Why two findings which were eventually refuted have been seminal for the field of psychiatric genetics.
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Schizophrenia and bipolar affective disorder are chronic, disabling illnesses that together affect 2% of the population. Genetic factors are known to be important in their development, but there are, as yet, no confirmed susceptibility genes. Here we discuss important issues in terms of alternative genetic strategies (linkage, association and/or cytogenetics) in the identification of candidate genes for the major psychoses. We discuss the impact of the Human Genome Project, the role of comparative genetics in finding and testing positional candidates, and the prospects for rational drug design and personalized medicine.
There is evidence suggesting that the primary (idiopathic) mental disorders are due to epimutations involving genes that determine the structure of the brain. Although in the past it has been suggested that the genes underlying the primary mental disorders may be unidentifiable, recent developments in neuroscience suggest otherwise. This paper outlines various epigenetic strategies that may help identify the genes underlying these disorders.
A duplication of part of chromosome 15q, apparently inherited in a non-Mendelian fashion, has been found to be strongly associated with phobic disorders. This unusual genetic mechanism may partly explain the heritability of phobias and other complex traits.
A nonsense mutation in the X-linked monoamine oxidase A gene has been associated with sex-linked aggressive behaviour.
Attempts to map the genes for psychotic illnesses have been fraught with problems. Studying why some family members do not become ill might prove to be a more successful strategy.
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There is good evidence from recent studies that depression is familial, and that a substantial proportion of the variation in liability is explained by genes. Suicidal behavior, including completed suicide, also seems to cluster in families. First-degree relatives of individuals who have committed suicide (included dizygotic twins) have more than twice the risk of the general population. For identical co-twins of suicides, the relative risk increases to about 11. Applying a simple structural equation model to the published data suggests a heritability for completed suicide of about 43% (95% confidence intervals 25-60). It is not known at present whether the genes predisposing to suicide are identical with those predisposing to affective disorder, but since only about half of those committing suicide have a diagnosis of depression, it seems probable that the overlap is incomplete. The mode of inheritance of suicidal behavior is almost certain to be complex, involving many genes. There have already been some initial studies of allelic association with polymorphisms in candidate genes such as those involved in serotonergic transmission. Further progress is likely to come from candidate gene and linkage disequilibrium studies that are capable of detecting multiple genes of small effect.
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