genetic, and oligogenic transmission is likely. The first stage of a two-stage genomic screen for autism was carried out by the Collaborative Linkage Study of Autism on individuals affected with autism from 75 families ascertained through an affected sib-pair. The strongest multipoint results were for regions on chromosomes 13 and 7. The highest maximum multipoint heterogeneity LOD (MMLS/het) score is 3.0 at D13S800 (approximately 55 cM from the telomere) under the recessive model, with an estimated 35% of families linked to this locus. The next highest peak is an MMLS/het score of 2.3 at 19 cM, between D13S217 and D13S1229. Our third highest MMLS/het score of 2.2 is on chromosome 7 and is consistent with the International Molecular Genetic Study of Autism Consortium report of a possible susceptibility locus somewhere within 7q31-33. These regions and others will be followed up in the second stage of our study by typing additional markers in both the original and a second set of identically ascertained autism families, which are currently being collected. By comparing results across a number of studies, we expect to be able to narrow our search for autism susceptibility genes to a small number of genomic regions. Am. J. Med. Genet. (Neuropsychiatr. Genet.) 88:609-615, 1999.
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Affiliation(s)
- S Barrett
- The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Folstein SE, Santangelo SL, Gilman SE, Piven J, Landa R, Lainhart J, Hein J, Wzorek M. Predictors of cognitive test patterns in autism families. J Child Psychol Psychiatry 1999; 40:1117-28. [PMID: 10576540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
In a case-control study of cognitive performance, tests of intelligence, reading, spelling, and pragmatic language were administered to the parents and siblings of 90 community-ascertained probands with autism (AU group) and to the parents and siblings of 40 similarly ascertained probands with trisomy 21 Down syndrome (DS group). The two samples were comparable for age and parents' education; both groups were well-educated and had above-average intelligence. AU parents scored slightly but significantly lower on the WAIS-R Full Scale and Performance IQ, on two subtests (Picture Arrangement and Picture Completion), and on the Word Attack Test (reading nonsense words) from the Woodcock-Johnson battery. There were no differences between AU and DS siblings. As in earlier studies, AU parents, more often than DS parents, reported a history of early language-related cognitive difficulties; we were not able to replicate this in siblings. AU parents who reported such difficulties scored significantly lower on Verbal IQ, spelling, and the nonsense reading test. AU parents without a history of early language-related cognitive difficulties often had a Verbal IQ that exceeded Performance IQ by more than one standard deviation. AU siblings with early language-related difficulties had similar findings: lower Verbal IQ, poorer spelling, and poorer reading scores, compared to AU siblings without such a history. Parents with a positive history also scored worse on a measure of pragmatic language,the Pragmatic Rating Scale, but not on measures of social-related components of the broader autism phenotype. We propose that cognitive differences in a subset of autism family members are manifestations of the language-related component of the broader autism phenotype, and separate from the social-related component. This is consistent with the hypothesis that there are several genes that may interact to cause autism which segregate independently and have distinguishable manifestations in family members. The hypothesis would be further supported by finding different patterns of genetic loci linked to autism in families where one or both parents has language difficulties.
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Affiliation(s)
- S E Folstein
- New England Medical Center/Tufts University School of Medicine, Boston and Eunice Kennedy Shriver Center for Developmental Disorders, Waltham, USA.
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Folstein SE, Bisson E, Santangelo SL, Piven J. Finding specific genes that cause autism: a combination of approaches will be needed to maximize power. J Autism Dev Disord 1998; 28:439-45. [PMID: 9813779 DOI: 10.1023/a:1026008606672] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Although autism is clearly inherited, it may be challenging to find the genes involved: The mechanism of inheritance is unknown, families with an autistic child are usually small, parent-child pairs are rare, and a fairly large number of genes may be involved, some or all of which may have a small effect on the phenotype. We discuss several strategies for finding genes, all of which may be used in combination to find the relevant genes.
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Affiliation(s)
- S E Folstein
- Department of Psychiatry, New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
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Folstein SE, Bisson E, Santangelo SL, Piven J. Finding specific genes that cause autism: a combination of approaches will be needed to maximize power. J Autism Dev Disord 1998. [PMID: 9813779 DOI: 10.1023/a:102600860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
Although autism is clearly inherited, it may be challenging to find the genes involved: The mechanism of inheritance is unknown, families with an autistic child are usually small, parent-child pairs are rare, and a fairly large number of genes may be involved, some or all of which may have a small effect on the phenotype. We discuss several strategies for finding genes, all of which may be used in combination to find the relevant genes.
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Affiliation(s)
- S E Folstein
- Department of Psychiatry, New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
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Abstract
OBJECTIVE To explore the frequency and onset of macrocephaly in autism and its relationship to clinical features. METHOD Head circumferences at birth, during early childhood, and at the time of examination were studied in a community-based sample of autistic children and adults. The authors investigated whether head circumference at the time of examination was associated with clinical features. RESULTS Fourteen percent of the autistic subjects had macrocephaly: 11% of males and 24% of females. In most, the macrocephaly was not present at birth; in some it became apparent in early and middle childhood as a result of increased rate of head growth. A small relationship was noted between head circumference percentile and less severe core features of autism. Neither macrocephaly nor head circumference percentile was associated with nonverbal IQ, verbal status, seizure disorder, neurological soft signs or minor physical anomalies in the autistic subjects. CONCLUSION Macrocephaly is common in autism and usually is not present at birth. Rates of head growth may be abnormal in early and middle childhood in some (37%) children with autism. Macrocephaly does not define a homogeneous subgroup of autistic individuals according to clinical features.
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Fulwiler C, Forbes C, Santangelo SL, Folstein M. Self-mutilation and suicide attempt: distinguishing features in prisoners. J Am Acad Psychiatry Law 1997; 25:69-77. [PMID: 9148884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Nonlethal forms of self-injury are often discussed together with suicide attempts as though they belonged on a continuum of self-harm. Both types of self-injury are common in prisons, which have a predominantly male population; however, most studies of nonlethal self-injury have been done with female subjects. This exploratory study tested the hypothesis that prisoners who injured themselves without intending to die would differ clinically from prisoners who had attempted suicide. Inmates admitted to the prison unit of a public hospital for treatment of self-inflicted wounds or who had a history of previous self-injury were administered a standardized intake protocol by the first author, which included asking about their intent at the time they injured themselves. Patients were classified as self-mutilators or suicide attempters on the basis of intent. Fifteen patients reported that they had attempted to take their own lives, while 16 reported other reasons for harming themselves. Suicide attempt was associated with adult affective disorder 13/15 versus 2/16 mutilators); self-mutilation with a history of childhood hyperactivity (12/16 versus 1/15 suicide attempters) and a mixed dysthymia/anxiety syndrome that began in childhood or early adolescence (9/16). Prison self-mutilators and suicide attempters had very different clinical presentations and histories. The history of childhood hyperactivity in self-mutilators deserves further study in both correctional and noncorrectional populations.
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Affiliation(s)
- C Fulwiler
- Clinical Neuroscience Service, Lemuel Shattuck Hospital, Boston, MA, USA,
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Santangelo SL, Pauls DL, Lavori PW, Goldstein JM, Faraone SV, Tsuang MT. Assessing risk for the Tourette spectrum of disorders among first-degree relatives of probands with Tourette syndrome. Am J Med Genet 1996; 67:107-16. [PMID: 8678107 DOI: 10.1002/(sici)1096-8628(19960216)67:1<107::aid-ajmg20>3.0.co;2-r] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Previous studies have indicated that genetic investigations of Tourette syndrome (TS) should focus on a phenotype that includes not only TS, but chronic tics (CT) and obsessive-compulsive disorder (OCD) as well. These studies have shown that sex may play a role in determining which of the disorders in the TS spectrum is expressed in a susceptible individual. Female relatives of TS probands far more often express OCD, while male relatives more often express TS or CT. Data from the Yale Family Study of TS were used to model risk to first-degree relatives of probands with TS for a variety of TS disease phenotypes. Risk to relatives was modeled using multivariate Cox regression analysis, a method appropriate for assessing risk when there is correlation among disease onsets. This is the first known application of this method to family data. The study identified two proband characteristics that increase the risk for disease onset among both male and female relatives for all TS spectrum disorders, lending credence to the hypothesis that TS spectrum disorders share a common etiology. These were a relatively younger age-at-onset, and no experience of simple motor tics. The predictive ability of two additional factors varied by both sex and disease phenotype. These characteristics, i.e., proband onset with compulsive tics, and proband onset with range, appear to increase risk primarily in female relatives, and for the OCD part of the spectrum.
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Affiliation(s)
- S L Santangelo
- Department of Epidemiology, Harvard Program in Psychiatric Epidemiology and Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA
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Biederman J, Santangelo SL, Faraone SV, Kiely K, Guite J, Mick E, Reed ED, Kraus I, Jellinek M, Perrin J. Clinical correlates of enuresis in ADHD and non-ADHD children. J Child Psychol Psychiatry 1995; 36:865-77. [PMID: 7559850 DOI: 10.1111/j.1469-7610.1995.tb01334.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Enuresis and attention deficit hyperactivity disorder (ADHD) are common childhood disorders that often co-occur. Although each has been linked to neurodevelopmental immaturity and increased risk for psychopathology, the clinical correlates of enuresis remain unclear. Subjects were 140 6-17-year-old boys with DSM-III-R ADHD and 120 non-ADHD controls. Information on enuresis and psychiatric diagnoses was obtained in a standardized manner blind to the child's clinical status. Our results show that (1) enuresis did not increase the risk for psychopathology in children with or without ADHD; (2) enuresis was not associated with psychosocial adversity or developmental immaturity; (3) enuresis was associated with increased risk for learning disability, impaired intellectual functioning, and impaired school achievement in normal control children but not in children with ADHD; and (4) the same pattern of findings was obtained after stratifying children with enuresis by primary versus secondary and by nocturnal versus diurnal subtypes. These results suggest that the clinical implications of enuresis may differ for ADHD and non-ADHD children.
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Affiliation(s)
- J Biederman
- Pediatric Psychopharmacology Unit (ACC 725), Massachusetts General Hospital, Boston 02114, USA
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Santangelo SL, Pauls DL, Goldstein JM, Faraone SV, Tsuang MT, Leckman JF. Tourette's syndrome: what are the influences of gender and comorbid obsessive-compulsive disorder? J Am Acad Child Adolesc Psychiatry 1994; 33:795-804. [PMID: 8083136 DOI: 10.1097/00004583-199407000-00004] [Citation(s) in RCA: 103] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To explore the influence of gender and comorbid obsessive-compulsive disorder (OCD) on the phenomenology of Tourette's syndrome (TS). METHOD TS proband groups defined by gender and comorbid OCD status were compared on a variety of sociodemographic variables, clinical characteristics, and perinatal complications. RESULTS Compared to females, males more often onset with rage and had ever experienced any form of simple tics. Females onset with compulsive tics more often than males. Probands with comorbid OCD were more likely than those without OCD to onset with complex tics. Delivery complications, especially forceps deliveries, were associated with being male and with having OCD. Fetal exposure to relatively high levels of coffee, cigarettes, or alcohol predicted OCD in TS probands. Diagnosis of TS occurred at later ages among females than among males. Males and females displayed different age distributions. CONCLUSIONS Males and females tend to experience different kinds of symptoms at onset. However, the overall experience of TS appears to be similar for both groups. Perinatal brain injury is implicated in the etiology of TS in some boys. Early brain injury may cause or exacerbate the development of OCD in some TS sufferers.
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Affiliation(s)
- S L Santangelo
- Department of Epidemiology, Harvard Program in Psychiatric Epidemiology and Biostatistics, Harvard School of Public Health, Boston, MA
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Abstract
The effect of gender on mortality was explored for a sample of DSM-III diagnosed schizophrenics followed for up to 42 years. The data for 332 cases and 304 matched normal controls were from the retrospective cohort family studies, the Iowa 500 and non-500. Survival analysis and Cox regression models were used to test the effects of gender, illness status and their interaction on the risks for natural and unnatural deaths. The control men experienced significantly more unnatural deaths than the control women, which was not found for schizophrenic men and women. The unnatural death rate among schizophrenic women was similar to the rate for schizophrenic and control men, and significantly higher than for control women during the early phase of the illness. Findings suggest that some factors that predict suicide may be similar for schizophrenic women and men.
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Affiliation(s)
- J M Goldstein
- Department of Psychiatry, Harvard Medical School, Mass
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50
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Abstract
Past literature suggests that schizophrenic men and women may be at different risks for developing different subtypes of schizophrenia. This hypothesis was tested using data from the well-known retrospective cohort family studies, the Iowa 500 and the Iowa non-500. The sample consisted of 171 male and 161 female DSM-III schizophrenic patients and 713 of their first-degree relatives. First, bivariate tests for gender differences were conducted regarding family morbidity, age of onset, premorbid history, season of birth, and expression of deficit and affective symptoms. Restricted maximum likelihood latent class analysis was then used to test whether there was a subgroup of schizophrenic men who were more likely to have a low familial risk for schizophrenia or schizophrenia spectrum disorders, deficit symptoms, poor premorbid history, and birth in the winter months, suggesting possible early environmental insults, compared to schizophrenic women. Results showed that although men were more likely to meet these criteria, women also met them, thus suggesting gender differences in the prevalence of the subtype. Schizophrenic women were more likely to express a form of the illness characterized by dysphoria, persecutory delusions, and a higher family morbidity risk for schizophrenia than schizophrenic men. Results for spectrum disorders among relatives were equivocal with regard to gender.
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Affiliation(s)
- J M Goldstein
- Brockton/West Roxbury VA Medical Center, Psychiatry Service, MA 02401
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