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PubMed1993

Identification of the phenotype in psychiatric genetics.

Statistical procedures and molecular genetic techniques have attained a fine degree of resolution. Their ability to find disease genes has revolutionized medicine and raised hopes for breakthroughs in psychiatry. However, such breakthroughs may require an equally discriminating nosology. A psychiatric genetic nosology seeks to classify patients into categories that correspond to distinct genetic entities by addressing the problem of diagnostic accuracy: the degree to which a diagnosis correctly classifies people with and without a putative genetic illness. We review methods that deal with misclassification in genetic studies. These are clinical and epidemiological approaches that deal directly with how to define the observable manifestation of a putative genotype. We discuss two groups of methods: those that use known phenotypes and those that design new phenotypes.

Aged↗
PubMed2004

Complexities in psychiatric genetics.

A substantial contribution of genetic factors to the risk of psychiatric disorders such as schizophrenia, bipolar disorder, autism, and drug and alcohol dependence has already been established. However, the familial transmission of these disorders cannot be explained by simple Mendelian models of inheritance, and non-genetic factors must also play a substantial role in their etiologies. Furthermore, the prevalence of any major psychiatric disorder is a great deal higher than that of Mendelian disorders. It has been suggested that evolutionary forces would rapidly eliminate large gene effects, which would suggest that mental disorders, which are highly prevalent, are associated with minor gene effects (Risch, 1994). The current paradigm is that genes with small interacting genetic effects, in conjunction with environmental factors, affect the risk for psychiatric disease. New laboratory and statistical methodology and database tools, and the availability of large clinical samples for the study of linkage and association sustain optimism that genes involved with these diseases will be characterized in the near future. This accomplishment should in turn lead not only to a better understanding of the primary molecular pathophysiology and to more specific and effective therapies, but also to a better understanding of non-genetic risk factors that could be targets for preventive strategies.

Alleles↗
PubMed1992

Psychiatric, genetic, and positron emission tomographic evaluation of persons at risk for Huntington's disease.

We examined chorea-free subjects at risk for Huntington's disease (n = 52) for lifetime psychiatric diagnoses, present mood, genetic marker status, and caudate glucose metabolic rates with positron emission tomography. Based on previous work, a caudate-ipsilateral hemisphere ratio less than 1.15 was defined as abnormal and predictive of Huntington's disease. None of three methods used to segregate subjects into groups more and less likely to develop Huntington's disease gave significant group rate differences for any formal psychiatric diagnoses. On present mood testing, however, subjective "anger/hostility" was significantly higher in those likely, compared with those less likely, to develop Huntington's disease, as determined by all three methods.

Adult↗
PubMed2000

Psychiatric genetics: back to the future.

For the last decade or more geneticists have been predicting that advances in molecular genetics are going to revolutionize our understanding of psychiatric disorders and human behavior. However, with a few exceptions, these expectations have yet to be fulfilled. As the century draws to a close and we contemplate the prospect of the complete sequence of the human genome it seems timely to consider the state of the field and to consider carefully how it might advance, the problems to be faced and the resources required. Molecular Psychiatry (2000) 5, 22-31.

Animals↗
PubMed2006

The endophenotype concept in psychiatric genetics.

The idea that some phenotypes bear a closer relationship to the biological processes that give rise to psychiatric illness than diagnostic categories has attracted considerable interest. Much effort has been devoted to finding such endophenotypes, partly because it is believed that the genetic basis of endophenotypes will be easier to analyse than that of psychiatric disease. This belief depends in part on the assumption that the effect sizes of genetic loci contributing to endophenotypes are larger than those contributing to disease susceptibility, hence increasing the chance that genetic linkage and association tests will detect them. We examine this assumption by applying meta-analytical techniques to genetic association studies of endophenotypes. We find that the genetic effect sizes of the loci examined to date are no larger than those reported for other phenotypes. A review of the genetic architecture of traits in model organisms also provides no support for the view that the effect sizes of loci contributing to phenotypes closer to the biological basis of disease is any larger than those contributing to disease itself. While endophenotype measures may afford greater reliability, it should not be assumed that they will also demonstrate simpler genetic architecture.

Catechol O-Methyltransferase↗
PubMed1986

Clinical methods in psychiatric genetics. II. The high risk approach.

The study of individuals at "high" risk for developing psychiatric disorders is useful in confirming that a biological trait marker identified in patient populations is also present in genetically susceptible individuals who have never been ill, and predicts the future onset of illness. We outline a systematic method for deciding which variables to choose and how many individuals are required in order for a study to have sufficient power. We demonstrate how these decisions depend on the assumptions that can be made with regard to the mode of inheritance of the biological trait, the relationship of the biological trait to illness, and the magnitude of the mean difference observed between patients and controls. We also quantify the increased power of studying offspring of two affected parents rather than offspring of one affected parent.

Affective Disorders, Psychotic↗
PubMed2006

Applications and limitations of empiric data in provision of recurrence risks for schizophrenia: a practical review for healthcare professionals providing clinical psychiatric genetics consultations.

Schizophrenia is a common disorder that may frequently be encountered when taking family histories in the genetics clinic, whether or not the referral is for a psychiatric indication. Like in other common disorders, the provision of recurrence risks for schizophrenia is a complex clinical issue because empiric recurrence risks (while reasonably well established) can rarely be used without individual tailoring. This review seeks to identify and detail some pertinent issues surrounding the clinical utility of empiric recurrence risks for schizophrenia, and to provide an overview of important factors to consider when tailoring empiric risks for individual patients.

Empirical Research↗
PubMed1996

The "equal environments assumption" in MZ-DZ twin comparisons: an untenable premise of psychiatric genetics?

The comparison of MZ-DZ twins in behavioral genetics has produced what seems like irrefutable evidence for the heritability of many psychiatric disorders. But such research depends on the validity of the EEA--the "equal environments assumption"--as an underlying premise. In this paper, several empirical studies which support the EEA are critically reviewed in terms of methodology and the way data has been processed in a mathematical model called "path analysis". It turns out that studies investigating the EEA appear to be largely inadequate in terms of technique, as well as biased in the inferences drawn. Further, the "heritability" estimate--often taken to mean the influence of trait-specific genes--is merely a statistical abstraction derived from a matrix of correlations; this estimate encompasses many buried environmental effects so that "heritability" does not correspond to any underlying DNA structure. In conclusion, many MZ-DZ pedigree studies have dubious scientific value, given the non-viable premise of the EEA, as well as the misleading operational definition of what has been called "heritability".

Humans↗
PubMed1993

Legal and ethical issues in psychiatric genetic research.

Genetic research may uncover the causes of severe mental disorders, and many projects have been undertaken to locate the genes responsible for schizophrenia, bipolar disorder, and Alzheimer disease. A number of sensitive legal and ethical issues have been raised, including 1) protection of confidential data concerning research subjects; 2) the assessment of types and degree of risk to subjects who participate in such studies; 3) the legal and ethical acceptability of substituted judgement on behalf of patients who may not be competent to provide informed consent; and 4) the separation of research and clinical roles in areas such as genetic counseling. Federal regulations and other guidelines are of limited value in dealing with such concerns, and many important human subjects issues will need to be dealt with by the investigator, subject to approval by a local Institutional Review Board. There does seem to be general agreement that informed consent must be obtained, potential risks of research need to be minimized, and confidentiality of sensitive data must be protected.

Advance Directives↗
PubMed2005

Meta-analysis in psychiatric genetics.

The article reviews literature on methods for meta-analysis of genetic linkage and association studies, and summarizes and comments on specific meta-analysis findings for psychiatric disorders. The Genome Scan Meta-Analysis and Multiple Scan Probability methods assess the evidence for linkage across studies. Multiple Scan Probability analysis suggested linkage of two chromosomal regions (13q and 22q) to schizophrenia and bipolar disorder, whereas Genome Scan Meta-Analysis on a larger sample identified at least 10 schizophrenia linkage regions, but none for bipolar disorder. Meta-analyses of pooled ORs support association of schizophrenia to the Ser311Cys polymorphism in DRD2 and the T102C polymorphism in HTR2A, and of attention deficit hyperactivity disorder to the 48-bp repeat in DRD4. The 5-HTTLPR polymorphism in the serotonin transporter gene (SLC6A4) may contribute to the risk of bipolar disorder, suicidal behavior, and neuroticism, but association to the lifetime risk of major depression has not been shown. Meta-analyses support linkage of schizophrenia to regions where replicable associations to candidate genes have been identified through positional cloning methods. There are additional supported regions where susceptibility genes are likely to be identified. Linkage meta-analysis has had less clear success for bipolar disorder based on a smaller dataset. Meta-analysis can guide the prioritization of regions for study, but proof of association requires biological confirmation of hypotheses about gene actions. Elucidation of causal mechanisms will require more comprehensive study of sequence variation in candidate genes, better statistical and meta-analytic methods to take all variation into account, and biological strategies for testing etiologic hypotheses.

Adolescent↗
PubMed1975

Some recent developments in psychiatric genetics.

The methods and results of some recent family, twin and adoption studies of childhood behaviour disorders, crime, alcoholism, psychopathic personality and neurosis are briefly described. The data of Slater (1938) on the parents and children of manic-depressives are reanalysed. Bipolar affective illness were more frequent in the families of bipolar than unipolar probands. There was no support for sex-linked inheritance in either group or for further genetic subdivision of the unipolar group according to age of onset or alcoholic or psychopathic family history. It is suggested that for the time being we may have to be satisfied with three broad and aetiologically overlapping clinical types of depression: bipolar, unipolar and reactive.

Adoption↗
PubMed2002

Psychiatric genetics: the case of single gene disorders.

Quantitative and molecular genetics have made important developments in the last three decades. There is increasing evidence of the role of heredity in the field of neuropsychiatric disorders in children. So far, only a few pathways between genes and behaviour have been unravelled. Quantitative genetics puts polygenic inheritance models forward. Molecular genetic research based on these models seems promising, but until now has provided only a limited explanation for the variance in the studied neuropsychiatric disorders. In these models the complexity of the expression of a single gene grows exponentially with the number of genes involved. Consequently, research on the gene-phenotype relationships and phenotypical variability in such models is extremely complex.The candidate gene approach, in which the gene-phenotype pathway of a single gene is studied, is more manageable, and in our opinion essential in understanding multiple gene models. We discuss recent findings in the field and their relevance for neuropsychiatric phenotypes. Single gene defects will only explain a part of the range of neuropsychiatric disorders in children, but the evidence that this approach can generate may help to clarify neuropsychiatric phenotypes. The discovery of single gene disorders in subgroups of subjects with a neuropsychiatric phenotype may result in new perspectives for their treatment.

Autistic Disorder↗