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Besterman AD. A genetics-guided approach to the clinical management of schizophrenia. Schizophr Res 2024; 267:462-469. [PMID: 37813777 DOI: 10.1016/j.schres.2023.09.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 09/27/2023] [Accepted: 09/29/2023] [Indexed: 10/11/2023]
Abstract
Schizophrenia is a highly heritable, severe mental illness characterized by hallucinations, delusions, social withdrawal, and cognitive dysfunction present in ∼1% of populations across cultures. There have been recent major advancements in our understanding of the genetic architecture of schizophrenia. Both rare, highly penetrant genetic variants as well as common, low-penetrant genetic variants can predispose individuals to schizophrenia and can impact the way people metabolize psychoactive medications used to treat schizophrenia. However, the impact of these findings on the clinical management of schizophrenia remains limited. This review highlights the few places where genetics currently informs schizophrenia management strategies, discusses major limitations, and reviews promising areas of genetics research that are most likely to impact future schizophrenia care. Specifically, I focuss on psychiatric genetic counseling, genetic testing strategies, pharmacogenetics, polygenic risk, and genetics-guided treatment. Lastly, I emphasize important ethical considerations in the clinical use of genetics for schizophrenia management, including the exacerbation of healthcare inequalities and unintended consequences of new genetic technologies.
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Affiliation(s)
- Aaron D Besterman
- University of California San Diego, Department of Psychiatry, San Diego, CA, USA; Rady Children's Hospital San Diego, Division of Behavioral Health Services, San Diego, CA, USA; Rady Children's Institute for Genomic Medicine, San Diego, CA, USA.
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2
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D'Souza DC, DiForti M, Ganesh S, George TP, Hall W, Hjorthøj C, Howes O, Keshavan M, Murray RM, Nguyen TB, Pearlson GD, Ranganathan M, Selloni A, Solowij N, Spinazzola E. Consensus paper of the WFSBP task force on cannabis, cannabinoids and psychosis. World J Biol Psychiatry 2022; 23:719-742. [PMID: 35315315 DOI: 10.1080/15622975.2022.2038797] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVES The liberalisation of cannabis laws, the increasing availability and potency of cannabis has renewed concern about the risk of psychosis with cannabis. METHODS The objective of the WFSBP task force was to review the literature about this relationship. RESULTS Converging lines of evidence suggest that exposure to cannabis increases the risk for psychoses ranging from transient psychotic states to chronic recurrent psychosis. The greater the dose, and the earlier the age of exposure, the greater the risk. For some psychosis outcomes, the evidence supports some of the criteria of causality. However, alternate explanations including reverse causality and confounders cannot be conclusively excluded. Furthermore, cannabis is neither necessary nor sufficient to cause psychosis. More likely it is one of the multiple causal components. In those with established psychosis, cannabis has a negative impact on the course and expression of the illness. Emerging evidence also suggests alterations in the endocannabinoid system in psychotic disorders. CONCLUSIONS Given that exposure to cannabis and cannabinoids is modifiable, delaying or eliminating exposure to cannabis or cannabinoids, could potentially impact the rates of psychosis related to cannabis, especially in those who are at high risk for developing the disorder.
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Affiliation(s)
- Deepak Cyril D'Souza
- Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA.,Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Marta DiForti
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London, UK.,South London and Maudsley NHS Mental Health Foundation Trust, London, UK
| | - Suhas Ganesh
- Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA.,Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Tony P George
- Addictions Division and Centre for Complex Interventions, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Wayne Hall
- The National Centre for Youth Substance Use Research, University of Queensland, Brisbane, Australia
| | - Carsten Hjorthøj
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University, Copenhagen, Denmark.,Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - Oliver Howes
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Institute for Clinical Sciences, Imperial College London, London, UK
| | - Matcheri Keshavan
- Beth Israel Deaconess Medical Center, Massachusetts Mental Health Center, Harvard Medical School, Boston, MA, USA
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Timothy B Nguyen
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London, UK.,Institute for Clinical Sciences, Imperial College London, London, UK
| | - Godfrey D Pearlson
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.,Olin Neuropsychiatry Ctr. Institute of Living, Hartford, CT, USA
| | - Mohini Ranganathan
- Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA.,Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Alex Selloni
- Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Nadia Solowij
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia.,Australian Centre for Cannabinoid Clinical and Research Excellence (ACRE), New Lambton Heights, NSW, Australia
| | - Edoardo Spinazzola
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Marchi M, Elkrief L, Alkema A, van Gastel W, Schubart CD, van Eijk KR, Luykx JJ, Branje S, Mastrotheodoros S, Galeazzi GM, van Os J, Cecil CA, Conrod PJ, Boks MP. Childhood maltreatment mediates the effect of the genetic background on psychosis risk in young adults. Transl Psychiatry 2022; 12:219. [PMID: 35650188 PMCID: PMC9160238 DOI: 10.1038/s41398-022-01975-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/29/2022] [Accepted: 05/10/2022] [Indexed: 11/09/2022] Open
Abstract
Childhood maltreatment (CM) and genetic vulnerability are both risk factors for psychosis, but the relations between them are not fully understood. Guided by the recent identification of genetic risk to CM, this study investigates the hypothesis that genetic risk to schizophrenia also increases the risk of CM and thus impacts psychosis risk. The relationship between schizophrenia polygenetic risk, CM, and psychotic-like experiences (PLE) was investigated in participants from the Utrecht Cannabis Cohort (N = 1262) and replicated in the independent IMAGEN cohort (N = 1740). Schizophrenia polygenic risk score (SZ-PRS) were calculated from the most recent GWAS. The relationship between CM, PRS, and PLE was first investigated using multivariate linear regression. Next, mediation of CM in the pathway linking SZ-PRS and PLE was examined by structural equation modeling, while adjusting for a set of potential mediators including cannabis use, smoking, and neuroticism. In agreement with previous studies, PLE were strongly associated with SZ-PRS (B = 0.190, p = 0.009) and CM (B = 0.575, p < 0.001). Novel was that CM was also significantly associated with SZ-PRS (B = 0.171, p = 0.001), and substantially mediated the effects of SZ-PRS on PLE (proportion mediated = 29.9%, p = 0.001). In the replication cohort, the analyses yielded similar results, confirming equally strong mediation by CM (proportion mediated = 34.7%, p = 0.009). Our results suggest that CM acts as a mediator in the causal pathway linking SZ-PRS and psychosis risk. These findings open new perspectives on the relations between genetic and environmental risks and warrant further studies into potential interventions to reduce psychosis risk in vulnerable people.
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Affiliation(s)
- Mattia Marchi
- grid.7548.e0000000121697570Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giuseppe Campi, 287 – 41125 Modena, Italy ,grid.5477.10000000120346234Department of Psychiatry, Brain Center University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Laurent Elkrief
- grid.14848.310000 0001 2292 3357Department of Psychiatry, Université de Montréal, CHU Sainte-Justine Hospital, Montréal, QC Canada ,grid.411418.90000 0001 2173 6322Center Hospitalier Universitaire Sainte-Justine Research Center, Montreal, QC Canada
| | - Anne Alkema
- grid.5477.10000000120346234Department of Psychiatry, Brain Center University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Willemijn van Gastel
- grid.5477.10000000120346234Department of Psychology, Utrecht University, Utrecht, The Netherlands
| | - Chris D. Schubart
- grid.413202.60000 0004 0626 2490Department of Psychiatry, Tergooi Hospital, Blaricum, The Netherlands
| | - Kristel R. van Eijk
- grid.5477.10000000120346234Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Jurjen J. Luykx
- grid.5477.10000000120346234Department of Psychiatry, Brain Center University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Susan Branje
- grid.5477.10000000120346234Department of Youth and Family, Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, The Netherlands
| | - Stefanos Mastrotheodoros
- grid.5477.10000000120346234Department of Youth and Family, Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, The Netherlands ,grid.8127.c0000 0004 0576 3437Department of Psychology, University of Crete, Rethymno, Greece
| | - Gian M. Galeazzi
- grid.7548.e0000000121697570Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giuseppe Campi, 287 – 41125 Modena, Italy ,Department of Mental Health and Addiction Services, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Jim van Os
- grid.5477.10000000120346234Department of Psychiatry, Brain Center University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Charlotte A. Cecil
- grid.5645.2000000040459992XDepartment of Child and Adolescent Psychiatry, Erasmus Medical Center, Sophia Children’s Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands ,grid.5645.2000000040459992XDepartment of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Patricia J. Conrod
- grid.14848.310000 0001 2292 3357Department of Psychiatry, Université de Montréal, CHU Sainte-Justine Hospital, Montréal, QC Canada ,grid.411418.90000 0001 2173 6322Center Hospitalier Universitaire Sainte-Justine Research Center, Montreal, QC Canada
| | - Marco P. Boks
- grid.5477.10000000120346234Department of Psychiatry, Brain Center University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
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Betz LT, Penzel N, Kambeitz J. A network approach to relationships between cannabis use characteristics and psychopathology in the general population. Sci Rep 2022; 12:7163. [PMID: 35504926 PMCID: PMC9065088 DOI: 10.1038/s41598-022-11092-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 04/08/2022] [Indexed: 11/27/2022] Open
Abstract
Cannabis use characteristics, such as earlier initiation and frequent use, have been associated with an increased risk for developing psychotic experiences and psychotic disorders. However, little is known how these characteristics relate to specific aspects of sub-clinical psychopathology in the general population. Here, we explore the relationships between cannabis use characteristics and psychopathology in a large general population sample (N = 2,544, mean age 29.2 years, 47% women) by employing a network approach. This allows for the identification of unique associations between two cannabis use characteristics (lifetime cumulative frequency of cannabis use, age of cannabis use initiation), and specific psychotic experiences and affective symptoms, while controlling for early risk factors (childhood trauma, urban upbringing). We found particularly pronounced unique positive associations between frequency of cannabis use and specific delusional experiences (persecutory delusions and thought broadcasting). Age of cannabis use initiation was negatively related to visual hallucinatory experiences and irritability, implying that these experiences become more likely the earlier use is initiated. Earlier initiation, but not lifetime frequency of cannabis use, was related to early risk factors. These findings suggest that cannabis use characteristics may contribute differentially to risk for specific psychotic experiences and affective symptoms in the general population.
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Affiliation(s)
- Linda T Betz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany.
| | - Nora Penzel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
- Group of Psychiatric Neuroscience, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
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