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Yu D, Mathews CA, Scharf JM, Neale BM, Davis LK, Gamazon ER, Derks EM, Evans P, Edlund CK, Crane J, Fagerness JA, Osiecki L, Gallagher P, Gerber G, Haddad S, Illmann C, McGrath LM, Mayerfeld C, Arepalli S, Barlassina C, Barr CL, Bellodi L, Benarroch F, Berrió GB, Bienvenu OJ, Black D, Bloch MH, Brentani H, Bruun RD, Budman CL, Camarena B, Campbell DD, Cappi C, Cardona Silgado JC, Cavallini MC, Chavira DA, Chouinard S, Cook EH, Cookson MR, Coric V, Cullen B, Cusi D, Delorme R, Denys D, Dion Y, Eapen V, Egberts K, Falkai P, Fernandez T, Fournier E, Garrido H, Geller D, Gilbert D, Girard SL, Grabe HJ, Grados MA, Greenberg BD, Gross-Tsur V, Grünblatt E, Hardy J, Heiman GA, Hemmings SM, Herrera LD, Hezel DM, Hoekstra PJ, Jankovic J, Kennedy JL, King RA, Konkashbaev AI, Kremeyer B, Kurlan R, Lanzagorta N, Leboyer M, Leckman JF, Lennertz L, Liu C, Lochner C, Lowe TL, Lupoli S, Macciardi F, Maier W, Manunta P, Marconi M, McCracken JT, Mesa Restrepo SC, Moessner R, Moorjani P, Morgan J, Muller H, Murphy DL, Naarden AL, Ochoa WC, Ophoff RA, Pakstis AJ, Pato MT, Pato CN, Piacentini J, Pittenger C, Pollak Y, Rauch SL, Renner T, Reus VI, Richter MA, Riddle MA, Robertson MM, Romero R, Rosário MC, Rosenberg D, Ruhrmann S, Sabatti C, Salvi E, Sampaio AS, Samuels J, Sandor P, Service SK, Sheppard B, Singer HS, Smit JH, Stein DJ, Strengman E, Tischfield JA, Turiel M, Valencia Duarte AV, Vallada H, Veenstra-VanderWeele J, Walitza S, Walkup J, Wang Y, Weale M, Weiss R, Wendland JR, Westenberg HG, Yao Y, Hounie AG, Miguel EC, Nicolini H, Wagner M, Ruiz-Linares A, Cath DC, McMahon W, Posthuma D, Oostra BA, Nestadt G, Rouleau GA, Purcell S, Jenike MA, Heutink P, Hanna GL, Conti DV, Arnold PD, Freimer N, Stewart SE, Knowles JA, Cox NJ, Pauls DL. Cross-disorder genome-wide analyses suggest a complex genetic relationship between Tourette's syndrome and OCD. Am J Psychiatry 2015; 172:82-93. [PMID: 25158072 PMCID: PMC4282594 DOI: 10.1176/appi.ajp.2014.13101306] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [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: 11/30/2022]
Abstract
OBJECTIVE Obsessive-compulsive disorder (OCD) and Tourette's syndrome are highly heritable neurodevelopmental disorders that are thought to share genetic risk factors. However, the identification of definitive susceptibility genes for these etiologically complex disorders remains elusive. The authors report a combined genome-wide association study (GWAS) of Tourette's syndrome and OCD. METHOD The authors conducted a GWAS in 2,723 cases (1,310 with OCD, 834 with Tourette's syndrome, 579 with OCD plus Tourette's syndrome/chronic tics), 5,667 ancestry-matched controls, and 290 OCD parent-child trios. GWAS summary statistics were examined for enrichment of functional variants associated with gene expression levels in brain regions. Polygenic score analyses were conducted to investigate the genetic architecture within and across the two disorders. RESULTS Although no individual single-nucleotide polymorphisms (SNPs) achieved genome-wide significance, the GWAS signals were enriched for SNPs strongly associated with variations in brain gene expression levels (expression quantitative loci, or eQTLs), suggesting the presence of true functional variants that contribute to risk of these disorders. Polygenic score analyses identified a significant polygenic component for OCD (p=2×10(-4)), predicting 3.2% of the phenotypic variance in an independent data set. In contrast, Tourette's syndrome had a smaller, nonsignificant polygenic component, predicting only 0.6% of the phenotypic variance (p=0.06). No significant polygenic signal was detected across the two disorders, although the sample is likely underpowered to detect a modest shared signal. Furthermore, the OCD polygenic signal was significantly attenuated when cases with both OCD and co-occurring Tourette's syndrome/chronic tics were included in the analysis (p=0.01). CONCLUSIONS Previous work has shown that Tourette's syndrome and OCD have some degree of shared genetic variation. However, the data from this study suggest that there are also distinct components to the genetic architectures of these two disorders. Furthermore, OCD with co-occurring Tourette's syndrome/chronic tics may have different underlying genetic susceptibility compared with OCD alone.
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Affiliation(s)
- Dongmei Yu
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA,Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA,Co-corresponding authors: Dongmei Yu, MS & David L. Pauls, Ph.D., Psychiatric & Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Simches Research Building, 6th Floor, 185 Cambridge Street, Boston, MA 02114
| | - Carol A. Mathews
- Department of Psychiatry, University of California at San Francisco, San Francisco, CA, USA
| | - Jeremiah M. Scharf
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA,Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA,Department of Neurology, Massachusetts General Hospital, Boston, MA, USA,Division of Cognitive and Behavioral Neurology, Brigham and Womens Hospital, Boston, MA, USA
| | - Benjamin M. Neale
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA,Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Lea K. Davis
- Section of Genetic Medicine, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Eric R. Gamazon
- Section of Genetic Medicine, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Eske M. Derks
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Patrick Evans
- Section of Genetic Medicine, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Christopher K. Edlund
- Department of Preventative Medicine, Division of Biostatistics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jacquelyn Crane
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jesen A. Fagerness
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lisa Osiecki
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Patience Gallagher
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Gloria Gerber
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Stephen Haddad
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Cornelia Illmann
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lauren M. McGrath
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA,Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA
| | - Catherine Mayerfeld
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sampath Arepalli
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Cristina Barlassina
- Genomic and Bioinformatic Unit, Filarete Foundation, Milano, Italy,Department of Health Sciences, Graduate School of Nephrology, University of Milano
| | - Cathy L. Barr
- The Toronto Western Research Institute, University Health Network, Toronto, ON, Canada,The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Fortu Benarroch
- Herman Dana Division of Child and Adolescent Psychiatry, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - O. Joseph Bienvenu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Donald Black
- Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Michael H. Bloch
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut, USA,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Helena Brentani
- Department of Psychiatry, University of São Paulo Medical School, Brazil
| | - Ruth D. Bruun
- North Shore-Long Island Jewish Medical Center, Manhasset, NY, USA,New York University Medical Center, New York, NY, USA
| | - Cathy L. Budman
- North Shore-Long Island Jewish Health System, Manhasset, NY, USA,Hofstra University School of Medicine, Hempstead, NY, USA
| | - Beatriz Camarena
- Instituto Nacional de Psiquiatría Ramon de la Fuente Muñiz, Mexico City, Mexico
| | - Desmond D. Campbell
- University College London, London, UK,Department of Psychiatry, University of Hong Kong, Hong Kong
| | - Carolina Cappi
- Department of Psychiatry, University of São Paulo Medical School, Brazil
| | | | | | - Denise A. Chavira
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA,Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Sylvain Chouinard
- Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Edwin H. Cook
- Institute for Juvenile Research, Department of Psychiatry, University of Illinois at Chicago, USA
| | - M. R. Cookson
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Vladimir Coric
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Bernadette Cullen
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Daniele Cusi
- Genomic and Bioinformatic Unit, Filarete Foundation, Milano, Italy,Department of Health Sciences, Graduate School of Nephrology, University of Milano
| | - Richard Delorme
- Human Genetics and Cognitive Functions, Institut Pasteur, Paris, France,Foundation Fondamental, French National Science Foundation, France,AP-HP, Robert Debré Hospital, Department of Child and Adolescent Psychiatry, Paris, France
| | - Damiaan Denys
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands,Netherlands Institute for Neuroscience, an Institute of the Royal Netherlands Academy of Arts and Sciences (NIN-KNAW), Amsterdam, The Netherlands
| | - Yves Dion
- Department of Psychiatry, University of Montreal, Montreal, Quebec, Canada
| | - Valsama Eapen
- Infant Child and Adolescent Psychiatry, University of New South Wales, Australia,Academic Unit of Child Psychiatry, South West Sydney LHD (AUCS), Australia
| | - Karin Egberts
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Würzburg, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University of Munich, Munich, Germany
| | - Thomas Fernandez
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut, USA,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | | | - Helena Garrido
- Clinica Herrera Amighetti, Avenida Escazú, San José, Costa Rica
| | - Daniel Geller
- OCD Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Donald Gilbert
- Cincinnati Children’s Hospital Medical Center and the University of Cincinnati, Cincinnati, OH, USA
| | - Simon L. Girard
- Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Hans J. Grabe
- Department of Psychiatry and Psychotherapy, Helios-Hospital Stralsund, University Medicine Greifswald, Greifswald, Germany
| | - Marco A. Grados
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Benjamin D. Greenberg
- Department of Psychiatry and Human Behavior, Brown Medical School, Butler Hospital, Providence, Rhode Island, USA
| | - Varda Gross-Tsur
- Neuropediatric Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Edna Grünblatt
- Department of Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland
| | | | - Gary A. Heiman
- Department of Genetics, Human Genetics Institute of New Jersey, Rutgers University, Piscataway, NJ, US
| | - Sian M.J. Hemmings
- Department of Psychiatry, University of Stellenbosch, Stellenbosch, South Africa
| | | | - Dianne M. Hezel
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Pieter J. Hoekstra
- Department of Psychiatry, University Medical Center, University of Groningen, Groningen, The Netherlands
| | - Joseph Jankovic
- Parkinson’s Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - James L. Kennedy
- Neurogenetics Section, Centre for Addiction and Mental Health, Toronto, Canada,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Robert A. King
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Anuar I. Konkashbaev
- Section of Genetic Medicine, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | | | - Roger Kurlan
- Atlantic Neuroscience Institute, Overlook Hospital, Summit, NJ, USA
| | | | - Marion Leboyer
- Foundation Fondamental, French National Science Foundation, France,AP-HP, Robert Debré Hospital, Department of Child and Adolescent Psychiatry, Paris, France,Institut Mondor de Recherche Biomédicale, Psychiatric Genetics, Créteil, F 94000, France
| | - James F. Leckman
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut, USA,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Leonhard Lennertz
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Chunyu Liu
- Department of Psychiatry, Institute of Human Genetics, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Christine Lochner
- MRC Unit on Anxiety & Stress Disorders, Department of Psychiatry, University of Stellenbosch, Stellenbosch, South Africa
| | - Thomas L. Lowe
- Department of Psychiatry, University of California at San Francisco, San Francisco, CA, USA
| | - Sara Lupoli
- Genomic and Bioinformatic Unit, Filarete Foundation, Milano, Italy,Department of Health Sciences, Graduate School of Nephrology, University of Milano
| | - Fabio Macciardi
- Department of Psychiatry and Human Behavior, School of Medicine, University of California Irvine (UCI), California, USA
| | - Wolfgang Maier
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Paolo Manunta
- Division of Nephrology and Dialysis, San Raffaele Scientific Institute - Chair of Nephrology, Università Vita Salute San Raffaele, Milan, Italy
| | - Maurizio Marconi
- Center of Transfusion Medicine and Immunohematology, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - James T. McCracken
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, David Geffen School of Medicine, California, USA
| | | | - Rainald Moessner
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Priya Moorjani
- Department of Genetics, Harvard University, Cambridge, MA, USA
| | | | | | - Dennis L. Murphy
- Laboratory of Clinical Science, NIMH Intramural Research Program, Bethesda, MD, USA
| | - Allan L. Naarden
- Department of Clinical Research, Medical City Dallas Hospital, Dallas, Texas, USA
| | | | - Roel A. Ophoff
- Department of Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Center, Utrecht, The Netherlands,Center for Neurobehavioral Genetics, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
| | - Andrew J. Pakstis
- Department of Genetics, Yale University School of Medicine, New Haven, CT, USA
| | - Michele T. Pato
- Department of Psychiatry and the Behavioral Sciences, Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Carlos N. Pato
- Department of Psychiatry and the Behavioral Sciences, Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, David Geffen School of Medicine, California, USA
| | - Christopher Pittenger
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut, USA,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Yehuda Pollak
- Neuropediatric Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Scott L. Rauch
- Partners Psychiatry and McLean Hospital, Boston, MA, USA
| | - Tobias Renner
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Würzburg, Germany
| | - Victor I. Reus
- Department of Psychiatry, University of California at San Francisco, San Francisco, CA, USA
| | - Margaret A. Richter
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada,Frederick W. Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Mark A. Riddle
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | | | - Maria C. Rosário
- Child and Adolescent Psychiatry Unit (UPIA), Department of Psychiatry, Federal University of São Paulo, Brazil
| | - David Rosenberg
- Department of Psychiatry & Behavioral Neurosciences, Wayne State University and the Detroit Medical Center
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Chiara Sabatti
- Department of Health Research and Policy, Stanford University, Stanford, CA, USA
| | - Erika Salvi
- Genomic and Bioinformatic Unit, Filarete Foundation, Milano, Italy,Department of Health Sciences, Graduate School of Nephrology, University of Milano
| | - Aline S. Sampaio
- University Health Care Services - SMURB, Universidade Federal da Bahia, Salvador, Bahia, Brazil,Department of Psychiatry, Faculdade de Medicina da Universidade de Sao Paulo, Brazil
| | - Jack Samuels
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Paul Sandor
- Department of Psychiatry, University of Toronto and University Health Network, Toronto Western Research Institute and Youthdale Treatment Centers, Toronto, Ontario, Canada
| | - Susan K. Service
- Center for Neurobehavioral Genetics, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
| | - Brooke Sheppard
- Department of Psychiatry, University of California at San Francisco, San Francisco, CA, USA
| | | | - Jan H. Smit
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - Dan J. Stein
- University of Cape Town, Cape Town, South Africa
| | - Eric Strengman
- Department of Medical Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jay A. Tischfield
- Department of Genetics, Human Genetics Institute of New Jersey, Rutgers University, Piscataway, NJ, US
| | - Maurizio Turiel
- Department of Health Technologies, University of Milano, Milano, Italy
| | | | - Homero Vallada
- Department of Psychiatry, University of São Paulo Medical School, Brazil
| | - Jeremy Veenstra-VanderWeele
- Departments of Psychiatry, Pediatrics, and Pharmacology, Kennedy Center for Research on Human Development, and Brain Institute, Vanderbilt University, Nashville, TN, USA
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland,Department of Child and Adolescent Psychiatry, University of Würzburg, Germany
| | - John Walkup
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Weill Cornell Medical Center, New York, NY, USA
| | - Ying Wang
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mike Weale
- Department of Medical & Molecular Genetics, King’s College London, UK
| | | | - Jens R. Wendland
- Laboratory of Clinical Science, NIMH Intramural Research Program, Bethesda, MD, USA
| | - Herman G.M. Westenberg
- Department of Psychiatry, Academic Medical Center and Netherlands Institute for Neuroscience, an Institute of the Royal Netherlands Academy of Arts and Sciences (NIN-KNAW), Amsterdam, The Netherlands
| | - Yin Yao
- Unit on Statistical Genomics, NIMH Intramural Research Program, Bethesda, MD, USA
| | - Ana G. Hounie
- Department of Psychiatry, Faculdade de Medicina da Universidade de Sao Paulo, Brazil
| | | | | | - Michael Wagner
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | | | - Danielle C. Cath
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands,Department of Clinical & Health Psychology, Utrecht University, Utrecht, The Netherlands
| | - William McMahon
- Department of Psychiatry, University of Utah, Salt Lake City, Utah, USA
| | - Danielle Posthuma
- Section of Medical Genomics, Department of Clinical Genetics, VU University Medical Center Amsterdam, The Netherlands,Department of Functional Genomics, Center for Neurogenomics and Cognitive Research, Neuroscience Campus Amsterdam, VU University Amsterdam, De Boelelaan Amsterdam, The Netherlands,Department of Child and Adolescent Psychiatry, Erasmus University Medical Centre, Wytemaweg 8, Rotterdam, The Netherlands
| | - Ben A. Oostra
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Gerald Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Guy A. Rouleau
- Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Shaun Purcell
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA,Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA,Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA,Mt. Sinai Medical Center, New York, NY, USA
| | - Michael A. Jenike
- OCD Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Peter Heutink
- Section of Medical Genomics, Department of Clinical Genetics, VU University Medical Center Amsterdam, The Netherlands,German Center for Neurodegenerative Diseases, Tübingen, Germany
| | - Gregory L. Hanna
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - David V. Conti
- Department of Preventative Medicine, Division of Biostatistics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Paul D. Arnold
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada,Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nelson Freimer
- Center for Neurobehavioral Genetics, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
| | - S. Evelyn Stewart
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA,British Columbia Mental Health and Addictions Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - James A. Knowles
- Department of Psychiatry and the Behavioral Sciences, Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Nancy J. Cox
- Section of Genetic Medicine, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - David L. Pauls
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA,Co-corresponding authors: Dongmei Yu, MS & David L. Pauls, Ph.D., Psychiatric & Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Simches Research Building, 6th Floor, 185 Cambridge Street, Boston, MA 02114
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McGrath LM, Yu D, Marshall C, Davis LK, Thiruvahindrapuram B, Li B, Cappi C, Gerber G, Wolf A, Schroeder FA, Osiecki L, O'Dushlaine C, Kirby A, Illmann C, Haddad S, Gallagher P, Fagerness JA, Barr CL, Bellodi L, Benarroch F, Bienvenu OJ, Black DW, Bloch MH, Bruun RD, Budman CL, Camarena B, Cath DC, Cavallini MC, Chouinard S, Coric V, Cullen B, Delorme R, Denys D, Derks EM, Dion Y, Rosário MC, Eapen V, Evans P, Falkai P, Fernandez TV, Garrido H, Geller D, Grabe HJ, Grados MA, Greenberg BD, Gross-Tsur V, Grünblatt E, Heiman GA, Hemmings SMJ, Herrera LD, Hounie AG, Jankovic J, Kennedy JL, King RA, Kurlan R, Lanzagorta N, Leboyer M, Leckman JF, Lennertz L, Lochner C, Lowe TL, Lyon GJ, Macciardi F, Maier W, McCracken JT, McMahon W, Murphy DL, Naarden AL, Neale BM, Nurmi E, Pakstis AJ, Pato MT, Pato CN, Piacentini J, Pittenger C, Pollak Y, Reus VI, Richter MA, Riddle M, Robertson MM, Rosenberg D, Rouleau GA, Ruhrmann S, Sampaio AS, Samuels J, Sandor P, Sheppard B, Singer HS, Smit JH, Stein DJ, Tischfield JA, Vallada H, Veenstra-VanderWeele J, Walitza S, Wang Y, Wendland JR, Shugart YY, Miguel EC, Nicolini H, Oostra BA, Moessner R, Wagner M, Ruiz-Linares A, Heutink P, Nestadt G, Freimer N, Petryshen T, Posthuma D, Jenike MA, Cox NJ, Hanna GL, Brentani H, Scherer SW, Arnold PD, Stewart SE, Mathews CA, Knowles JA, Cook EH, Pauls DL, Wang K, Scharf JM. Copy number variation in obsessive-compulsive disorder and tourette syndrome: a cross-disorder study. J Am Acad Child Adolesc Psychiatry 2014; 53:910-9. [PMID: 25062598 PMCID: PMC4218748 DOI: 10.1016/j.jaac.2014.04.022] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 03/16/2014] [Accepted: 06/18/2014] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Obsessive-compulsive disorder (OCD) and Tourette syndrome (TS) are heritable neurodevelopmental disorders with a partially shared genetic etiology. This study represents the first genome-wide investigation of large (>500 kb), rare (<1%) copy number variants (CNVs) in OCD and the largest genome-wide CNV analysis in TS to date. METHOD The primary analyses used a cross-disorder design for 2,699 case patients (1,613 ascertained for OCD, 1,086 ascertained for TS) and 1,789 controls. Parental data facilitated a de novo analysis in 348 OCD trios. RESULTS Although no global CNV burden was detected in the cross-disorder analysis or in secondary, disease-specific analyses, there was a 3.3-fold increased burden of large deletions previously associated with other neurodevelopmental disorders (p = .09). Half of these neurodevelopmental deletions were located in a single locus, 16p13.11 (5 case patient deletions: 0 control deletions, p = .08 in the current study, p = .025 compared to published controls). Three 16p13.11 deletions were confirmed de novo, providing further support for the etiological significance of this region. The overall OCD de novo rate was 1.4%, which is intermediate between published rates in controls (0.7%) and in individuals with autism or schizophrenia (2-4%). CONCLUSION Several converging lines of evidence implicate 16p13.11 deletions in OCD, with weaker evidence for a role in TS. The trend toward increased overall neurodevelopmental CNV burden in TS and OCD suggests that deletions previously associated with other neurodevelopmental disorders may also contribute to these phenotypes.
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Affiliation(s)
- Lauren M McGrath
- Massachusetts General Hospital, Boston; American University, Washington, DC; Harvard-MIT Broad Institute, Boston
| | - Dongmei Yu
- Massachusetts General Hospital, Boston; Harvard-MIT Broad Institute, Boston
| | | | | | | | - Bingbin Li
- University of Toronto and the Hospital for Sick Children, Toronto
| | | | | | | | | | | | | | | | | | | | | | | | - Cathy L Barr
- University of Toronto and the Hospital for Sick Children, Toronto; Toronto Western Research Institute, University Health Network, Toronto
| | | | | | | | | | | | - Ruth D Bruun
- North Shore-Long Island Jewish Medical Center, New Hyde Park, NY; New York University Medical Center, New York
| | - Cathy L Budman
- North Shore-Long Island Jewish Medical Center, New Hyde Park, NY; Hofstra University School of Medicine, Hempstead, NY
| | - Beatriz Camarena
- Instituto Nacional de Psiquiatría Ramon de la Fuente Muñiz, Mexico
| | | | | | | | | | | | - Richard Delorme
- Robert Debre University Hospital, Paris and the French National Science Foundation, Creteil, France; Institut Pasteur, Paris
| | - Damiaan Denys
- Netherlands Institute for Neuroscience, Amsterdam; Academic Medical Center, Amsterdam
| | | | | | | | | | | | | | | | - Helena Garrido
- Hospital Nacional de Niños, San Jose, Costa Rica; Clinica Herrera Amighetti, Avenida Escazú, San José, Costa Rica
| | | | - Hans J Grabe
- University Medicine Greifswald, Greifswald, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Marion Leboyer
- Robert Debre University Hospital, Paris and the French National Science Foundation, Creteil, France; Institut Mondor de Recherche Biomédicale, Créteil, France
| | | | | | | | - Thomas L Lowe
- University of California at San Francisco School of Medicine
| | | | | | | | | | | | - Dennis L Murphy
- National Institute of Mental Health (NIMH) Intramural Research Program, Bethesda, MD
| | | | - Benjamin M Neale
- Massachusetts General Hospital, Boston; Harvard-MIT Broad Institute, Boston
| | - Erika Nurmi
- University of California, Los Angeles (UCLA) School of Medicine
| | | | | | | | - John Piacentini
- University of California, Los Angeles (UCLA) School of Medicine
| | | | | | - Victor I Reus
- University of California at San Francisco School of Medicine
| | - Margaret A Richter
- University of Toronto and the Hospital for Sick Children, Toronto; Sunnybrook Health Sciences Centre, Toronto
| | - Mark Riddle
- Johns Hopkins University School of Medicine, Baltimore
| | | | | | | | | | - Aline S Sampaio
- Federal University of São Paulo; Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Jack Samuels
- Johns Hopkins University School of Medicine, Baltimore
| | - Paul Sandor
- University of Toronto and the Hospital for Sick Children, Toronto; Toronto Western Research Institute, University Health Network, Toronto
| | - Brooke Sheppard
- University of California at San Francisco School of Medicine
| | | | - Jan H Smit
- VU Amsterdam and Erasmus University Medical Centre, Rotterdam; VU University Amsterdam; VU Medical Center, Amsterdam
| | | | | | | | | | | | - Ying Wang
- Johns Hopkins University School of Medicine, Baltimore
| | - Jens R Wendland
- National Institute of Mental Health (NIMH) Intramural Research Program, Bethesda, MD
| | - Yin Yao Shugart
- National Institute of Mental Health (NIMH) Intramural Research Program, Bethesda, MD
| | | | | | - Ben A Oostra
- Erasmus Medical Center Rotterdam, the Netherlands
| | | | | | | | - Peter Heutink
- German Center for Neurodegenerative Diseases, Bonn and VU Medical Center Amsterdam
| | | | - Nelson Freimer
- University of California, Los Angeles (UCLA) School of Medicine; Semel Institute for Neuroscience and Human Behavior, UCLA
| | - Tracey Petryshen
- Massachusetts General Hospital, Boston; Harvard-MIT Broad Institute, Boston
| | | | | | | | | | | | | | - Paul D Arnold
- University of Toronto and the Hospital for Sick Children, Toronto
| | - S Evelyn Stewart
- Massachusetts General Hospital, Boston; University of British Columbia, Vancouver
| | - Carol A Mathews
- University of California at San Francisco School of Medicine
| | | | | | | | - Kai Wang
- Zilkha Neurogenetic Institute, Los Angeles
| | - Jeremiah M Scharf
- Massachusetts General Hospital, Boston; Brigham and Womens Hospital, Boston; Harvard-MIT Broad Institute, Boston.
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Davis LK, Yu D, Keenan CL, Gamazon ER, Konkashbaev AI, Derks EM, Neale BM, Yang J, Lee SH, Evans P, Barr CL, Bellodi L, Benarroch F, Berrio GB, Bienvenu OJ, Bloch MH, Blom RM, Bruun RD, Budman CL, Camarena B, Campbell D, Cappi C, Cardona Silgado JC, Cath DC, Cavallini MC, Chavira DA, Chouinard S, Conti DV, Cook EH, Coric V, Cullen BA, Deforce D, Delorme R, Dion Y, Edlund CK, Egberts K, Falkai P, Fernandez TV, Gallagher PJ, Garrido H, Geller D, Girard SL, Grabe HJ, Grados MA, Greenberg BD, Gross-Tsur V, Haddad S, Heiman GA, Hemmings SMJ, Hounie AG, Illmann C, Jankovic J, Jenike MA, Kennedy JL, King RA, Kremeyer B, Kurlan R, Lanzagorta N, Leboyer M, Leckman JF, Lennertz L, Liu C, Lochner C, Lowe TL, Macciardi F, McCracken JT, McGrath LM, Mesa Restrepo SC, Moessner R, Morgan J, Muller H, Murphy DL, Naarden AL, Ochoa WC, Ophoff RA, Osiecki L, Pakstis AJ, Pato MT, Pato CN, Piacentini J, Pittenger C, Pollak Y, Rauch SL, Renner TJ, Reus VI, Richter MA, Riddle MA, Robertson MM, Romero R, Rosàrio MC, Rosenberg D, Rouleau GA, Ruhrmann S, Ruiz-Linares A, Sampaio AS, Samuels J, Sandor P, Sheppard B, Singer HS, Smit JH, Stein DJ, Strengman E, Tischfield JA, Valencia Duarte AV, Vallada H, Van Nieuwerburgh F, Veenstra-VanderWeele J, Walitza S, Wang Y, Wendland JR, Westenberg HGM, Shugart YY, Miguel EC, McMahon W, Wagner M, Nicolini H, Posthuma D, Hanna GL, Heutink P, Denys D, Arnold PD, Oostra BA, Nestadt G, Freimer NB, Pauls DL, Wray NR, Stewart SE, Mathews CA, Knowles JA, Cox NJ, Scharf JM. Partitioning the heritability of Tourette syndrome and obsessive compulsive disorder reveals differences in genetic architecture. PLoS Genet 2013; 9:e1003864. [PMID: 24204291 PMCID: PMC3812053 DOI: 10.1371/journal.pgen.1003864] [Citation(s) in RCA: 171] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 08/21/2013] [Indexed: 11/18/2022] Open
Abstract
The direct estimation of heritability from genome-wide common variant data as implemented in the program Genome-wide Complex Trait Analysis (GCTA) has provided a means to quantify heritability attributable to all interrogated variants. We have quantified the variance in liability to disease explained by all SNPs for two phenotypically-related neurobehavioral disorders, obsessive-compulsive disorder (OCD) and Tourette Syndrome (TS), using GCTA. Our analysis yielded a heritability point estimate of 0.58 (se = 0.09, p = 5.64e-12) for TS, and 0.37 (se = 0.07, p = 1.5e-07) for OCD. In addition, we conducted multiple genomic partitioning analyses to identify genomic elements that concentrate this heritability. We examined genomic architectures of TS and OCD by chromosome, MAF bin, and functional annotations. In addition, we assessed heritability for early onset and adult onset OCD. Among other notable results, we found that SNPs with a minor allele frequency of less than 5% accounted for 21% of the TS heritability and 0% of the OCD heritability. Additionally, we identified a significant contribution to TS and OCD heritability by variants significantly associated with gene expression in two regions of the brain (parietal cortex and cerebellum) for which we had available expression quantitative trait loci (eQTLs). Finally we analyzed the genetic correlation between TS and OCD, revealing a genetic correlation of 0.41 (se = 0.15, p = 0.002). These results are very close to previous heritability estimates for TS and OCD based on twin and family studies, suggesting that very little, if any, heritability is truly missing (i.e., unassayed) from TS and OCD GWAS studies of common variation. The results also indicate that there is some genetic overlap between these two phenotypically-related neuropsychiatric disorders, but suggest that the two disorders have distinct genetic architectures.
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Affiliation(s)
- Lea K. Davis
- Section of Genetic Medicine, Department of Medicine, University of Chicago, Chicago, Illinois, United States of America
- * E-mail: (LKD); (JMS)
| | - Dongmei Yu
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, Massachusetts, United States of America
| | - Clare L. Keenan
- Department of Medicine, University of Chicago, Chicago, Illinois, United States of America
- Department of Human Genetics, University of Chicago, Chicago, Illinois, United States of America
| | - Eric R. Gamazon
- Section of Genetic Medicine, Department of Medicine, University of Chicago, Chicago, Illinois, United States of America
| | - Anuar I. Konkashbaev
- Section of Genetic Medicine, Department of Medicine, University of Chicago, Chicago, Illinois, United States of America
| | - Eske M. Derks
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Benjamin M. Neale
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, Massachusetts, United States of America
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Jian Yang
- The University of Queensland, Diamantina Institute, Queensland, Australia
- The University of Queensland, Queensland Brain Institute, Queensland, Australia
| | - S. Hong Lee
- The University of Queensland, Queensland Brain Institute, Queensland, Australia
| | - Patrick Evans
- Section of Genetic Medicine, Department of Medicine, University of Chicago, Chicago, Illinois, United States of America
| | - Cathy L. Barr
- The Toronto Western Research Institute, University Health Network, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Fortu Benarroch
- Herman Dana Division of Child and Adolescent Psychiatry, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Oscar J. Bienvenu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Michael H. Bloch
- Department of Psychiatry, Yale University, New Haven, Connecticut, United States of America
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Rianne M. Blom
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Ruth D. Bruun
- North Shore-Long Island Jewish Medical Center, Manhasset, New York, United States of America
- New York University Medical Center, New York, New York, United States of America
| | - Cathy L. Budman
- North Shore-Long Island Jewish Health System, Manhasset, New York, United States of America
- Hofstra University School of Medicine, Hempstead, New York, United States of America
| | - Beatriz Camarena
- Instituto Nacional de Psiquiatría Ramon de la Fuente Muñiz, Mexico City, Mexico
| | - Desmond Campbell
- University College London, London, United Kingdom
- Department of Psychiatry, University of Hong Kong, Hong Kong, China
| | - Carolina Cappi
- Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | | | - Danielle C. Cath
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
- Department of Clinical & Health Psychology, Utrecht University, Utrecht, The Netherlands
- Altrecht Academic Anxiety Center, Utrecht, The Netherlands
| | | | - Denise A. Chavira
- Department of Psychology, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Psychiatry, University of California San Diego, La Jolla, California, United States of America
| | | | - David V. Conti
- Department of Preventative Medicine, Division of Biostatistics, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Edwin H. Cook
- Institute for Juvenile Research, Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Vladimir Coric
- Department of Psychiatry, Yale University, New Haven, Connecticut, United States of America
| | - Bernadette A. Cullen
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Dieter Deforce
- Laboratory of Pharmaceutical Biotechnology, Ghent University, Ghent, Belgium
| | - Richard Delorme
- Human Genetics and Cognitive Functions, Institut Pasteur, Paris, France
- Fondation Fondamental, French National Science Foundation, Creteil, France
- AP-HP, Robert Debré Hospital, Department of Child and Adolescent Psychiatry, Paris, France
| | - Yves Dion
- Department of Psychiatry, University of Montreal, Montreal, Quebec, Canada
| | - Christopher K. Edlund
- Department of Preventative Medicine, Division of Biostatistics, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Karin Egberts
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University of Munich, Munich, Germany
| | - Thomas V. Fernandez
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut, United States of America
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Patience J. Gallagher
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Helena Garrido
- Clinica Herrera Amighetti, Avenida Escazú, San José, Costa Rica
| | - Daniel Geller
- OCD Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | | | - Hans J. Grabe
- Department of Psychiatry and Psychotherapy, Helios-Hospital Stralsund, University Medicine Greifswald, Greifswald, Germany
| | - Marco A. Grados
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Benjamin D. Greenberg
- Department of Psychiatry and Human Behavior, Brown Medical School, Butler Hospital, Providence, Rhode Island, United States of America
| | - Varda Gross-Tsur
- Neuropediatric Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Stephen Haddad
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Gary A. Heiman
- Department of Genetics, Human Genetics Institute of New Jersey, Rutgers University, Piscataway, New Jersey, United States of America
| | - Sian M. J. Hemmings
- Department of Psychiatry, University of Stellenbosch, Stellenbosch, South Africa
| | - Ana G. Hounie
- Department of Psychiatry, Faculdade de Medicina da Universidade de Säo Paulo, Brazil
| | - Cornelia Illmann
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas, United States of America
| | - Michael A. Jenike
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - James L. Kennedy
- Neurogenetics Section, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Robert A. King
- Yale Child Study Center, Department of Genetics, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | | | - Roger Kurlan
- Atlantic Neuroscience Institute, Overlook Hospital, Summit, New Jersey, United States of America
| | | | - Marion Leboyer
- Fondation Fondamental, French National Science Foundation, Creteil, France
- AP-HP, Robert Debré Hospital, Department of Child and Adolescent Psychiatry, Paris, France
- Institut Mondor de Recherche Biomédicale, Psychiatric Genetics, Créteil, France
| | - James F. Leckman
- Child Study Center, Psychiatry, Pediatrics and Psychology, Yale University, New Haven, Connecticut, United States of America
| | - Leonhard Lennertz
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Chunyu Liu
- Department of Psychiatry, Institute of Human Genetics, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Christine Lochner
- MRC Unit on Anxiety & Stress Disorders, Department of Psychiatry, University of Stellenbosch, Stellenbosch, South Africa
| | - Thomas L. Lowe
- Department of Psychiatry, University of California at San Francisco, San Francisco, California, United States of America
| | - Fabio Macciardi
- Department of Psychiatry and Human Behavior, School of Medicine, University of California Irvine (UCI), Irvine, California, United States of America
| | - James T. McCracken
- Department of Psychiatry and Human Behavior, School of Medicine, University of California Irvine (UCI), Irvine, California, United States of America
| | - Lauren M. McGrath
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | | | - Rainald Moessner
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Jubel Morgan
- University of Utah, Salt Lake City, Utah, United States of America
| | - Heike Muller
- University College London, London, United Kingdom
| | - Dennis L. Murphy
- Laboratory of Clinical Science, NIMH Intramural Research Program, Bethesda, Maryland, United States of America
| | - Allan L. Naarden
- Department of Clinical Research, Medical City Dallas Hospital, Dallas, Texas, United States of America
| | | | - Roel A. Ophoff
- Department of Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Center, Utrecht, The Netherlands
- Center for Neurobehavioral Genetics, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, California, United States of America
| | - Lisa Osiecki
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Andrew J. Pakstis
- Department of Genetics, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Michele T. Pato
- Department of Psychiatry and the Behavioral Sciences, Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Carlos N. Pato
- Department of Psychiatry and the Behavioral Sciences, Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, United States of America
| | - Christopher Pittenger
- Departments of Psychiatry and Psychology and the Child Study Center, Yale University, New Haven, Connecticut, United States of America
| | - Yehuda Pollak
- Neuropediatric Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Scott L. Rauch
- Partners Psychiatry and McLean Hospital, Boston, Massachusetts, United States of America
| | - Tobias J. Renner
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Victor I. Reus
- Department of Psychiatry, University of California at San Francisco, San Francisco, California, United States of America
| | - Margaret A. Richter
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Frederick W. Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Mark A. Riddle
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Mary M. Robertson
- University College London, London, United Kingdom
- St George's Hospital and Medical School, London, United Kingdom
| | | | - Maria C. Rosàrio
- Child and Adolescent Psychiatry Unit (UPIA), Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - David Rosenberg
- Department of Psychiatry & Behavioral Neurosciences, Wayne State University and the Detroit Medical Center, Detroit, Michigan, United States of America
| | - Guy A. Rouleau
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | | | - Aline S. Sampaio
- Department of Psychiatry, Faculdade de Medicina da Universidade de Säo Paulo, Brazil
- University Health Care Services - SMURB, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Jack Samuels
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Paul Sandor
- Department of Psychiatry, University of Toronto and University Health Network, Toronto Western Research Institute and Youthdale Treatment Centers, Toronto, Ontario, Canada
| | - Brooke Sheppard
- Department of Psychiatry, University of California at San Francisco, San Francisco, California, United States of America
| | - Harvey S. Singer
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Jan H. Smit
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - Dan J. Stein
- University of Cape Town, Cape Town, South Africa
| | - E. Strengman
- Department of Medical Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jay A. Tischfield
- Department of Genetics, Human Genetics Institute of New Jersey, Rutgers University, Piscataway, New Jersey, United States of America
| | | | - Homero Vallada
- Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | | | - Jeremy Veenstra-VanderWeele
- Departments of Psychiatry, Pediatrics, and Pharmacology, Kennedy Center for Research on Human Development, and Brain Institute, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland
- Department of Child and Adolescent Psychiatry, University of Würzburg, Würzburg, Germany
| | - Ying Wang
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Jens R. Wendland
- Laboratory of Clinical Science, NIMH Intramural Research Program, Bethesda, Maryland, United States of America
| | - Herman G. M. Westenberg
- Department of Psychiatry, Academic Medical Center and Netherlands Institute for Neuroscience, an Institute of the Royal Netherlands Academy of Arts and Sciences (NIN-KNAW), Amsterdam, The Netherlands
| | - Yin Yao Shugart
- Unit on Statistical Genomics, NIMH Intramural Research Program, Bethesda, Maryland, United States of America
| | - Euripedes C. Miguel
- Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - William McMahon
- Department of Psychiatry, University of Utah, Salt Lake City, Utah, United States of America
| | - Michael Wagner
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Humberto Nicolini
- National Institute of Genomic Medicine-SAP, Carracci Medical Group, Mexico City, Mexico
| | - Danielle Posthuma
- Department of Functional Genomics, Center for Neurogenomics and Cognitive Research, Neuroscience Campus Amsterdam, VU University Amsterdam, De Boelelaan, Amsterdam, The Netherlands
- Department of Clinical Genetics, VU Medical Centre, De Boelelaan, Amsterdam, The Netherlands
- Department of Child and Adolescent Psychiatry, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Gregory L. Hanna
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Peter Heutink
- Section of Medical Genomics, Department of Clinical Genetics, VU University Medical Center Amsterdam, The Netherlands
- German Center for Neurodegenerative Diseases, Tübingen, Germany
| | - Damiaan Denys
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Netherlands Institute for Neuroscience, an Institute of the Royal Netherlands Academy of Arts and Sciences (NIN-KNAW), Amsterdam, The Netherlands
| | - Paul D. Arnold
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ben A. Oostra
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Gerald Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Nelson B. Freimer
- Center for Neurobehavioral Genetics, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, California, United States of America
| | - David L. Pauls
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Naomi R. Wray
- The University of Queensland, Queensland Brain Institute, Queensland, Australia
| | - S. Evelyn Stewart
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- British Columbia Mental Health and Addictions Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Carol A. Mathews
- Department of Psychiatry, University of California at San Francisco, San Francisco, California, United States of America
| | - James A. Knowles
- Department of Psychiatry and the Behavioral Sciences, Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Nancy J. Cox
- Section of Genetic Medicine, Department of Medicine, University of Chicago, Chicago, Illinois, United States of America
| | - Jeremiah M. Scharf
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, Massachusetts, United States of America
- Division of Cognitive and Behavioral Neurology, Brigham and Womens Hospital, Boston, Massachusetts, United States of America
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- * E-mail: (LKD); (JMS)
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Mathews CA, Jang KL, Herrera LD, Lowe TL, Budman CL, Erenberg G, Naarden A, Bruun RD, Schork NJ, Freimer NB, Reus VI. Tic symptom profiles in subjects with Tourette Syndrome from two genetically isolated populations. Biol Psychiatry 2007; 61:292-300. [PMID: 16581034 DOI: 10.1016/j.biopsych.2006.02.009] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [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] [Received: 06/16/2005] [Revised: 10/04/2005] [Accepted: 12/16/2006] [Indexed: 11/17/2022]
Abstract
BACKGROUND Tourette Syndrome (TS) has a complex etiology and wide variability in phenotypic expression. Identifying underlying symptom patterns may be useful for etiological and outcome studies of TS. METHODS Lifetime tic and related symptom data were collected between 1996 and 2001 in 121 TS subjects from the Central Valley of Costa Rica and 133 TS subjects from the Ashkenazi Jewish (AS) population in the US. Subjects were grouped by tic symptoms using an agglomerative hierarchical cluster analysis. Cluster membership was tested for association with available ancillary information (age of onset, tic severity, comorbid disorders, medication treatment and family history). RESULTS Cluster analysis identified two distinct groups in each sample, those with predominantly simple tics (cluster 1), and those with multiple complex tics (cluster 2). Membership in cluster 2 was correlated with increased tic severity, global impairment, medication treatment, and presence of comorbid obsessive-compulsive symptoms in both samples, and with family history of tics, lower verbal IQ, earlier age of onset, and comorbid obsessive-compulsive disorder and attention-deficit/hyperactivity disorder in the AS sample. CONCLUSIONS This study provides evidence for consistent and reproducible symptom profiles in two independent TS study samples. These findings have implications for etiological studies of TS.
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Affiliation(s)
- Carol A Mathews
- Department of Psychiatry, University of California, San Diego, La Jolla, California 92093-0810, USA.
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Keen-Kim D, Mathews CA, Reus VI, Lowe TL, Herrera LD, Budman CL, Gross-Tsur V, Pulver AE, Bruun RD, Erenberg G, Naarden A, Sabatti C, Freimer NB. Overrepresentation of rare variants in a specific ethnic group may confuse interpretation of association analyses. Hum Mol Genet 2006; 15:3324-8. [PMID: 17035247 DOI: 10.1093/hmg/ddl408] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.2] [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: 01/01/2023] Open
Abstract
Rare sequence variants may be important in understanding the biology of common diseases, but clearly establishing their association with disease is often difficult. Association studies of such variants are becoming increasingly common as large-scale sequence analysis of candidate genes has become feasible. A recent report suggested SLITRK1 (Slit and Trk-like 1) as a candidate gene for Tourette Syndrome (TS). The statistical evidence for this suggestion came from association analyses of a rare 3'-UTR variant, var321, which was observed in two patients but not observed in more than 2000 controls. We genotyped 307 Costa Rican and 515 Ashkenazi individuals (TS probands and their parents) and observed var321 in five independent Ashkenazi parents, two of whom did not transmit this variant to their affected child. Furthermore, we identified var321 in one subject from an Ashkenazi control sample. Our findings do not support the previously reported association and suggest that var321 is overrepresented among Ashkenazi Jews compared with other populations of European origin. The results further suggest that overrepresentation of rare variants in a specific ethnic group may complicate the interpretation of association analyses of such variants, highlighting the particular importance of precisely matching case and control populations for association analyses of rare variants.
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Affiliation(s)
- Dianne Keen-Kim
- Center for Neurobehavioral Genetics, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
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Mathews CA, Bimson B, Lowe TL, Herrera LD, Budman CL, Erenberg G, Naarden A, Bruun RD, Freimer NB, Reus VI. Association between maternal smoking and increased symptom severity in Tourette's syndrome. Am J Psychiatry 2006; 163:1066-73. [PMID: 16741208 DOI: 10.1176/ajp.2006.163.6.1066] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [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: 11/30/2022]
Abstract
OBJECTIVE Substantial evidence suggests that both environmental and genetic factors contribute to the development and clinical expression of Tourette's syndrome. Although genetic studies of Tourette's syndrome are common, studies of environmental factors are relatively few and have not identified consistent risk factors across studies. This study examines in a large cohort of subjects (N=180) the relationship between prenatal/perinatal adverse events with Tourette's syndrome severity as determined by tic severity and rates of commonly comorbid disorders such as obsessive-compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), and self-injurious behavior. METHOD Tic severity, OCD, ADHD, self-injurious behavior, and exposure to a variety of prenatal/perinatal events were systematically assessed in all subjects enrolled in three genetic studies of Tourette's syndrome. Using linear and logistic regression, a best-fit model was determined for each outcome of interest. RESULTS Prenatal maternal smoking was strongly correlated with increased tic severity and with the presence of comorbid OCD in these Tourette's syndrome subjects. Other variables, such as paternal age and subject's birth weight, were significantly but less strongly associated with increased symptom severity. The authors found no association between symptom severity and hypoxia, forceps delivery, or hyperemesis during pregnancy, which have been previously identified as risk factors. CONCLUSIONS This study identifies prenatal maternal smoking as a strong risk factor for increased symptom severity in Tourette's syndrome.
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Affiliation(s)
- Carol A Mathews
- Department of Psychiatry, University of California San Diego, La Jolla, CA, and the Department of Psychiatry, North-Shore University Hospital/New York University School of Medicine, Manhasset, NY, USA.
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Mathews CA, Waller J, Glidden D, Lowe TL, Herrera LD, Budman CL, Erenberg G, Naarden A, Bruun RD, Freimer NB, Reus VI. Self injurious behaviour in Tourette syndrome: correlates with impulsivity and impulse control. J Neurol Neurosurg Psychiatry 2004; 75:1149-55. [PMID: 15258218 PMCID: PMC1739182 DOI: 10.1136/jnnp.2003.020693] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.1] [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: 11/04/2022]
Abstract
BACKGROUND Self injurious behaviour (SIB), the deliberate, repetitive infliction of self harm, is present in a wide variety of neuropsychiatric disorders, including Tourette syndrome (TS). Although SIB occurs in up to 60% of individuals with TS, and can cause significant clinical impairment and distress, little is known about its aetiology. OBJECTIVE This study examined the relationship between SIB and other behavioural features that commonly co-occur with TS in nearly 300 subjects with TS participating in three genetic studies. SIB, obsessions, compulsions, tic severity, attention deficit hyperactivity disorder related impulsivity, risk taking behaviours, and rages were systematically assessed in all subjects. METHODS Using logistic regression, a best fit model was determined for both mild to moderate SIB and severe SIB. RESULTS Mild/moderate SIB in TS was correlated with the presence of obsessive and compulsive symptoms such as the presence of aggressive obsessions or violent or aggressive compulsions, and with the presence of obsessive-compulsive disorder and overall number of obsessions. Severe SIB in TS was correlated with variables related to affect or impulse dysregulation; in particular, with the presence of episodic rages and risk taking behaviours. Both mild/moderate and severe SIB were also correlated with tic severity. CONCLUSIONS This study suggests that mild/moderate and severe SIB in TS may represent different phenomena, which has implications for clinical management of these symptoms.
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Affiliation(s)
- C A Mathews
- Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093-0810, USA.
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Abstract
BACKGROUND An open-label trial was performed to explore efficacy and safety of olanzapine, an atypical neuroleptic with diverse receptor activity including both dopamine-2 and serotonin-2A and -2C antagonism, for treatment of Tourette's disorder. METHOD Ten adult patients aged 20 to 44 years with Tourette's disorder were treated using an open-label, flexible dosing schedule for 8 weeks. Three patients who continued olanzapine were reevaluated after 6 months. Three subjects were psychotropic medication naive, 5 patients experienced intolerable side effects with conventional neuroleptics, and 2 patients had remote (> or = 10 years) successful response to conventional neuroleptics. Tic severity was rated by the Yale Global Tic Severity Scale; weight, vital signs, and adverse effects were assessed weekly. Electrocardiogram, laboratory studies, and comorbid symptoms, assessed by the Yale-Brown Obsessive Compulsive Scale and ADHD Behavior Checklist for Adults, were measured at baseline and at week 8. RESULTS Two of 10 patients prematurely discontinued olanzapine owing to excessive sedation. Of 8 patients who completed the 8-week trial, 4 (50%) demonstrated reduction of global tic severity scores by > or = 20 points, and 6 (75%) demonstrated reductions by > or = 10 points. No significant changes in comorbid symptoms were demonstrated. Sedation, weight gain, increased appetite, dry mouth, and transient asymptomatic hypoglycemia were the most common side effects. Tic improvements were maintained in 3 patients reassessed 6 months later. Final olanzapine dosages ranged from 2.5 mg to 20 mg daily (mean = 10.9 mg/day). CONCLUSION This open-label study suggests that olanzapine should be explored as a potential alternative to conventional neuroleptic medications for treatment of motor tics and Tourette's disorder.
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Affiliation(s)
- C L Budman
- Department of Psychiatry, New York University School of Medicine, North Shore University Hospital, Manhasset 11030, USA
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Abstract
OBJECTIVE Sudden, explosive outbursts of behavior occur in some children with Tourette's disorder (TD). The etiology of these symptoms is unknown. This study investigated the relationship between explosive outbursts, TD, and its comorbid disorders. METHOD Tic type and severity and the presence of specific comorbid disorders were compared in 37 children with TD and explosive outbursts and 31 children with TD who did not have such symptoms. RESULTS Children with TD and explosive outbursts were more likely to demonstrate significant comorbid conditions, particularly attention-deficit/hyperactivity disorder, obsessive-compulsive disorder, and oppositional defiant disorder. Tic type and severity did not appear related to the presence of explosive outbursts. A highly significant relationship was demonstrated between the number of comorbid psychiatric diagnoses and explosive outbursts. CONCLUSIONS Explosive outbursts in children with TD resemble intermittent explosive disorder and may reflect dysregulation of diverse domains of brain function. The presence of such symptoms should alert the clinician to underlying comorbid conditions.
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Affiliation(s)
- C L Budman
- Department of Neurology and Psychiatry, New York University School of Medicine, New York, USA
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Abstract
BACKGROUND Episodic rages have been estimated to occur in as many as 30% of patients with Tourette's syndrome (Tourette's disorder), but their treatment has never been systematically investigated. We report on the results of an open-label pilot study using paroxetine for the treatment of Tourette's disorder-associated rage episodes. METHOD Forty-five Tourette's/rage patients (DSM-IV) were treated with paroxetine, specifically to control their rages. Other symptoms such as tics, attention-deficit/hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD) were not targeted by this study. Treatment was deemed to be therapeutic when rage symptoms were diminished by 75% or more by patient report and were diminished in frequency by at least 1 point on a 4-point scale devised by the authors. RESULTS After 8 weeks on paroxetine treatment, 29 patients (76% of those who completed the study) reported that rages were significantly diminished or completely absent. Nine patients reported no significant change in rages. Seven patients did not complete the study (3 because of side effects and 4 whose rage frequency increased). The mean dose of paroxetine was 33 mg/day; minimum effective dose was 15 mg/day. CONCLUSION We were unable to determine any factors that significantly altered the efficacy of paroxetine for treatment of Tourette's disorder-associated rage episodes. The great majority (87%) of the patients had both ADHD and OCD in addition to Tourette's disorder. The age, sex, and concomitant use of other medications revealed no significant differences in treatment outcome. The results suggest that paroxetine may have an important role in the clinical treatment of episodic rages in Tourette's disorder patients.
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Affiliation(s)
- R D Bruun
- Department of Psychiatry, New York University Medical Center-North Shore University Hospital, Manhasset, USA
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Abstract
BACKGROUND Sudden, explosive episodes of rage occur in a significant number of clinically referred children with Tourette's disorder and cause considerable psychosocial morbidity. The etiology of these symptoms is unknown. We conducted a pilot study of 12 consecutive children with Tourette's disorder and rage attacks to determine whether comorbidity of Tourette's-associated disorders is related to these symptoms. METHOD Twelve consecutive children with Tourette's disorder who presented with rage attacks were evaluated, including 2 females and 10 males. Tourette's disorder diagnosis, presence of comorbid disorders, and tic severity were assessed using DSM-IV diagnostic criteria and standardized rating scales. RESULTS All 12 children met diagnostic criteria for Tourette's disorder, obsessive-compulsive disorder (OCD), and attention-deficit/hyperactivity disorder (ADHD). Two children were also diagnosed with comorbid oppositional defiant disorder, and 4 children were diagnosed with comorbid conduct disorder. None of the subjects met diagnostic criteria for a mood disorder. All subjects had only mild tic severity. CONCLUSION The clinical phenomenon of rage attacks in children with Tourette's disorder resembles intermittent explosive disorder and may reflect specific underlying neurologic disturbances. This pilot study suggests that rage attacks in Tourette's disorder may be related to the presence of comorbid disorders.
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Affiliation(s)
- C L Budman
- Department of Psychiatry, New York University School of Medicine, North Shore University Hospital, Manhasset 11030, USA
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Abstract
The view of Tourette syndrome as a lifelong disorder, once held as a certainty, has changed considerably in the past two decades. It is now known that in the majority of cases, tics will ebb in severity and will no longer be problematic in the adult years. This discovery, however, has been accompanied by the realization that Tourette syndrome is a far more complex disorder than was originally discerned and that it has many unanswered questions.
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Affiliation(s)
- R D Bruun
- Department of Psychiatry, Cornell University Medical College, Manhasset, New York, USA
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Bruun RD, Budman CL. Risperidone as a treatment for Tourette's syndrome. J Clin Psychiatry 1996; 57:29-31. [PMID: 8543544] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND An open-label trial was performed to assess the efficacy and safety of risperidone, a benzisoxazole derivative with potent D2 and 5-HT2 antagonism, for treatment of Tourette's syndrome. METHOD Thirty-eight patients with Tourette's syndrome volunteered to take risperidone for treatment of their tics. All patients had failed to respond adequately to conventional treatments (with neuroleptics such as haloperidol and/or with the alpha 2-adrenergic agonist clonidine) or had suffered from intolerable side effects from such treatments. Patients were rated for tic severity by the Yale Global Tic Severity Scale (YGTSS) before treatment and after 1 month of treatment with risperidone. Patients were monitored carefully for side effects and clinical response. RESULTS Of the 38 patients, 8 discontinued risperidone treatment before the end of the trial because of intolerable side effects. At the end of the 4-week trial, 22 patients (58%) were improved, 7 patients (18%) had no appreciable change in their symptoms, and 1 patient (3%) had a documented worsening of tics. Doses of risperidone at the end of the trial ranged from 0.5 mg to 9 mg/day (mean = 2.7 mg/day). CONCLUSION This open clinical trial suggests that risperidone may be a promising alternative to conventional medications used for treating the symptoms of Tourette's syndrome.
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Affiliation(s)
- R D Bruun
- Cornell University Medical School, New York, N.Y., USA
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Stein DJ, Bruun RD, Josephson SC, Hollander E. Obsessional severity in Tourette's syndrome. J Clin Psychiatry 1991; 52:388. [PMID: 1894593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Abstract
A variety of side effects developed in children treated with neuroleptics for Tourette's disorder. Of 208 children, 34 manifested dose-related symptoms of dysphoria, nine experienced a worsening of symptoms of Tourette's disorder that was attributed to akathisia, five became hostile and aggressive, three developed "fog states" that disappeared with discontinuation of neuroleptics or treatment with primidone, and three experienced symptoms of tardive dyskinesia that resolved with time. This data base of neuroleptic-treated children with Tourette's disorder demonstrates a variety of subtle and underrecognized side effects that may not be as readily discernible in children receiving neuroleptics for a primary psychiatric disorder.
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Affiliation(s)
- R D Bruun
- Department of Psychiatry, Cornell University Medical School, New York
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Abstract
The authors conducted a follow-up study of 78 patients with Gilles de la Tourette's syndrome. Four of the patients were in spontaneous remission; 59 patients taking haloperidol showed an average improvement of 79.3% and the remaining patients, 3 of whom were taking medication other than haloperidol and 12 of whom were not taking any medication, showed an average improvement of 24.7%. Side effects were the main cause of discontinuing haloperidol. The authors found that response to haloperidol was unrelated to family history of tics, age at onset, type or severity of symptoms, or signs of organicity.
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Bruun RD, Shapiro AK, Shapiro E. A followup of eighty patients with Tourette's syndrome. Psychopharmacol Bull 1976; 12:15-7. [PMID: 769020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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