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Ritish D, Reddy PV, Sreeraj VS, Chhabra H, Kumar V, Venkatasubramanian G, Muralidharan K. Oculomotor Abnormalities and Aberrant Neuro-Developmental Markers: Composite Endophenotype for Bipolar I Disorder: Anomalies Oculomotrices et Marqueurs Neuro-Développementaux Aberrants : Endophénotype Composite du Trouble Bipolaire I. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2024:7067437241248048. [PMID: 38651336 DOI: 10.1177/07067437241248048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND Neurological soft signs (NSSs), minor physical anomalies (MPAs), and oculomotor abnormalities were plausible biomarkers in bipolar disorder (BD). However, specific impairments in these markers in patients after the first episode mania (FEM), in comparison with first-degree relatives (high risk [HR]) of BD and healthy subjects (health control [HC]) are sparse. AIM OF THE STUDY This study aimed at examining NSSs, MPAs, and oculomotor abnormalities in remitted adult subjects following FEM and HR subjects in comparison with matched healthy controls. Investigated when taken together, could serve as composite endophenotype for BD. METHODS NSSs, MPAs, and oculomotor abnormalities were evaluated in FEM (n = 31), HR (n = 31), and HC (n = 30) subjects, matched for age (years) (p = 0.44) and sex (p = 0.70) using neurological evaluation scale, Waldrop's physical anomaly scale and eye tracking (SPEM) and antisaccades (AS) paradigms, respectively. RESULTS Significant differences were found between groups on NSSs, MPAs, and oculomotor parameters. Abnormalities are higher in FEM subjects compared to HR and HC subjects. Using linear discriminant analysis, all 3 markers combined accurately classified 72% of the original 82 subjects (79·2% BD, 56·70% HR, and 82·1% HC subjects). CONCLUSIONS AS and SPEM could enhance the utility of NSSs, and MPAs as markers for BD. The presence of these abnormalities in FEM suggests their role in understanding the etiopathogenesis of BD in patients who are in the early course of illness. These have the potential to be composite endophenotypes and have further utility in early identification in BD.
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Affiliation(s)
- Daniel Ritish
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Preethi V Reddy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Vanteemar S Sreeraj
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Harleen Chhabra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Vijay Kumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | - Kesavan Muralidharan
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
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Pang JY, Wang YP, Teng HM, He J, Luo R, Feng SM, Yue WH, Li HF. Interaction between HTR2A rs3125 and negative life events in suicide attempts among patients with major depressive disorder: a cross-sectional study. BMC Psychiatry 2024; 24:249. [PMID: 38565988 PMCID: PMC10988927 DOI: 10.1186/s12888-024-05713-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 03/25/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Both genetic and environmental factors play crucial roles in the development of major depressive disorder (MDD) and suicide attempts (SA). However, the interaction between both items remains unknown. This study aims to explore the interactions between the genetic variants of the serotonin 2 A receptor (HTR2A) and the nitric oxide synthase 1 (NOS1) and environmental factors in patients who experience MDD and SA. METHODS A total of 334 patients with MDD and a history of SA (MDD-SA) were recruited alongside 518 patients with MDD with no history of SA (MDD-NSA), and 716 healthy controls (HC). The demographic data and clinical characteristics were collected. Sequenom mass spectrometry was used to detect eight tag-single nucleotide polymorphisms (tagSNPs) in HTR2A (rs1328683, rs17068986, and rs3125) and NOS1 (rs1123425, rs2682826, rs3741476, rs527590, and rs7959232). Generalized multifactor dimensionality reduction (GMDR) was used to analyze the gene-environment interactions. RESULTS Four tagSNPs (rs17068986, rs3125, rs527590, and rs7959232) exhibited significant differences between the three groups. However, these differences were not significant between the MDD-SA and MDD-NSA groups after Bonferroni correction. A logistic regression analysis revealed that negative life events (OR = 1.495, 95%CI: 1.071-2.087, P = 0.018), self-guilt (OR = 2.263, 95%CI: 1.515-3.379, P < 0.001), and negative cognition (OR = 2.252, 95%CI: 1.264-4.013, P = 0.006) were all independently associated with SA in patients with MDD. Furthermore, GMDR analysis indicated a significant interaction between HTR2A rs3125 and negative life events. Negative life events in conjunction with the HTR2A rs3125 CG + GG genotype were associated with a higher SA risk in patients with MDD when compared to the absence of negative life events in conjunction with the CC genotype (OR = 2.547, 95% CI: 1.264-5.131, P = 0.009). CONCLUSION Several risk factors and a potential interaction between HTR2A rs3125 and negative life events were identified in patients with SA and MDD. The observed interaction likely modulates the risk of MDD and SA, shedding light on the pathogenesis of SA in patients with MDD.
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Affiliation(s)
- Jian-Yue Pang
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, 450052, Zhengzhou, China
| | - Yi-Ping Wang
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, 450052, Zhengzhou, China
| | - Hui-Min Teng
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, 450052, Zhengzhou, China
| | - Jin He
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, 450052, Zhengzhou, China
| | - Rui Luo
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, 450052, Zhengzhou, China
| | - Si-Meng Feng
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, 450052, Zhengzhou, China
| | - Wei-Hua Yue
- Peking University Sixth Hospital, Peking University Institute of Mental Health, 100191, Beijing, China.
- National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), 100191, Beijing, China.
- NHC Key Laboratory of Mental Health (Peking University), 100191, Beijing, China.
- PKU-IDG/McGovern Institute for Brain Research, Peking University, 100871, Beijing, China.
- Chinese Institute for Brain Research, Beijing102206, China.
| | - Heng-Fen Li
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, 450052, Zhengzhou, China.
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Behera C, Kaushik R, Bharti DR, Nayak B, Bhardwaj DN, Pradhan D, Singh H. PsychArray-Based Genome Wide Association Study of Suicidal Deaths in India. Brain Sci 2023; 13:brainsci13010136. [PMID: 36672117 PMCID: PMC9856809 DOI: 10.3390/brainsci13010136] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
Background: Suicide is a preventable but escalating global health crisis. Genome-wide association studies (GWAS) studies to date have been limited, and some are underpowered. In this study, we aimed to perform the PsychArray-based GWAS study to identify single nucleotide variations associated with suicide in the Indian population. Methods: We recruited unrelated subjects who died by suicide as cases (N = 313) and the non-suicidal deaths as controls (N = 294). The 607 samples were genotyped, including cases and controls using the Illumina Infinium PsychArray-24 BeadChip v1.3 Results: In our study, four single nucleotide polymorphisms (SNPs) crossed the threshold of significance level <1 × 10−5. One of them is intronic at Chromosome2:rs1901851 and three are intergenic at Chromosome12:rs3847911, Chromosome8:rs2941489, Chromosome8:rs1464092. At a significance level of 5 × 10−5, we found a few more SNPs, with the majority of them being intergenic variants. The associated genes were associated with various important functions ranging from cell signaling, GTP binding, GPCR binding, and transcription factor binding. Conclusions: The SNPs identified in our study were not reported earlier. To our best knowledge, this study is one of the first GWAS for suicide in the Indian population. The results indicate few novel SNPs that may be associated with suicide and require further investigation. Their clinical significance is to be studied in the future.
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Affiliation(s)
- Chittaranjan Behera
- Department of Forensic Medicine & Toxicology, All India Institute of Medical Sciences, New Delhi 110029, India
- Correspondence: ; Tel.: +91-9968320486; Fax: +91-1126588641
| | - Ruchika Kaushik
- Department of Forensic Medicine & Toxicology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Deepak Ramkumar Bharti
- Department of Forensic Medicine & Toxicology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Baibaswata Nayak
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Daya Nand Bhardwaj
- Department of Forensic Medicine & Toxicology, All India Institute of Medical Sciences, New Delhi 110029, India
| | | | - Harpreet Singh
- Biomedical Informatics (BMI), ICMR, New Delhi 110029, India
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Zai CC, Fabbri C, Hosang GM, Zhang RS, Koyama E, de Luca V, Tiwari AK, King N, Strauss J, Jones I, Jones L, Breen G, Farmer AE, McGuffin P, Vincent JB, Kennedy JL, Lewis CM. Genome-wide association study of suicidal behaviour severity in mood disorders. World J Biol Psychiatry 2021; 22:722-731. [PMID: 33783297 DOI: 10.1080/15622975.2021.1907711] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/08/2020] [Accepted: 01/17/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Suicide is a major public health problem and it has a prominent genetic component. We performed a genome-wide association study (GWAS) of suicidal behaviour severity. METHODS Suicide behaviour severity was assessed within the Schedules for Clinical Assessment in Neuropsychiatry in our mood disorder sample (n = 3506) for the GWAS. We also performed polygenic risk score analyses to explore genetic sharing between suicidal behaviour severity and a number of phenotypes, including bipolar disorder, major depressive disorder, alcoholism, post-traumatic stress disorder, impulsivity, insomnia, educational attainment, loneliness, maltreatment, and amygdala volume. RESULTS We did not detect genome-wide significant findings at the single-marker or gene level. We report a number of suggestive single-marker and gene-based findings. Our polygenic risk score analyses did not yield significant findings with these phenotypes. CONCLUSIONS Larger sample sizes are required to detect moderate effects.
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Affiliation(s)
- Clement C Zai
- Neurogenetics Section, Tanenbaum Centre for Pharmacogenetics, Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
- Harvard Chan School of Public Health, Boston, MA, USA
| | - Chiara Fabbri
- Social, Genetic & Developmental Psychiatry Centre, King's College London, London, UK
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Georgina M Hosang
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Dentistry and Medicine, Queen Mary University of London, London, UK
| | - Ruo Su Zhang
- Neurogenetics Section, Tanenbaum Centre for Pharmacogenetics, Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - Emiko Koyama
- Neurogenetics Section, Tanenbaum Centre for Pharmacogenetics, Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - Vincenzo de Luca
- Neurogenetics Section, Tanenbaum Centre for Pharmacogenetics, Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Arun K Tiwari
- Neurogenetics Section, Tanenbaum Centre for Pharmacogenetics, Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Nicole King
- Neurogenetics Section, Tanenbaum Centre for Pharmacogenetics, Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - John Strauss
- Neurogenetics Section, Tanenbaum Centre for Pharmacogenetics, Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Ian Jones
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Lisa Jones
- Department of Psychological Medicine, University of Worcester, Worcester, UK
| | - Gerome Breen
- Social, Genetic & Developmental Psychiatry Centre, King's College London, London, UK
| | - Anne E Farmer
- Social, Genetic & Developmental Psychiatry Centre, King's College London, London, UK
| | - Peter McGuffin
- Social, Genetic & Developmental Psychiatry Centre, King's College London, London, UK
| | - John B Vincent
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
- Molecular Neuropsychiatry and Development (MiND) Laboratory, Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - James L Kennedy
- Neurogenetics Section, Tanenbaum Centre for Pharmacogenetics, Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Cathryn M Lewis
- Social, Genetic & Developmental Psychiatry Centre, King's College London, London, UK
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Almeida VFD, Bezerra-Filho S, Studart-Bottó P, Léda-Rego G, Silva ITF, Kapczinski F, Miranda-Scippa Â. History of suicide attempts in patients with bipolar disorder type I: socio-demographic and clinical factors, quality of life and functioning. Nord J Psychiatry 2021; 75:306-313. [PMID: 33302763 DOI: 10.1080/08039488.2020.1853230] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION This study aims to evaluate sociodemographic and clinical factors, quality of life (QoL) and functioning associated with history of suicide attempts (SA) in a sample of bipolar disorder (BD) type I patients. METHODS A total of 417 BD type I patients, with and without history of SA were recruited from two Brazilian specialized Mood Disorder Centers. They were assessed with a sociodemographic and clinical questionnaire, the Young Mania Rating Scale, the Hamilton Depression Rating Scale, the Structured Clinical Interviews for DSM-IV Axis I Disorders, the World Health Organization Quality of Life-BREF, and the Sheehan Disability Scale. RESULTS One hundred and seventy-nine (42.9%) patients had a history of SA. There were no statistically significant sociodemographic differences between BD patients with and without a history of SA. Logistic regression found that lifetime hospitalization, comorbid anxiety disorders, depressive polarity in the first episode, current intensity of depressive symptoms, history of rapid cycling, family history of suicide and age at onset were significantly associated with SA in BD. Multiple linear regression showed that SA had no effect on QoL and functioning, which were affected mainly by comorbid anxiety disorders and current intensity of depressive symptoms, even in patients considered euthymic. CONCLUSION Suicidal behavior in patients with BD is a complex phenomenon and reflects a more severe course of illness. Patients with history of SA may have worse QoL and functional impairment not because of its direct effect, but because of the greater association with clinical factors related to poor prognosis.
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Affiliation(s)
| | | | - Paula Studart-Bottó
- Mood and Anxiety Disorders Program (CETHA), UFBA, Salvador, Brazil.,Postgraduate Program in Medicine and Health, UFBA, Salvador, Brazil
| | - Gabriela Léda-Rego
- Mood and Anxiety Disorders Program (CETHA), UFBA, Salvador, Brazil.,Postgraduate Program in Medicine and Health, UFBA, Salvador, Brazil
| | | | - Flávio Kapczinski
- Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Ângela Miranda-Scippa
- Mood and Anxiety Disorders Program (CETHA), UFBA, Salvador, Brazil.,Postgraduate Program in Medicine and Health, UFBA, Salvador, Brazil.,Department of Neurosciences and Mental Health, Bahia Medical School, UFBA, Salvador, Brazil
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6
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Bokor J, Sutori S, Torok D, Gal Z, Eszlari N, Gyorik D, Baksa D, Petschner P, Serafini G, Pompili M, Anderson IM, Deakin B, Bagdy G, Juhasz G, Gonda X. Inflamed Mind: Multiple Genetic Variants of IL6 Influence Suicide Risk Phenotypes in Interaction With Early and Recent Adversities in a Linkage Disequilibrium-Based Clumping Analysis. Front Psychiatry 2021; 12:746206. [PMID: 34777050 PMCID: PMC8585756 DOI: 10.3389/fpsyt.2021.746206] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Understanding and predicting suicide remains a challenge, and a recent paradigm shift regarding the complex relationship between the immune system and the brain brought attention to the involvement of inflammation in neuropsychiatric conditions including suicide. Among cytokines, IL-6 has been most frequently implicated in suicide, yet only a few candidate gene studies and without considering the effect of stress investigated the role of IL6 in suicidal behaviour. Our study aimed to investigate the association of IL6 variation with a linkage disequilibrium-based clumping method in interaction with childhood adversities and recent stress on manifestations along the suicide spectrum. Methods: One thousand seven hundred and sixty-two participants provided information on previous suicide attempts, current suicidal ideation, thoughts of death, and hopelessness, and were genotyped for 186 variants in IL6. Early childhood adversities were recorded with an instrument adapted from the Childhood Trauma Questionnaire, recent life events were registered using the List of Threatening Life Events. Following a 3-step quality control, logistic and linear regression models were run to explore the effect of genotype and gene-environment interactions on suicide phenotypes. All regression models were followed by a clumping process based on empirical estimates of linkage disequilibrium between clumps of intercorrelated SNPs. Interaction effects of distinct types of recent life events were also analysed. Results: No clumps with significant main effects emerged, but we identified several clumps significantly interacting with childhood adversities on lifetime suicide attempts, current suicidal ideation, and current thoughts of death. We also identified clumps significantly interacting with recent negative life events on current suicidal ideation. We reported no clumps with significant effect on hopelessness either as a main effect or in interaction with childhood adversities or recent stress. Conclusion: We identified variant clumps in IL6 influencing suicidal behaviour, but only in interaction with childhood or recent adversities. Our results may bring us a step further in understanding the role of neuroinflammation and specifically of IL-6 in suicide, towards identifying novel biological markers of suicidal behaviour especially in those exposed to stressful experiences, and to fostering the adaptation of a new paradigm and identifying novel approaches and targets in the treatment of suicidal behaviour.
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Affiliation(s)
- Janos Bokor
- Department of Forensic and Insurance Medicine, Semmelweis University, Budapest, Hungary
| | - Sara Sutori
- Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary
| | - Dora Torok
- Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary
| | - Zsofia Gal
- Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary
| | - Nora Eszlari
- Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary.,NAP-2-SE New Antidepressant Target Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
| | - Dorka Gyorik
- Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary
| | - Daniel Baksa
- Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary.,SE-NAP-2 Genetic Brain Imaging Migraine Research Group, Semmelweis University, Budapest, Hungary
| | - Peter Petschner
- Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary.,Bioinformatics Center, Institute for Chemical Research, Kyoto University, Uji, Japan
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal, and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maurizio Pompili
- Department of Neurosciences Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, University of Rome, Rome, Italy
| | - Ian M Anderson
- Neuroscience and Psychiatry Unit, Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biological, Medical, and Human Sciences, The University of Manchester and Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Bill Deakin
- Neuroscience and Psychiatry Unit, Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biological, Medical, and Human Sciences, The University of Manchester and Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Gyorgy Bagdy
- Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary.,NAP-2-SE New Antidepressant Target Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
| | - Gabriella Juhasz
- Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary.,SE-NAP-2 Genetic Brain Imaging Migraine Research Group, Semmelweis University, Budapest, Hungary
| | - Xenia Gonda
- NAP-2-SE New Antidepressant Target Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary.,Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
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Nielsen DA, Deng H, Patriquin MA, Harding MJ, Oldham J, Salas R, Fowler JC, Frueh BC. Association of TPH1 and serotonin transporter genotypes with treatment response for suicidal ideation: a preliminary study. Eur Arch Psychiatry Clin Neurosci 2020; 270:633-642. [PMID: 30923939 DOI: 10.1007/s00406-019-01009-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 03/26/2019] [Indexed: 12/14/2022]
Abstract
Variants in three genes coding for components of the serotonergic system, the tryptophan hydroxylase 1 (TPH1) rs1799913, serotonin transporter (SLC6A4) 5-HTTLPR, and serotonin receptor 2A (HTR2A) rs6311, were evaluated for association with suicidal ideation (SI) and with recovery from SI in a psychiatric inpatient population. Five hundred and eighty-two adult inpatients, including 390 patients who had SI, collected from December 2012 to April 2016 were assessed. SI recovery, calculated as change in SI between the first two-week period after admission and weeks 5 and 6, was appraised for association with the three variants. In this preliminary study, both TPH1 and 5-HTTLPR genotypes were associated with recovery (TPH1: recessive model, increased recovery with AC genotype, P = 0.026; additive model, increased recovery with AC genotype, P = 0.037; 5-HTTLPR: recessive model, increased recovery with AC, P = 0.043). When patients with comorbid alcohol use disorder (AUD) were removed, given that TPH1 has been associated with alcoholism, the associations of those recovered from SI with TPH1 rs1799913 remained significant for the additive (increased recovery with AC, P = 0.045) and recessive (increased recovery with C-carriers, P = 0.008) models, and with 5-HTTLPR using the dominant model (increased recovery with S'S', P = 0.016). In females, an association of SI recovery with TPH1 rs1799913 was found using a recessive model (increased recovery with C-carriers, P = 0.031), with 5-HTTLPR using additive (increased recovery with L'S', P = 0.048) and recessive (increased recovery with S'S', P = 0.042) models. Additionally, an association of SI with TPH1 rs1799913 was found in females using both additive (increased risk in AC, P = 0.033) and recessive (increased risk in C-carriers, P = 0.043) models, and with 5-HTTLPR using a recessive model (increased risk in S'S', P = 0.030). This study provides evidence that variation in the TPH1 and serotonin transporter genes play key roles in moderating recovery from SI during treatment in an inpatient psychiatric clinic.
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Affiliation(s)
- David A Nielsen
- The Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 2002 Holcombe Blvd., Research 151, Building 110, Suite 227, Houston, TX, 77030, USA. .,Department of Pharmacology and Chemical Biology, Baylor College of Medicine, Houston, TX, USA. .,Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
| | - Huiqiong Deng
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Michelle A Patriquin
- The Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 2002 Holcombe Blvd., Research 151, Building 110, Suite 227, Houston, TX, 77030, USA.,Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.,The Menninger Clinic, Houston, TX, USA
| | - Mark J Harding
- The Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 2002 Holcombe Blvd., Research 151, Building 110, Suite 227, Houston, TX, 77030, USA.,Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - John Oldham
- The Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 2002 Holcombe Blvd., Research 151, Building 110, Suite 227, Houston, TX, 77030, USA
| | - Ramiro Salas
- The Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 2002 Holcombe Blvd., Research 151, Building 110, Suite 227, Houston, TX, 77030, USA.,Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.,The Menninger Clinic, Houston, TX, USA
| | - J Christopher Fowler
- The Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 2002 Holcombe Blvd., Research 151, Building 110, Suite 227, Houston, TX, 77030, USA.,The Menninger Clinic, Houston, TX, USA
| | - B Christopher Frueh
- The Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 2002 Holcombe Blvd., Research 151, Building 110, Suite 227, Houston, TX, 77030, USA.,The Menninger Clinic, Houston, TX, USA.,Department of Psychology, University of Hawaii, Hilo, USA
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8
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High polygenic burden is associated with blood DNA methylation changes in individuals with suicidal behavior. J Psychiatr Res 2020; 123:62-71. [PMID: 32036075 DOI: 10.1016/j.jpsychires.2020.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/06/2020] [Accepted: 01/24/2020] [Indexed: 12/27/2022]
Abstract
Suicidal behavior is result of the interaction of several contributors, including genetic and environmental factors. The integration of approaches considering the polygenic component of suicidal behavior, such as polygenic risk scores (PRS) and DNA methylation is promising for improving our understanding of the complex interplay between genetic and environmental factors in this behavior. The aim of this study was the evaluation of DNA methylation differences between individuals with high and low genetic burden for suicidality. The present study was divided into two phases. In the first phase, genotyping with the Psycharray chip was performed in a discovery sample of 568 Mexican individuals, of which 149 had suicidal behavior (64 individuals with suicidal ideation, 50 with suicide attempt and 35 with completed suicide). Then, a PRS analysis based on summary statistics from the Psychiatric Genomic Consortium was performed in the discovery sample. In a second phase, we evaluated DNA methylation differences between individuals with high and low genetic burden for suicidality in a sub-sample of the discovery sample (target sample) of 94 subjects. We identified 153 differentially methylated sites between individuals with low and high-PRS. Among genes mapped to differentially methylated sites, we found genes involved in neurodevelopment (CHD7, RFX4, KCNA1, PLCB1, PITX1, NUMBL) and ATP binding (KIF7, NUBP2, KIF6, ATP8B1, ATP11A, CLCN7, MYLK, MAP2K5). Our results suggest that genetic variants might increase the predisposition to epigenetic variations in genes involved in neurodevelopment. This study highlights the possible implication of polygenic burden in the alteration of epigenetic changes in suicidal behavior.
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Cheung S, Woo J, Maes MS, Zai CC. Suicide epigenetics, a review of recent progress. J Affect Disord 2020; 265:423-438. [PMID: 32090769 DOI: 10.1016/j.jad.2020.01.040] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 11/17/2019] [Accepted: 01/11/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Suicide results in over 800,000 deaths every year, making it a major public health concern worldwide. It is highly complex, with genetic and environmental influences. Epigenetic mechanisms, including DNA methylation, miRNA, and histone modifications, could explain the complex interplay of environmental risk factors with genetic risk factors in the emergence of suicidal behavior. METHODS Here, we review the literature on suicide epigenetics over the past 10 years. RESULTS There has been significant progress in the field of suicide epigenetics, with emerging findings in the brain-derived neurotrophic factor and hypothalamic-pituitary-adrenal axis genes. LIMITATIONS Studying patient subgroups is needed in order to extract more comparable and reproducible epigenetic findings in suicide. CONCLUSIONS It is crucial to consider suicidal patients or suicide victims' distal and proximal past history e.g., early-life adversity and psychiatric disorder in epigenetic studies of suicidality.
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Affiliation(s)
- Serina Cheung
- Neurogenetics Section, Tanenbaum Centre for Pharmacogenetics, Molecular Brain Science, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Canada
| | - Julia Woo
- Neurogenetics Section, Tanenbaum Centre for Pharmacogenetics, Molecular Brain Science, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Canada; Faculty of Medicine, University of Toronto, Canada
| | - Miriam S Maes
- Neurogenetics Section, Tanenbaum Centre for Pharmacogenetics, Molecular Brain Science, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Canada
| | - Clement C Zai
- Neurogenetics Section, Tanenbaum Centre for Pharmacogenetics, Molecular Brain Science, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Canada; Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto, Canada; Institute of Medical Science, University of Toronto, Canada; Laboratory Medicine and Pathobiology, University of Toronto, Canada; Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
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10
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Abstract
PURPOSE OF REVIEW Bipolar disorder has the highest rate of suicide of all psychiatric conditions and is approximately 20-30 times that of the general population. The purpose of this review is to discuss findings relevant to bipolar disorder and suicide. RECENT FINDINGS Risk factors include male gender, living alone, divorced, no children, Caucasian, younger age (< 35 years), elderly age (> 75 years), unemployment, and a personal history of suicide attempt and family history of suicide attempt or suicide completion, as well as predominant depressive polarity. Suicide is associated with the depressed or mixed subtypes, not mania. Although there are emerging treatments for bipolar depression, such as ketamine and TMS, lithium remains the only medication associated with lowered suicide rates in bipolar disorder. Understanding clinical and demographic risk factors for suicide in bipolar disorder remains the best way to prevent suicidal behavior. Early intervention and treatment with anti-suicidal medications, such as lithium, along with close observation and follow-up is the best way to mitigate suicide in patients with bipolar disorder.
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11
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Rodríguez-López ML, Martínez-Magaña JJ, Cabrera-Mendoza B, Genis-Mendoza AD, García-Dolores F, López-Armenta M, Flores G, Vázquez-Roque RA, Nicolini H. Exploratory analysis of genetic variants influencing molecular traits in cerebral cortex of suicide completers. Am J Med Genet B Neuropsychiatr Genet 2020; 183:26-37. [PMID: 31418530 DOI: 10.1002/ajmg.b.32752] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 05/13/2019] [Accepted: 07/09/2019] [Indexed: 12/28/2022]
Abstract
Genetic factors have been implicated in suicidal behavior. It has been suggested that one of the roles of genetic factors in suicide could be represented by the effect of genetic variants on gene expression regulation. Alteration in the expression of genes participating in multiple biological systems in the suicidal brain has been demonstrated, so it is imperative to identify genetic variants that could influence gene expression or its regulatory mechanisms. In this study, we integrated DNA methylation, gene expression, and genotype data from the prefrontal cortex of suicides to identify genetic variants that could be factors in the regulation of gene expression, generally called quantitative trait locus (xQTLs). We identify 6,224 methylation quantitative trait loci and 2,239 expression quantitative trait loci (eQTLs) in the prefrontal cortex of suicide completers. The xQTLs identified influence the expression of genes involved in neurodevelopment and cell organization. Two of the eQTLs identified (rs8065311 and rs1019238) were previously associated with cannabis dependence, highlighting a candidate genetic variant for the increased suicide risk in subjects with substance use disorders. Our findings suggest that genetic variants may regulate gene expression in the prefrontal cortex of suicides through the modulation of promoter and enhancer activity, and to a lesser extent, binding transcription factors.
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Affiliation(s)
- Mariana L Rodríguez-López
- Genomics of Psychiatric and Neurodegenerative Diseases Laboratory, National Institute of Genomic Medicine (INMEGEN), Mexico City, Mexico
| | - José J Martínez-Magaña
- Genomics of Psychiatric and Neurodegenerative Diseases Laboratory, National Institute of Genomic Medicine (INMEGEN), Mexico City, Mexico
| | - Brenda Cabrera-Mendoza
- Genomics of Psychiatric and Neurodegenerative Diseases Laboratory, National Institute of Genomic Medicine (INMEGEN), Mexico City, Mexico
| | - Alma D Genis-Mendoza
- Genomics of Psychiatric and Neurodegenerative Diseases Laboratory, National Institute of Genomic Medicine (INMEGEN), Mexico City, Mexico.,Psychiatric Care Services, Child Psychiatric Hospital Dr. Juan N Navarro, CDMX, Mexico
| | | | | | - Gonzalo Flores
- Neuropsychiatry Laboratory, Institute of Physiology, Meritorious Autonomous University of Puebla, Puebla, Mexico
| | - Rubén A Vázquez-Roque
- Neuropsychiatry Laboratory, Institute of Physiology, Meritorious Autonomous University of Puebla, Puebla, Mexico
| | - Humberto Nicolini
- Genomics of Psychiatric and Neurodegenerative Diseases Laboratory, National Institute of Genomic Medicine (INMEGEN), Mexico City, Mexico.,Carracci Medical Group, CDMX, Mexico
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12
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Bokor J, Krause S, Torok D, Eszlari N, Sutori S, Gal Z, Petschner P, Anderson IM, Deakin B, Bagdy G, Juhasz G, Gonda X. "Out, out, brief candle! Life's but a walking shadow": 5-HTTLPR Is Associated With Current Suicidal Ideation but Not With Previous Suicide Attempts and Interacts With Recent Relationship Problems. Front Psychiatry 2020; 11:567. [PMID: 32670107 PMCID: PMC7331851 DOI: 10.3389/fpsyt.2020.00567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/03/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Suicide is an unresolved psychiatric and public health emergency, claiming 800,000 lives each year, however, its neurobiological etiology is still not understood. In spite of original reports concerning the involvement of 5-HTTLPR in interaction with recent stress in the appearance of suicidal ideation and attempts, replication studies have yielded contradictory results. In our study, we analyzed the association between 5-HTTLPR and lifetime suicide attempts, current suicidal ideation, hopelessness and thoughts of death as main effects, and in interaction with childhood adversities, recent stress, and different types of recent life events in a general population sample. METHODS Two thousand and three hundred fifty-eight unrelated European volunteers were genotyped for 5-HTTLPR, provided phenotypic data on previous suicide attempts, and current suicidal ideation, hopelessness and thoughts about death, and information on childhood adversities and recent life events. Logistic and linear regression models were run with age, gender, and population as covariates to test for the effect of 5-HTTLPR as a main effect and in interaction with childhood adversities and recent life events on previous suicide attempts and current suicidal ideation. Benjamini-Hochberg FDR Q values were calculated to correct for multiple testing. RESULTS 5-HTTLPR had no significant effect on lifetime suicide attempts either as a main effect on in interaction with childhood adversities. 5-HTTLPR had a significant main effect on current suicidal ideation in the dominant model (Q=0.0344). 5-HTTLPR did not interact with childhood adversities or total number of recent life events on any phenotypes related to current suicidal risk, however, a significant interaction effect between 5-HTTLPR and current relationship problems emerged in the case of current suicidal ideation in the dominant model (Q=0.0218) and in the case of thoughts about death and dying in the dominant (Q=0.0094) and additive models (Q=0.0281). CONCLUSION While 5-HTTLPR did not influence previous suicide attempts or interacted with childhood adversities, it did influence current suicidal ideation with, in addition, an interaction with recent relationship problems supporting the involvement of 5-HTTLPR in suicide. Our findings that 5-HTTLPR impacts only certain types of suicide risk-related behaviors and that it interacts with only distinct types of recent stressors provides a possible explanation for previous conflicting findings.
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Affiliation(s)
- Janos Bokor
- Department of Forensic and Insurance Medicine, Semmelweis University, Budapest, Hungary
| | - Sandor Krause
- Nyírő Gyula National Institute of Psychiatry and Addictions, Budapest, Hungary
| | - Dora Torok
- Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary
| | - Nora Eszlari
- Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary.,NAP-2-SE New Antidepressant Target Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
| | - Sara Sutori
- Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary.,Faculty of Humanity and Social Sciences, Institute of Psychology, Pazmany Peter Catholic University, Budapest, Hungary
| | - Zsofia Gal
- Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary
| | - Peter Petschner
- Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary.,MTA-SE Neuropsychopharmacology and Neurochemistry Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
| | - Ian M Anderson
- Neuroscience and Psychiatry Unit, Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biological, Medical and Human Sciences, The University of Manchester and Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Bill Deakin
- Neuroscience and Psychiatry Unit, Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biological, Medical and Human Sciences, The University of Manchester and Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Gyorgy Bagdy
- Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary.,NAP-2-SE New Antidepressant Target Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary.,MTA-SE Neuropsychopharmacology and Neurochemistry Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
| | - Gabriella Juhasz
- Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary.,MTA-SE Neuropsychopharmacology and Neurochemistry Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary.,SE-NAP-2 Genetic Brain Imaging Migraine Research Group, Semmelweis University, Budapest, Hungary
| | - Xenia Gonda
- NAP-2-SE New Antidepressant Target Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary.,MTA-SE Neuropsychopharmacology and Neurochemistry Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary.,Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
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13
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Duffy A, Goodday S, Keown-Stoneman C, Grof P. The Emergent Course of Bipolar Disorder: Observations Over Two Decades From the Canadian High-Risk Offspring Cohort. Am J Psychiatry 2019; 176:720-729. [PMID: 30525908 DOI: 10.1176/appi.ajp.2018.18040461] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors sought to describe the emergent course of bipolar disorder in offspring of affected parents subgrouped by parental response to lithium prophylaxis. METHODS Parent bipolar disorder was confirmed by the best-estimate procedure and lithium response by research protocol. High-risk offspring (N=279) and control subjects (N=87) were blindly assessed, annually on average, with the Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime version or the Schedule for Affective Disorders and Schizophrenia-Lifetime version. DSM-IV diagnoses were confirmed using the best-estimate procedure in blind consensus reviews. Cumulative incidence and median age at onset were determined for lifetime syndrome- and symptom-level data. Mixed models assessed the association between parent and offspring course. A multistate model was used to estimate the clinical trajectory into bipolar disorder. RESULTS The cumulative incidence of bipolar disorder was 24.5%, and the median age at onset was 20.7 years (range, 12.4 to 30.3). The clinical course of the affected parent was associated with that of the affected child. Depressive episodes predominated during the early bipolar course, especially among offspring of lithium responders. Childhood sleep and anxiety disorders significantly predicted 1.6-fold and 1.8-fold increases in risk of mood disorder, respectively, and depressive and manic symptoms predicted 2.7-fold and 2.3-fold increases in risk, respectively. The best-fit model of emerging bipolar disorder was a progressive sequence from nonspecific childhood antecedents to adolescent depression to index manic or hypomanic episode. Subthreshold sleep symptoms were significantly associated with transition from well to non-mood disorder, and psychotic symptoms in mood episodes were significantly associated with transition from unipolar to bipolar disorder. CONCLUSIONS Bipolar disorder in individuals at familial risk typically unfolds in a progressive clinical sequence. Childhood sleep and anxiety disorders are important predictors, as are clinically significant mood symptoms and psychotic symptoms in depressive episodes.
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Affiliation(s)
- Anne Duffy
- The Department of Psychiatry, Queens University, Kingston, Ontario (Duffy); the Mood Disorders Centre of Ottawa, Ottawa (Duffy, Grof); the Department of Psychiatry, University of Oxford, Oxford, U.K. (Goodday); and the Dalla Lana School of Public Health, University of Toronto, Toronto (Keown-Stoneman)
| | - Sarah Goodday
- The Department of Psychiatry, Queens University, Kingston, Ontario (Duffy); the Mood Disorders Centre of Ottawa, Ottawa (Duffy, Grof); the Department of Psychiatry, University of Oxford, Oxford, U.K. (Goodday); and the Dalla Lana School of Public Health, University of Toronto, Toronto (Keown-Stoneman)
| | - Charles Keown-Stoneman
- The Department of Psychiatry, Queens University, Kingston, Ontario (Duffy); the Mood Disorders Centre of Ottawa, Ottawa (Duffy, Grof); the Department of Psychiatry, University of Oxford, Oxford, U.K. (Goodday); and the Dalla Lana School of Public Health, University of Toronto, Toronto (Keown-Stoneman)
| | - Paul Grof
- The Department of Psychiatry, Queens University, Kingston, Ontario (Duffy); the Mood Disorders Centre of Ottawa, Ottawa (Duffy, Grof); the Department of Psychiatry, University of Oxford, Oxford, U.K. (Goodday); and the Dalla Lana School of Public Health, University of Toronto, Toronto (Keown-Stoneman)
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14
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Plans L, Barrot C, Nieto E, Rios J, Schulze TG, Papiol S, Mitjans M, Vieta E, Benabarre A. Association between completed suicide and bipolar disorder: A systematic review of the literature. J Affect Disord 2019; 242:111-122. [PMID: 30173059 DOI: 10.1016/j.jad.2018.08.054] [Citation(s) in RCA: 125] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 07/25/2018] [Accepted: 08/12/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Completed suicide is a major cause of death in bipolar disorder (BD) patients. OBJECTIVE The aim of this paper is to provide an overall review of the existing literature of completed suicide in BD patients, including clinical and genetic data DATA SOURCES: We performed a systematic review of English and non-English articles published on MEDLINE/PubMed, PsycInfo and Cochrane database (1970-2017). Additional studies were identified by contacting clinical experts, searching bibliographies, major textbooks and website of World Health Organization. Initially we did a broad search for the association of bipolar disorder and suicide and we were narrowing the search in terms included "bipolar disorder" and "completed suicide". STUDY SELECTION Inclusion criteria were articles about completed suicide in patients with BD. Articles exclusively focusing on suicide attempts and suicidal behaviour have been excluded. We used PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) consensus for drafting this systematic review. RESULTS The initial search generated 2806 articles and a total of 61 meeting our inclusion criteria. We reviewed epidemiological data, genetic factors, risk factors and treatment of completed suicide in BD. Suicide rates in BD vary between studies but our analyses show that they are approximately 20-30-fold greater than in general population. The highest risk of successful suicide was observed in BD-II subjects. The heritability of completed suicide is about 40% and some genes related to major neurotransmitter systems have been associated with suicide. Lithium is the only treatment that has shown anti-suicide potential. LIMITATIONS The most important limitation of the present review is the limited existing literature on completed suicide in BD. CONCLUSIONS BD patients are at high risk for suicide. It is possible to identify some factors related to completed suicide, such as early onset, family history of suicide among first-degree relatives, previous attempted suicides, comorbidities and treatment. However it is necessary to promote research on this serious health problem.
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Affiliation(s)
- L Plans
- Mental Health Division of Althaia, Xarxa Assistencial Universitària de Manresa, Catalonia, Spain
| | - C Barrot
- Forensic Genetic Laboratori, University of Barcelona, Catalonia, Spain
| | - E Nieto
- Mental Health Division of Althaia, Xarxa Assistencial Universitària de Manresa, Catalonia, Spain
| | - J Rios
- Universitat Autònoma de Barcelona, Laboratório de Bioestatística e Epidemiologia, Barcelona, Spain; Hospital Clínic, IDIBAPS, Bioestadística y Plataforma de Gestión de Datos, Barcelona, Spain
| | - T G Schulze
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, Ludwig Maximilian University, Munich, Germany
| | - S Papiol
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, Ludwig Maximilian University, Munich, Germany; Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University, Munich, Germany
| | - M Mitjans
- Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany
| | - E Vieta
- Bipolar Disorder Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
| | - A Benabarre
- Bipolar Disorder Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
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15
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Naghavi-Gargari B, Zahirodin A, Ghaderian SMH, Shirvani-Farsani Z. Significant increasing of DISC2 long non-coding RNA expression as a potential biomarker in bipolar disorder. Neurosci Lett 2018; 696:206-211. [PMID: 30599263 DOI: 10.1016/j.neulet.2018.12.044] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 12/07/2018] [Accepted: 12/28/2018] [Indexed: 11/18/2022]
Abstract
Bipolar disorder (BD) is a mental disorder that is often misdiagnosed with ineffective treatment. It has strong genetic component but unknown pathophysiology. Long non-coding RNAs (lncRNAs) have been recently recognized as one of the important genetic factors and are considered as one of the regulatory mechanisms of nervous system. Given that lncRNAs may be diagnostic biomarkers for BD, we aimed to quantify the levels of DISC1 and DISC2 lncRNA transcripts. The levels of DISC1 and DISC2 lncRNA were tested in peripheral blood mononuclear cells (PBMCs) of 50 BD and 50 controls by real-time PCR. In addition, we performed ROC curve analysis as well as correlation analysis between the gene expression and some clinical features of BD cases. Computational analysis of miRNAs binding sites and CpG Islands on DISC1 and DISC2 lncRNA was performed as well. Significant down-regulation of DISC1 and up-regulation of DISC2 were observed in BD cases compared with controls. The areas under the ROC curve (AUC) for DISC1 and DISC2 lncRNA were 0.76 and 0.68 respectively. There was no significant correlation between the levels of mRNA expression in PBMCs of BD patients and clinical features. These data demonstrated that DISC1 and DISC2 lncRNA expression was potentially associated with an increased risk of bipolar disorder and might involve several molecular mechanisms. Our results revealed that the transcript levels of DISC1 and DISC2 lncRNA could be considered as a good putative biomarker for individuals with bipolar disorder.
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Affiliation(s)
- Bahar Naghavi-Gargari
- Department of Basic Science, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Alireza Zahirodin
- Behavioral Science Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | | | - Zeinab Shirvani-Farsani
- Department of Cellular and Molecular Biology, Faculty of Life Sciences and Biotechnology, Shahid Beheshti University G.C., Tehran, Islamic Republic of Iran.
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Rao S, Siu CO, Shi M, Zhang J, Lam MHB, Yu M, Wing YK, Waye MMY. Associations of Homer Scaffolding Protein 1 gene and psychological correlates with suicide attempts in Chinese: A pilot study of multifactorial risk model. Gene 2018; 679:382-388. [DOI: 10.1016/j.gene.2018.09.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 08/29/2018] [Accepted: 09/12/2018] [Indexed: 10/28/2022]
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17
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González-Castro TB, Hernández-Díaz Y, Juárez-Rojop IE, López-Narváez ML, Tovilla-Zárate CA, Ramírez-Bello J, Pérez-Hernández N, Genis-Mendoza AD, Fresan A, Guzmán-Priego CG. The role of COMT gene Val108/158Met polymorphism in suicidal behavior: systematic review and updated meta-analysis. Neuropsychiatr Dis Treat 2018; 14:2485-2496. [PMID: 30319259 PMCID: PMC6167979 DOI: 10.2147/ndt.s172243] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND It is accepted that there is a genetic factor that influences the risk of suicidal behavior. The catechol-O-methyltransferase (COMT) gene, especially the Val108/158Met polymorphism, has been associated with suicide; however, no conclusive outcome has been attained. Therefore, the aim of the present study was to assess the role of COMT Val108/158Met in suicidal behavior throughout an updated meta-analysis. METHODS We performed an online search using PubMed and Web of Science (up to March 2017). Our systematic review included case-control studies of individuals who attempted suicide and completed suicide. We tested allelic, homozygous, heterozygous, dominant, and recessive inheritance models. The meta-analysis was performed in accordance with the statement of Preferred Reporting Items for Systematic Reviews and Meta-Analyses. RESULTS The meta-analysis comprised 17 studies, which included 3,282 cases and 3,774 controls, and showed that when evaluating the overall population, the Val108/158Met polymorphism of COMT was not associated with suicidal behavior in any of the inheritance models; however, the subanalyses showed that this polymorphism exhibits a risk factor in males and a protective effect in females. Additionally, it conveyed a risk factor in Asian populations when using the allelic (OR 1.25; CI: 1.04-1.51) and recessive models (OR 1.32; CI: 1.03-1.68). CONCLUSION Our updated meta-analysis suggests a possible association between COMT Val108/158Met and suicidal behavior in Asian populations. However, in view of the small number of studies, these results should be considered exploratory. We recommend that more studies be performed with larger samples.
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Affiliation(s)
- Thelma Beatriz González-Castro
- Multidisciplinary Academic Division of Jalpa de Méndez, Juarez Autonomous University of Tabasco, Jalpa de Méndez, Tabasco, Mexico
| | - Yazmín Hernández-Díaz
- Multidisciplinary Academic Division of Jalpa de Méndez, Juarez Autonomous University of Tabasco, Jalpa de Méndez, Tabasco, Mexico
| | - Isela Esther Juárez-Rojop
- Multidisciplinary Academic Division of Health Sciences, Juarez Autonomous University of Tabasco, Villahermosa, Tabasco, Mexico
| | | | - Carlos Alfonso Tovilla-Zárate
- Multidisciplinary Academic Division of Comalcalco, Juarez Autonomous University of Tabasco, Comalcalco, Tabasco, Mexico,
| | - Julian Ramírez-Bello
- Research Unit, Juárez Hospital of Mexico, Ministry of Health, Mexico City, Mexico
| | | | - Alma Delia Genis-Mendoza
- Psychiatric Care Services, National Institute of Genomic Medicine (INMEGEN), Health Secretary, Ministry of Health, Mexico City, Mexico
| | - Ana Fresan
- Sub-direction of Clinical Research, Children's Psychiatric Hospital "Dr. Juan N. Navarro", Mexico City, Mexico
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18
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The role of the Cys23Ser (rs6318) polymorphism of the HTR2C gene in suicidal behavior. Psychiatr Genet 2017; 27:199-209. [DOI: 10.1097/ypg.0000000000000184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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19
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Duffy A, Vandeleur C, Heffer N, Preisig M. The clinical trajectory of emerging bipolar disorder among the high-risk offspring of bipolar parents: current understanding and future considerations. Int J Bipolar Disord 2017; 5:37. [PMID: 29164495 PMCID: PMC5698240 DOI: 10.1186/s40345-017-0106-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 09/25/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Relatively little is known about the onset of bipolar disorder, yet the early illness course is already associated with significant morbidity and mortality. Therefore, characterizing the bipolar illness trajectory is key to risk prediction and early intervention advancement. MAIN BODY In this narrative review, we discuss key findings from prospective longitudinal studies of the high-risk offspring of bipolar parents and related meta-analyses that inform us about the clinical trajectory of emerging bipolar disorder. Challenges such as phenotypic and etiologic heterogeneity and the non-specificity of early symptoms and syndromes are highlighted. Implications of the findings for both research and clinical practice are discussed. CONCLUSION Bipolar disorder in young people at familial risk does not typically onset with a hypomanic or manic episode. Rather the first activated episode is often preceded by years of impairing psychopathological states that vary over development and across emerging bipolar subtype. Taking heterogeneity into account and adopting a more comprehensive approach to diagnosis seems necessary to advance earlier identification and our understanding of the onset of bipolar disorder.
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Affiliation(s)
- A Duffy
- Student Wellness Centre, Department of Psychiatry, Queen's University, 146 Stuart Street, Kingston, ON, K7L3N6, Canada.
| | - C Vandeleur
- Department of Psychiatry Lausanne, University Hospital of Lausanne, Lausanne, Switzerland
| | - N Heffer
- Medical Sciences Division, University of Oxford, Oxford, UK
| | - M Preisig
- Department of Psychiatry Lausanne, University Hospital of Lausanne, Lausanne, Switzerland
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Perry LM, Goldstein-Piekarski AN, Williams LM. Sex differences modulating serotonergic polymorphisms implicated in the mechanistic pathways of risk for depression and related disorders. J Neurosci Res 2017; 95:737-762. [PMID: 27870440 DOI: 10.1002/jnr.23877] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 07/12/2016] [Accepted: 07/14/2016] [Indexed: 12/27/2022]
Abstract
Despite consistent observations of sex differences in depression and related emotional disorders, we do not yet know how these sex differences modulate the effects of genetic polymorphisms implicated in risk for these disorders. This Mini-Review focuses on genetic polymorphisms of the serotonergic system to illustrate how sex differences might modulate the neurobiological pathways involved in the development of depression. We consider the interacting role of environmental factors such as early-life stress. Given limited current knowledge about this topic, we highlight methodological considerations, challenges, and guidelines for future research. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- LeeAnn M Perry
- Neurosciences Program, Stanford University, Stanford, California
| | - Andrea N Goldstein-Piekarski
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California.,Sierra-Pacific Mental Illness Research, Education, and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Leanne M Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California.,Sierra-Pacific Mental Illness Research, Education, and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
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Bryleva EY, Brundin L. Suicidality and Activation of the Kynurenine Pathway of Tryptophan Metabolism. Curr Top Behav Neurosci 2017; 31:269-284. [PMID: 27221623 DOI: 10.1007/7854_2016_5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A recent report by the World Health Organization declared suicide to be a major global problem. With more than 800,000 lives lost each year, suicide is calculated to be the 14th leading cause of death around the world. While the biological mechanisms causing suicidal ideation and behavior are not fully understood, increased levels of inflammation, arising from various sources, have been detected in the central nervous system and the peripheral blood of suicidal patients and suicide completers. Inflammation induces the kynurenine pathway of tryptophan metabolism, which generates a range of metabolites with potent effects on neurotransmitter systems as well as on inflammation. Recent evidence indicates that a dysregulation of the enzymes in the kynurenine pathway may be present in suicidal patients, with a resulting imbalance of metabolites that modulate glutamate neurotransmission and neuroinflammation. As the body of research in these areas grows, targeting the kynurenine pathway enzymes and metabolites may provide novel therapeutic opportunities for detection, treatment, and ultimately prevention of suicidal behavior.
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Affiliation(s)
- Elena Y Bryleva
- Laboratory of Behavioral Medicine, Center for Neurodegenerative Science, Van Andel Research Institute, 333 Bostwick Ave., Grand Rapids, MI, 49503, USA
| | - Lena Brundin
- Laboratory of Behavioral Medicine, Center for Neurodegenerative Science, Van Andel Research Institute, 333 Bostwick Ave., Grand Rapids, MI, 49503, USA.
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Pawlak J, Dmitrzak-Weglarz M, Wilkosc M, Szczepankiewicz A, Leszczynska-Rodziewicz A, Zaremba D, Kapelski P, Rajewska-Rager A, Hauser J. Suicide behavior as a quantitative trait and its genetic background. J Affect Disord 2016; 206:241-250. [PMID: 27479537 DOI: 10.1016/j.jad.2016.07.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 07/06/2016] [Accepted: 07/16/2016] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Studies have not given yet a clear answer what is the genetic background of suicidal predisposition. The associations between polymorphisms of the TPH1 and 5-HTTLPR genes and violent suicidal behavior was revealed with the least inconsistencies. METHOD We selected 10 "strong candidate genes" and 35 SNPs, SLC6A4 and ACP1 for replication study. We searched associations between precisely described suicidal phenotype in 825 affective patients and polymorphisms of selected neurobiological pathways genes as well as their interactions that constitute suicidal risk. RESULTS The results confirm the role of TPH1, TPH2, 5HT2A, CRHR1 and ACP1 variants in the risk of suicidal behavior. LIMITATIONS In our study we analyzed limited number of candidate genes and only one of them is linked to lithium mechanism of action. We had no data on pharmacological treatment of investigated patients and its relation to the time of suicide attempt. CONCLUSION Our results indicate that polymorphisms of various signaling pathways are involved in the pathogenesis of suicidal behavior. Non-genetic factors are also involved in the risk of suicidal attempts.
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Affiliation(s)
- Joanna Pawlak
- Psychiatric Genetics Unit, Department of Psychiatry, Poznan University of Medical Sciences, Poland.
| | - Monika Dmitrzak-Weglarz
- Psychiatric Genetics Unit, Department of Psychiatry, Poznan University of Medical Sciences, Poland
| | - Monika Wilkosc
- Department of Individual Differences, Institute of Psychology, University of Bydgoszcz, Poland
| | - Aleksandra Szczepankiewicz
- Psychiatric Genetics Unit, Department of Psychiatry, Poznan University of Medical Sciences, Poland; Department of Pediatrics, Laboratory of Molecular and Cell Biology, Poznan University of Medical Sciences, Poland
| | | | - Dorota Zaremba
- Psychiatric Genetics Unit, Department of Psychiatry, Poznan University of Medical Sciences, Poland
| | - Pawel Kapelski
- Psychiatric Genetics Unit, Department of Psychiatry, Poznan University of Medical Sciences, Poland
| | | | - Joanna Hauser
- Psychiatric Genetics Unit, Department of Psychiatry, Poznan University of Medical Sciences, Poland
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Doucette S, Levy A, Flowerdew G, Horrocks J, Grof P, Ellenbogen M, Duffy A. Early parent-child relationships and risk of mood disorder in a Canadian sample of offspring of a parent with bipolar disorder: findings from a 16-year prospective cohort study. Early Interv Psychiatry 2016; 10:381-9. [PMID: 25356767 DOI: 10.1111/eip.12195] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 09/16/2014] [Indexed: 01/14/2023]
Abstract
AIM Exposure to parental bipolar disorder (BD) early in life may increase the risk of developing a mood disorder. However, the impact of early parent-child relationships when a parent is affected and how this impacts an offspring's risk remains unclear. The primary objective of this study was to determine the association between parent-child relationships and risk of mood disorder in offspring of parents with BD and, secondly, to determine the interaction of temperament and life stress on this association. METHODS Two hundred and thirty-three offspring completed annual clinical assessments following Kiddie Schedule for Affective Disorders (KSADS) format interviews as part of an ongoing Canadian prospective cohort study conducted from 1996 to 2013. Offspring completed measures of early adversity, life stress and temperament. Clinical data from the affected parents were prospectively collected over the first decade of their offspring's life using SADS format interviews. RESULTS Higher perceived neglect from mother and offspring emotionality were significantly associated with the hazard of mood disorder (hazard ratio (HR): 1.1, 95% confidence interval (CI): 1.0-1.2 and HR: 1.7, 95% CI: 1.0-3.1, respectively). Duration of exposure to parental BD significantly interacted with offspring emotionality to predict mood disorder (P = 0.01). Further, perceived neglect from mother was associated with offspring high emotionality (P = 0.02). CONCLUSIONS Neglect from mother is a significant early predictor of mood disorder in offspring at familial risk for BD and may increase emotional sensitivity. Psychosocial support and interventions for high-risk families could be beneficial in reducing early adversity, maternal neglect and the risk of subsequent mood disorders in offspring.
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Affiliation(s)
- Sarah Doucette
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Adrian Levy
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Gordon Flowerdew
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Julie Horrocks
- Department of Mathematics and Statistics, University of Guelph, Guelph, Ontario, Canada
| | - Paul Grof
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Mood Disorders Centre of Ottawa, Ottawa University Health Services, Ottawa, Ontario, Canada
| | - Mark Ellenbogen
- Department of Psychology, Concordia University, Montreal, Quebec, Canada
| | - Anne Duffy
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada. .,Mood Disorders Centre of Ottawa, Ottawa University Health Services, Ottawa, Ontario, Canada. .,Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.
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Bryleva EY, Brundin L. Kynurenine pathway metabolites and suicidality. Neuropharmacology 2016; 112:324-330. [PMID: 26820800 DOI: 10.1016/j.neuropharm.2016.01.034] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 01/19/2016] [Accepted: 01/22/2016] [Indexed: 12/27/2022]
Abstract
Suicide is a major global problem, claiming more than 800,000 lives annually. The neurobiological changes that underlie suicidal ideation and behavior are not fully understood. Suicidal patients have been shown to display elevated levels of inflammation both in the central nervous system and the peripheral blood. A growing body of evidence suggests that inflammation is associated with a dysregulation of the kynurenine pathway in suicidal patients, resulting in an imbalance of neuroactive metabolites. Specifically, an increase in the levels of the NMDA receptor agonist quinolinic acid and a simultaneous decrease in neuroprotective metabolites have been observed in suicidal patients, and may contribute to the development of suicidality via changes in glutamate neurotransmission and neuroinflammation. The cause of the dysregulation of kynurenine metabolites in suicidality is not known, but is likely due to differential activity of the involved enzymes in patients. As knowledge in these areas is rapidly growing, targeting the kynurenine pathway enzymes may provide novel therapeutic approaches for managing suicidal behavior. This article is part of the Special Issue entitled 'The Kynurenine Pathway in Health and Disease'.
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Affiliation(s)
- Elena Y Bryleva
- Laboratory of Behavioral Medicine, Center for Neurodegenerative Science, Van Andel Research Institute, Grand Rapids, MI, USA
| | - Lena Brundin
- Laboratory of Behavioral Medicine, Center for Neurodegenerative Science, Van Andel Research Institute, Grand Rapids, MI, USA.
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Brundin L, Erhardt S, Bryleva EY, Achtyes ED, Postolache TT. The role of inflammation in suicidal behaviour. Acta Psychiatr Scand 2015; 132:192-203. [PMID: 26256862 PMCID: PMC4531386 DOI: 10.1111/acps.12458] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/01/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Over the past decade, clinical data have accumulated showing that inflammation might contribute to the pathophysiology of suicide. To evaluate the associations and to identify the support for pathways linking inflammatory processes with suicidal behaviour, a comprehensive review of the literature was undertaken. METHOD The search terms 'cytokine', 'risk factors', 'kynurenine', 'asthma', 'allergy', 'autoimmunity', 'traumatic brain injury', 'infection' along with the terms 'inflammation' and 'suicide' were entered into PubMed, and a thorough analysis of the publications and their reference lists was performed. RESULTS The effects of inflammation on mood and behaviour could partially be mediated by kynurenine pathway metabolites, modulating neuroinflammation and glutamate neurotransmission. At the same time, the triggers of the inflammatory changes documented in suicidal patients may be attributed to diverse mechanisms such as autoimmunity, neurotropic pathogens, stress or traumatic brain injury. CONCLUSION Targeting the inflammatory system might provide novel therapeutic approaches as well as potential biomarkers to identify patients at increased risk. For the goal of improved detection and treatment of suicidal individuals to be achieved, we need to develop a detailed understanding of the origin, mechanisms and outcomes of inflammation in suicidal behaviour.
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Affiliation(s)
- L. Brundin
- Division of Psychiatry and Behavioral Medicine College of Human Medicine Michigan State University Grand Rapids MI USA
- Laboratory of Behavioral Medicine Center for Neurodegenerative Science Van Andel Research Institute Grand Rapids MI USA
| | - S. Erhardt
- Department of Physiology & Pharmacology Karolinska Institute Stockholm Sweden
| | - E. Y. Bryleva
- Laboratory of Behavioral Medicine Center for Neurodegenerative Science Van Andel Research Institute Grand Rapids MI USA
| | - E. D. Achtyes
- Division of Psychiatry and Behavioral Medicine College of Human Medicine Michigan State University Grand Rapids MI USA
| | - T. T. Postolache
- Department of Psychiatry University of Maryland School of Medicine Baltimore MD USA
- Veterans Integrated Service Network 19 Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC) Denver CO USA
- Veterans Integrated Service Network 5 MIRECC Baltimore MD USA
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26
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Duffy A. Toward a comprehensive clinical staging model for bipolar disorder: integrating the evidence. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2014; 59:659-66. [PMID: 25702367 PMCID: PMC4304586 DOI: 10.1177/070674371405901208] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To describe key findings relating to the natural history and heterogeneity of bipolar disorder (BD) relevant to the development of a unitary clinical staging model. Currently proposed staging models are briefly discussed, highlighting complementary findings, and a comprehensive staging model of BD is proposed integrating the relevant evidence. METHOD A selective review of key published findings addressing the natural history, heterogeneity, and clinical staging models of BD are discussed. RESULTS The concept of BD has broadened, resulting in an increased spectrum of disorders subsumed under this diagnostic category. Different staging models for BD have been proposed based on the early psychosis literature, studies of patients with established BD, and prospective studies of the offspring of parents with BD. The overarching finding is that there are identifiable sequential clinical phases in the development of BD that differ in important ways between classical episodic and psychotic spectrum subtypes. In addition, in the context of familial risk, early risk syndromes add important predictive value and inform the staging model for BD. CONCLUSIONS A comprehensive clinical staging model of BD can be derived from the available evidence and should consider the natural history of BD and the heterogeneity of subtypes. This model will advance both early intervention efforts and neurobiological research.
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Affiliation(s)
- Anne Duffy
- Campus Alberta Innovates Program Professor in Youth Mental Health, Medical Director Mood Disorders Program, Department of Psychiatry, University of Calgary, Calgary, Alberta
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Finseth PI, Sønderby IE, Djurovic S, Agartz I, Malt UF, Melle I, Morken G, Andreassen OA, Vaaler AE, Tesli M. Association analysis between suicidal behaviour and candidate genes of bipolar disorder and schizophrenia. J Affect Disord 2014; 163:110-4. [PMID: 24461634 DOI: 10.1016/j.jad.2013.12.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 12/17/2013] [Accepted: 12/18/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND The present study investigated associations between the strongest joint genetic risk variants for bipolar disorder (BD) and schizophrenia (SCZ) and a history of suicide attempt in patients with BD, SCZ and related psychiatric disorders. METHODS A history of suicide attempt was assessed in a sample of 1009 patients with BD, SCZ and related psychosis spectrum disorders, and associations with the joint genetic risk variants for BD and SCZ (rs2239547 (ITIH3/4-region), rs10994359 (ANK3) and rs4765905 (CACNA1C)) were investigated. Previously reported susceptibility loci for suicide attempt in BD were also investigated. Associations were tested by logistic regression with Bonferroni correction for multiple testing. RESULTS The risk allele in rs2239547 (ITIH3/4-region) was significantly associated with a history of suicide attempt (p=0.01) after multiple testing correction (p threshold<0.017). The previous suicide attempt susceptibility loci were only nominally associated, but had the same direction of risk in the replication sample (sign test, p=0.02). LIMITATIONS Relatively small sample size and retrospective clinical assessment. CONCLUSIONS We detected a novel association between suicide attempt and the ITIH3/4-region in a combined group of patients with BD, SCZ and related psychosis spectrum disorders. This may be useful in understanding molecular mechanisms of suicidal behaviour in severe mental disorders, although replication is warranted.
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Affiliation(s)
- Per Ivar Finseth
- Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Østmarka Psychiatric Department, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Ida Elken Sønderby
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway; K. G. Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Srdjan Djurovic
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway; K. G. Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ingrid Agartz
- K. G. Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Ulrik Fredrik Malt
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Neuropsychiatry and Psychosomatic Medicine, Division of Surgery and Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Ingrid Melle
- K. G. Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; K. G. Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Gunnar Morken
- Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Research and Development, Psychiatry, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Ole Andreas Andreassen
- K. G. Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; K. G. Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Arne Einar Vaaler
- Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Østmarka Psychiatric Department, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Martin Tesli
- K. G. Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; K. G. Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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Maussion G, Yang J, Suderman M, Diallo A, Nagy C, Arnovitz M, Mechawar N, Turecki G. Functional DNA methylation in a transcript specific 3'UTR region of TrkB associates with suicide. Epigenetics 2014; 9:1061-70. [PMID: 24802768 DOI: 10.4161/epi.29068] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Previous studies indicate that a subgroup of suicide completers has low cortical brain expression levels of TrkB-T1, a TrkB gene transcript that is highly expressed in astrocytes. Epigenetic modifications, including methylation changes in the TrkB promoter, partially explain TrkB-T1 low expression levels in brain tissue from suicide completers. The aim of this study was to investigate whether methylation changes in other regions of the TrkB gene could also contribute to the significant downregulation of the TrkB-T1 transcript observed in the brain of suicide completers. Methylation levels were assessed on BA8/9 from suicide completers expressing low TrkB-T1 transcript levels and controls, using custom-made Agilent arrays tiling the whole TrkB gene. After statistical correction for multiple testing, five probes located in the TrkB-T1 3'UTR region were found hypermethylated in the frontal cortex of suicide completers. These results were validated for four CpGs spanning a 150 bp sequence by cloning and Sanger sequencing bisulfite treated DNA. We found a significant correlation between the methylation level at these four CpGs and TrkB-T1 expression in BA8/9. Site-specific hypermethylation on this 3'UTR sequence induced decreased luciferase activity in reporter gene cell assays. Site-specific differential methylation in the TrkB-T1 3'UTR region associates with functional changes in TrkB-T1 expression and may play a significant role in the important decrease of cortical TrkB-T1 expression observed among suicide completers.
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Affiliation(s)
- Gilles Maussion
- McGill Group for Suicide Studies; Douglas Hospital Research Institute; McGill University; Montreal, QC Canada
| | - Jennie Yang
- McGill Group for Suicide Studies; Douglas Hospital Research Institute; McGill University; Montreal, QC Canada
| | - Matthew Suderman
- Departments of Pharmacology and Therapeutics; McGill University; Montreal, QC Canada
| | - Alpha Diallo
- McGill Group for Suicide Studies; Douglas Hospital Research Institute; McGill University; Montreal, QC Canada
| | - Corina Nagy
- McGill Group for Suicide Studies; Douglas Hospital Research Institute; McGill University; Montreal, QC Canada
| | - Mitchell Arnovitz
- McGill Group for Suicide Studies; Douglas Hospital Research Institute; McGill University; Montreal, QC Canada
| | - Naguib Mechawar
- McGill Group for Suicide Studies; Douglas Hospital Research Institute; McGill University; Montreal, QC Canada
| | - Gustavo Turecki
- McGill Group for Suicide Studies; Douglas Hospital Research Institute; McGill University; Montreal, QC Canada
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Brandt F, Thvilum M, Almind D, Christensen K, Green A, Hegedüs L, Brix TH. Hyperthyroidism and psychiatric morbidity: evidence from a Danish nationwide register study. Eur J Endocrinol 2014; 170:341-8. [PMID: 24282192 DOI: 10.1530/eje-13-0708] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Thyroid hormones are essential for the normal development of the fetal brain, while hyperthyroidism in adults is associated with mood symptoms and reduced quality of life. In this study, we aimed to investigate the association and temporal relationship between hyperthyroidism and psychiatric morbidity. DESIGN Register-based nationwide cohort study. METHOD Data on hyperthyroidism and psychiatric morbidity were obtained by record linkage of the Danish National Patient Registry and the Danish National Prescription Registry. A total of 2631 hyperthyroid individuals were identified and matched 1:4 with non-hyperthyroid controls and followed for a mean duration of 6 years (range 0-13). Logistic and Cox regression models were used to assess the risk of psychiatric morbidity before and after the diagnosis of hyperthyroidism respectively. RESULTS BEFORE THE DIAGNOSIS OF HYPERTHYROIDISM, SUCH INDIVIDUALS HAD AN INCREASED RISK OF BEING HOSPITALIZED WITH PSYCHIATRIC DIAGNOSES (ODDS RATIO (OR): 1.33; 95% CI: 0.98-1.80) and an increased risk of being treated with antipsychotics (OR: 1.17; 95% CI: 1.00-1.38), antidepressants (OR: 1.13; 95% CI: 1.01-1.27), or anxiolytics (OR: 1.28; 95% CI: 1.16-1.42). After the diagnosis of hyperthyroidism, there was a higher risk of being hospitalized with psychiatric diagnoses (hazard ratio (HR): 1.51; 95% CI: 1.11-2.05) and an increased risk of being treated with antipsychotics (HR: 1.46; 95% CI: 1.20-1.79), antidepressants (HR: 1.54; 95% CI: 1.36-1.74), or anxiolytics (HR: 1.47; 95% CI: 1.27-1.69). CONCLUSIONS Hyperthyroid individuals have an increased risk of being hospitalized with psychiatric diagnoses and being treated with antipsychotics, antidepressants, and anxiolytics, both before and after the diagnosis of hyperthyroidism.
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Affiliation(s)
- Frans Brandt
- Department of Endocrinology and Metabolism, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark
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Duffy A, Horrocks J, Doucette S, Keown-Stoneman C, McCloskey S, Grof P. The developmental trajectory of bipolar disorder. Br J Psychiatry 2014; 204:122-8. [PMID: 24262817 DOI: 10.1192/bjp.bp.113.126706] [Citation(s) in RCA: 181] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Bipolar disorder is highly heritable and therefore longitudinal observation of children of affected parents is important to mapping the early natural history. AIMS To model the developmental trajectory of bipolar disorder based on the latest findings from an ongoing prospective study of the offspring of parents with well-characterised bipolar disorder. METHOD A total of 229 offspring from families in which 1 parent had confirmed bipolar disorder and 86 control offspring were prospectively studied for up to 16 years. High-risk offspring were divided into subgroups based on the parental long-term response to lithium. Offspring were clinically assessed and DSM-IV diagnoses determined on masked consensus review using best estimate procedure. Adjusted survival analysis and generalised estimating equations were used to calculate differences in lifetime psychopathology. Multistate models were used to examine the progression through proposed clinical stages. RESULTS High-risk offspring had an increased lifetime risk of a broad spectrum of disorders including bipolar disorder (hazard ratio (HR) = 20.89; P = 0.04), major depressive disorder (HR = 17.16; P = 0.004), anxiety (HR = 2.20; P = 0.03), sleep (HR = 28.21; P = 0.02) and substance use disorders (HR = 2.60; P = 0.05) compared with controls. However, only offspring from lithium non-responsive parents developed psychotic disorders. Childhood anxiety disorder predicted an increased risk of major mood disorder and evidence supported a progressive transition through clinical stages, from non-specific psychopathology to depressive and then manic or psychotic episodes. CONCLUSIONS Findings underscore the importance of a developmental approach in conjunction with an appreciation of familial risk to facilitate earlier accurate diagnosis in symptomatic youth.
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Affiliation(s)
- Anne Duffy
- Anne Duffy, MSc, MD, FRCPC Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Alberta; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia; and Mood Disorders Centre of Ottawa, Ontario; Julie Horrocks, PhD, Department of Mathematics & Statistics, University of Guelph, Ontario; Sarah Doucette, MSc, Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia; Charles Keown-Stoneman, MSc, Department of Mathematics & Statistics, University of Guelph, Ontario; Shannon McCloskey, MEd, Mood Disorders Centre of Ottawa, Ontario; Paul Grof, MD, PhD, FRCPC, Mood Disorders Centre of Ottawa, Ontario, and Department of Psychiatry, University of Toronto, Ontario, Canada
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Association, haplotype, and gene-gene interactions of the HPA axis genes with suicidal behaviour in affective disorders. ScientificWorldJournal 2013; 2013:207361. [PMID: 24379738 PMCID: PMC3863451 DOI: 10.1155/2013/207361] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 10/22/2013] [Indexed: 02/03/2023] Open
Abstract
Family twin and adoption studies have noted the heritability of specific biological factors that influence suicidal behaviour.
Exposure to stress is one of the factors that strongly contribute to suicide attempts. The biological response
to stress involves the hypothalamic-pituitary-adrenal axis (HPA). Therefore, we found it interesting to study polymorphisms of
genes involved in the HPA axis (CRHR1, NR3C1, and AVPBR1). The study was performed on
597 patients, 225 of whom had a history of suicide attempts. We did not observe any significant differences in the studied
polymorphisms between the group of patients with a history of suicide attempts and the control subjects. Our haplotype analysis
of the AVPR1b gene revealed an association between the GCA haplotype and suicide attempts; however,
this association was not significant after correcting for multiple testing. We did not observe any other association in haplotype
and MDR analysis. We report here a comprehensive analysis of the HPA axis genes and a lack of association for genetic
variations regarding the risk of suicide attempts in affective disorder patients. Nonetheless, the inconsistencies with the previously
published results indicate the importance of the further investigation of these polymorphisms with respect to the risk of suicide attempts.
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Jiménez E, Arias B, Mitjans M, Goikolea JM, Roda E, Sáiz PA, García-Portilla MP, Burón P, Bobes J, Oquendo MA, Vieta E, Benabarre A. Genetic variability at IMPA2, INPP1 and GSK3β increases the risk of suicidal behavior in bipolar patients. Eur Neuropsychopharmacol 2013; 23:1452-62. [PMID: 23453640 DOI: 10.1016/j.euroneuro.2013.01.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 11/20/2012] [Accepted: 01/27/2013] [Indexed: 11/16/2022]
Abstract
Bipolar patients (BP) are at high risk of suicide. Causal factors underlying suicidal behavior are still unclear. However, it has been shown that lithium has antisuicidal properties. Genes involved in its putative mechanism of action such as the phosphoinositol and the Wnt/β-catenine pathways could be considered candidates for suicidal behavior (SB). Our aim was to investigate the association of the IMPA1 and 2, INPP1, GSK3α and β genes with suicidal behavior in BP. 199 BP were recruited. Polymorphisms at the IMPA1 (rs915, rs1058401 and rs2268432) and IMPA2 (rs66938, rs1020294, rs1250171 and rs630110), INPP1 (rs3791809, rs4853694 and 909270), GSK3α (rs3745233) and GSK3β (rs334558, rs1732170 and rs11921360) genes were genotyped. All patients were grouped and compared according to the presence or not of history of SB (defined as the presence of at least one previous suicidal attempt). Single SNP analyses showed that suicide attempters had higher frequencies of AA genotype of the rs669838-IMPA2 and GG genotype of the rs4853694-INPP1gene compared to non-attempters. Results also revealed that T-allele carriers of the rs1732170-GSK3β gene and A-allele carriers of the rs11921360-GSK3β gene had a higher risk for attempting suicide. Haplotype analysis showed that attempters had lower frequencies of A:A haplotype (rs4853694:rs909270) at the INPP1 gene. Higher frequencies of the C:A haplotype and lower frequencies of the A:C haplotype at the GSK-3β gene (rs1732170:rs11921360) were also found to be associated to SB in BP. Therefore, our results suggest that genetic variability at IMPA2, INPP1 and GSK3β genes is associated with the emergence of SB in BP.
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Affiliation(s)
- E Jiménez
- Bipolar Disorder Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
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Smoller JW. Disorders and borders: psychiatric genetics and nosology. Am J Med Genet B Neuropsychiatr Genet 2013; 162B:559-78. [PMID: 24132891 DOI: 10.1002/ajmg.b.32174] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 05/07/2013] [Indexed: 01/10/2023]
Abstract
Over the past century, the definition and classification of psychiatric disorders has evolved through a combination of historical trends, clinical observations, and empirical research. The current nosology, instantiated in the DSM-5 and ICD-10, rests on descriptive criteria agreed upon by a consensus of experts. While the development of explicit criteria has enhanced the reliability of diagnosis, the validity of the current diagnostic categories has been the subject of debate and controversy. Genetic studies have long been regarded as a key resource for validating the boundaries among diagnostic categories. Genetic epidemiologic studies have documented the familiality and heritability of clinically defined psychiatric disorders and molecular genetic studies have begun to identify specific susceptibility variants. At the same time, there is growing evidence from family, twin and genomic studies that genetic influences on psychiatric disorders transcend clinical boundaries. Here I review this evidence for cross-disorder genetic effects and discuss the implications of these findings for psychiatric nosology. Psychiatric genetic research can inform a bottom-up reappraisal of psychopathology that may help the field move beyond a purely descriptive classification and toward an etiology-based nosology.
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Affiliation(s)
- Jordan W Smoller
- Psychiatric and Neurodevelopmental Genetics Unit and Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
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Childhood anxiety: an early predictor of mood disorders in offspring of bipolar parents. J Affect Disord 2013; 150:363-9. [PMID: 23707033 DOI: 10.1016/j.jad.2013.04.021] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Accepted: 04/19/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND Anxiety disorders are common among the offspring of parents with bipolar disorder (BD). This study investigated the nature of the association between anxiety disorders and mood disorders in a prospectively studied high-risk cohort. METHODS High-risk offspring were identified from families in which one parent had confirmed BD based on SADS-L interviews and best estimate diagnostic procedures. All agreeable offspring aged 8-25 years were enrolled in a longitudinal study involving repeated KSADS-PL format clinical assessments. Control (C) offspring from families in which neither parent met lifetime criteria for a psychiatric disorder were similarly assessed. All DSM-IV diagnoses in the offspring were confirmed on blind consensus review. Cumulative incidence and adjusted Cox Proportional Hazards models were used to calculate the risk of anxiety disorders and the predictive association with mood disorders. RESULTS The cumulative incidence of anxiety disorders was higher (23.40% vs. 10.42%; HR=2.136; p=.0382) and occurred earlier (9.79 vs. 14.84 years; p=.0125) in high-risk compared to C offspring. In high-risk offspring generalized anxiety disorders (GAD) followed by social phobia were the most incident anxiety subtypes; while high emotionality (HR 1.111; p=.0096) and shyness (HR 1.144; p=.0053) increased the risk of anxiety disorders. Anxiety disorders increased the adjusted risk of mood disorders (HR 2.166; p=.0004), on average 8.49 years later (SD 5.97). LIMITATIONS The cumulative incidence of BD is relatively low, as the cohort is still in the period of risk. CONCLUSIONS Findings highlight the need for longitudinal surveillance of symptomatic high-risk children and suggest anxiety disorders are an important early intervention target.
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Manchia M, Hajek T, O'Donovan C, Deiana V, Chillotti C, Ruzickova M, Del Zompo M, Alda M. Genetic risk of suicidal behavior in bipolar spectrum disorder: analysis of 737 pedigrees. Bipolar Disord 2013; 15:496-506. [PMID: 23734877 DOI: 10.1111/bdi.12088] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 03/03/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Suicide is a significant cause of mortality in patients with major affective disorders (MAD), and suicidal behavior and MAD co-aggregate in families. However, the transmission of suicidal behavior is partially independent from that of MAD. We analyzed the lifetime prevalence of completed and attempted suicides in a large sample of families with bipolar disorder (BD), its relation to family history of MAD and BD, and the contribution of clinical and treatment factors to the risk of suicidal behavior. METHODS We studied 737 families of probands with MAD with 4919 first-degree relatives (818 affected, 3948 unaffected, and 153 subjects with no information available). Lifetime psychiatric diagnoses and suicidal behavior in first-degree relatives were assessed using semi-structured interviews, family history methods, and reviews of clinical records. Cox proportional hazard and logistic regression models were used to investigate the role of clinical covariates in the risk of suicidal behavior, and in the prevalence of MAD and BD. RESULTS The estimated lifetime prevalence of suicidal behavior (attempted and completed suicides) in 737 probands was 38.4 ± 3.0%. Lithium treatment decreased suicide risk in probands (p = 0.007). In first-degree relatives, a family history of suicidal behavior contributed significantly to the joint risk of MAD and suicidal behavior (p = 0.0006). CONCLUSIONS The liability to suicidal behavior is influenced by genetic factors (particularly family history of suicidal behavior and MAD). Even in the presence of high genetic risk for suicidal behavior, lithium treatment decreases suicide rates significantly.
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Affiliation(s)
- Mirko Manchia
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
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Lim CS, Baldessarini RJ, Vieta E, Yucel M, Bora E, Sim K. Longitudinal neuroimaging and neuropsychological changes in bipolar disorder patients: Review of the evidence. Neurosci Biobehav Rev 2013; 37:418-35. [PMID: 23318228 DOI: 10.1016/j.neubiorev.2013.01.003] [Citation(s) in RCA: 165] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 12/23/2012] [Accepted: 01/03/2013] [Indexed: 01/23/2023]
Affiliation(s)
- Chin Siang Lim
- School of Biological Sciences, Nanyang Technological University, Singapore, Singapore
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Adolescent substance use disorder during the early stages of bipolar disorder: a prospective high-risk study. J Affect Disord 2012; 142:57-64. [PMID: 22959686 DOI: 10.1016/j.jad.2012.04.010] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 03/23/2012] [Accepted: 04/13/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND There is a paucity of longitudinal data characterizing the relationship between substance use disorder (SUD) and the early clinical course of bipolar disorder (BD). We studied this relationship in a prospectively assessed cohort of high-risk offspring. METHODS Eligible families had one parent with confirmed BD based on SADS-L interviews and best estimate diagnostic procedure. Offspring completed KSADS-PL interviews at baseline and were reassessed prospectively. DSM-IV diagnoses were made on blind consensus review using all available information. This analysis included 211 offspring ≥12 years, and used GEE and linear mixed models to determine clinical characteristics differentiating those with compared to those without SUD, and CPH models to assess the relationship between SUD and the early stages of BD. RESULTS Lifetime SUD was diagnosed in 24% of offspring; cannabis use being most common. The peak hazard of SUD was between 14 and 20 years of age. Male sex (HR 3.285; p=.0007), a prior mood disorder (HR 2.437; p=.0091) and parental history of SUD (HR 2.999; p=.0027) contributed to the risk of SUD in the offspring, while SUD predicted an increased risk of psychosis (HR 3.225; p=.0074). The estimated hazard of a major mood disorder in those offspring with compared to those without a prior SUD was almost 3-fold (HR 2.990 (p≤0.01). LIMITATIONS The novel clinical staging model requires independent replication. CONCLUSIONS SUD is a common comorbidity arising during the early course of BD, even before the first activated episode. Further research is needed to understand causative factors and to develop effective early intervention and prevention strategies.
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Kékesi KA, Juhász G, Simor A, Gulyássy P, Szegő EM, Hunyadi-Gulyás E, Darula Z, Medzihradszky KF, Palkovits M, Penke B, Czurkó A. Altered functional protein networks in the prefrontal cortex and amygdala of victims of suicide. PLoS One 2012; 7:e50532. [PMID: 23272063 PMCID: PMC3516509 DOI: 10.1371/journal.pone.0050532] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 10/26/2012] [Indexed: 12/18/2022] Open
Abstract
Probing molecular brain mechanisms related to increased suicide risk is an important issue in biological psychiatry research. Gene expression studies on post mortem brains indicate extensive changes prior to a successful suicide attempt; however, proteomic studies are scarce. Thus, we performed a DIGE proteomic analysis of post mortem tissue samples from the prefrontal cortex and amygdala of suicide victims to identify protein changes and biomarker candidates of suicide. Among our matched spots we found 46 and 16 significant differences in the prefrontal cortex and amygdala, respectively; by using the industry standard t test and 1.3 fold change as cut off for significance. Because of the risk of false discoveries (FDR) in these data, we also made FDR adjustment by calculating the q-values for all the t tests performed and by using 0.06 and 0.4 as alpha thresholds we reduced the number of significant spots to 27 and 9 respectively. From these we identified 59 proteins in the cortex and 11 proteins in the amygdala. These proteins are related to biological functions and structures such as metabolism, the redox system, the cytoskeleton, synaptic function, and proteolysis. Thirteen of these proteins (CBR1, DPYSL2, EFHD2, FKBP4, GFAP, GLUL, HSPA8, NEFL, NEFM, PGAM1, PRDX6, SELENBP1 and VIM,) have already been suggested to be biomarkers of psychiatric disorders at protein or genome level. We also pointed out 9 proteins that changed in both the amygdala and the cortex, and from these, GFAP, INA, NEFL, NEFM and TUBA1 are interacting cytoskeletal proteins that have a functional connection to glutamate, GABA, and serotonin receptors. Moreover, ACTB, CTSD and GFAP displayed opposite changes in the two examined brain structures that might be a suitable characteristic for brain imaging studies. The opposite changes of ACTB, CTSD and GFAP in the two brain structures were validated by western blot analysis.
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Affiliation(s)
- Katalin Adrienna Kékesi
- Laboratory of Proteomics, Institute of Biology, Eötvös Loránd University, Budapest, Hungary.
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Kranz TM, Ekawardhani S, Lin MK, Witzmann SR, Streit F, Schuelter U, Bauer H, Henseler D, Turner JD, Muller CP, Reif A, Schote AB, Meyer J. The chromosome 15q14 locus for bipolar disorder and schizophrenia: is C15orf53 a major candidate gene? J Psychiatr Res 2012; 46:1414-20. [PMID: 22944046 DOI: 10.1016/j.jpsychires.2012.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Revised: 06/10/2012] [Accepted: 08/10/2012] [Indexed: 10/27/2022]
Abstract
Bipolar disorder (BD) and schizophrenia are complexly inherited and highly heritable disorders with currently unknown etiologies. Recently, two independent genome-wide association studies for BD identified a small region on chromosome 15q14-15.1, pointing to a locus close to the gene C15orf53. Previously, this genomic region was also found to co-segregate with periodic catatonia (SCZD10, OMIM %605419), an unsystematic schizophrenia according to Leonhard's classification, in several multiplex families, thus pointing to overlapping etiologies of both conditions. A susceptibility locus on chromosome 15q14-15.1 was narrowed down to a 4.38 Mb region in these affected families followed by mutation and segregation analyses of C15orf53. Association analysis of individuals affected by BD and/or SCZD10 (n = 274) and controls (n = 230) and expression analyses in distinct post-mortem human limbic brain tissues were conducted. C15orf53 revealed no mutations in our SCZD10 family members, but segregation of two common haplotypes was found. No association of identified haplotypes was found in our case-control samples. Gene expression could be demonstrated for immune-system-derived cells but not for the post-mortem human limbic brain tissue. Our results indicate that C15orf53 is probably neither causative for the etiology of BD nor for SCZD10 in our samples.
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Affiliation(s)
- Thorsten M Kranz
- Department of Neurobehavioral Genetics, Institute of Psychobiology, University of Trier, Johanniterufer 15, 54290 Trier, Germany.
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Duffy A, Lewitzka U, Doucette S, Andreazza A, Grof P. Biological indicators of illness risk in offspring of bipolar parents: targeting the hypothalamic-pituitary-adrenal axis and immune system. Early Interv Psychiatry 2012; 6:128-37. [PMID: 22182213 DOI: 10.1111/j.1751-7893.2011.00323.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AIM The study aims to provide a selective review of the literature pertaining to the hypothalamic-pituitary-adrenal (HPA) axis and immune abnormalities as informative biological indicators of vulnerability in bipolar disorder (BD). METHOD We summarize key findings relating to HPA axis and immunological abnormalities in bipolar patients and their high-risk offspring. Findings derive from a review of selected original papers published in the literature, and supplemented by papers identified through bibliography review. Neurobiological findings are discussed in the context of emergent BD in those at genetic risk and synthesized into a neurodevelopmental model of illness onset and progression. RESULTS BD is associated with a number of genetic and possibly epigenetic abnormalities associated with neurotransmitter, hormonal and immunologically mediated neurobiological pathways. Data from clinical and high-risk studies implicate HPA axis and immune system abnormalities, which may represent inherited vulnerabilities important for the transition to illness onset. Post-mortem and clinical studies implicate intracellular signal transduction processes and disturbance in energy metabolism associated with established BD. Specifically, long-standing maladaptive alterations such as changes in neuronal systems may be mediated through changes in intracellular signalling pathways, oxidative stress, cellular energy metabolism and apoptosis associated with substantial burden of illness. CONCLUSIONS Prospective longitudinal studies of endophenotypes and biomarkers such as HPA axis and immune abnormalities in high-risk offspring will be helpful to understand genetically mediated biological pathways associated with illness onset and progression. A clinical staging model describing emergent illness in those at genetic risk should facilitate this line of investigation.
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Affiliation(s)
- Anne Duffy
- Departments of Psychiatry, Dalhousie University, Halifax, Nova Scotia.
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Shahid M. Clinical Need and Rationale for Multi-Target Drugs in Psychiatry. DESIGNING MULTI-TARGET DRUGS 2012. [DOI: 10.1039/9781849734912-00014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
High attrition in attempts to discover new pharmacological agents for the treatment of psychiatric disorders has triggered a decline in R&D investment in important disease categories such as schizophrenia and mood disorders. Poor knowledge about disease molecular pathology and molecular target validation coupled with notable costly failures involving clinical trials with highly novel and selective single target agents (STAs) have contributed to the development of this trend. One positive development arising from the current situation is the renewed interest in investigating approaches involving multi-target agents (MTAs), which have historically shown a strong track record of success and utility in the treatment of psychiatric disorders. However, it is clear that the traditional serendipity-dependent drug discovery approach for multi-target agents is suboptimal and has to evolve towards a new model of rationally designed and tailored MTAs. It is of course highly challenging to optimise compounds across several therapeutic targets whilst minimising potential broad receptor promiscuity as well as other properties to generate high quality drug candidates. Nevertheless, recent developments in medicinal chemistry approaches and pharmacological evaluation suggest that feasibility for tailored MTAs is not unrealistic. Appropriately designed MTAs, such as hybrids of validated and unprecedented novel molecular targets, offer a multi-functional pharmacology with the potential for multi-symptomatic efficacy and multi-indicational use. If successful this will help to address the compelling unmet medical need and the treatment requirements of schizophrenia and mood disorder patients as well as easing the burden of carers and the societal costs arising from these devastating illnesses.
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Duffy A, Doucette S, Lewitzka U, Alda M, Hajek T, Grof P. Findings from bipolar offspring studies: methodology matters. Early Interv Psychiatry 2011; 5:181-91. [PMID: 21718461 DOI: 10.1111/j.1751-7893.2011.00276.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM High-risk studies provide the opportunity to describe the early natural history of bipolar disorder (BD); however, findings have varied substantially. In this review, we compare different methods of ascertainment and assessment, and their impact on study findings. METHODS Through a literature search, we identified 11 high-risk studies meeting inclusion criteria for this review. Studies included were those that focused on lifetime psychopathology in the offspring as the main outcome and provided adequate information on the methods of family ascertainment, as well as on parent and offspring assessment. We compared and contrasted psychopathological outcomes in the offspring among the studies using different methods. RESULTS High-risk studies that identified affected parents through their involvement in neurobiological research and confirmed diagnosis in the parent and offspring through best estimate procedures tended to report lower rates of co-morbidity in the proband parent, lower rates of psychopathology in the non-proband parent, lower rates of attention deficit hyperactivity disorder and externalizing disorders, and older ages of onset of major mood disorders in the offspring compared with studies that identified affected parents through self-referral and confirmed diagnosis in the parent and offspring through structured research interviews. Studies that identified severely ill parents and used semi-structured assessments tended to have an intermediate position in terms of outcomes. CONCLUSIONS This review indicates that different methods of family ascertainment and of assessment of parent and offspring impact the findings pertaining to lifetime psychopathology and clinical course of BD in high-risk studies. The implications of this finding for mapping the natural history of BD are discussed.
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Affiliation(s)
- Anne Duffy
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Nova Scotia, Canada.
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Lazary J, Juhasz G, Hunyady L, Bagdy G. Personalized medicine can pave the way for the safe use of CB1 receptor antagonists. Trends Pharmacol Sci 2011; 32:270-80. [DOI: 10.1016/j.tips.2011.02.013] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Revised: 02/14/2011] [Accepted: 02/18/2011] [Indexed: 12/15/2022]
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