Schizophrenia polygenic risk scores in youth mental health: preliminary associations with diagnosis, clinical stage and functioning

Polygenic risk for schizophrenia and subjective well-being in a general population sample

BACKGROUND

Previous evidence has reported associations of a polygenic risk score for schizophrenia (PRSSCZ) with negative developmental outcomes, such as psychiatric symptoms, adverse health behaviors, and reduced everyday functioning. We now investigated the relationship of PRSSCZ with subjectively experienced well-being.

METHODS

Participants (n = 1866) came from the prospective population-based Young Finns Study (YFS). Subjective well-being in adulthood was assessed in terms of life satisfaction, optimism, and self-acceptance (when participants were 20-50 years old). A PRSSCZ was calculated based on the most recent genome-wide association study on schizophrenia. Covariates included age, sex, early family environment, adulthood socioeconomic factors, and adulthood health behaviors.

RESULTS

The PRSSCZ did not predict any domain of subjective well-being, including life satisfaction, optimism, and self-acceptance. After adding covariates in a stepwise manner or including/excluding participants with diagnosed non-affective psychotic disorders, all the associations remained non-significant. Age- and sex-interaction analyses showed that PRSSCZ was not associated with subjective well-being in either sex or in any age between 20 and 50 years.

CONCLUSIONS

While high PRSSCZ has been linked to multiple adversities in previous studies, we did not find any association between high PRSSCZ and subjective measures of life satisfaction, optimism, and self-acceptance.

Transdiagnostic Effects of Schizophrenia Polygenic Scores on Treatment Outcomes in Major Psychiatric Disorders

Schizophrenia polygenic risk scores (SCZ PRS) have emerged as important tools for modulating factors not only in schizophrenia but also in major psychiatric disorders, such as major depression (MDD) and bipolar disorder (BD). Initially developed to capture the common variant risk for SCZ, accumulating evidence highlights the transdiagnostic impact of SCZ PRS on clinical severity, treatment response, and functional outcomes. This review synthesizes recent findings on the relationship between SCZ PRS and treatment outcomes across SCZ, BD, and MDD. A higher SCZ PRS is associated with poorer treatment outcomes, including treatment resistance or non-remission to antidepressants in MDD, reduced antipsychotic response in SCZ, and diminished lithium efficacy in BD. SCZ PRS is also linked to persistent negative symptoms, cognitive impairments, and long-term illness severity in SCZ. While the effect sizes are generally modest, integration of SCZ PRS with environmental factors, multiomics, and neuroimaging may enhance predictive accuracy. Despite variability in reported associations, the overarching evidence supports a transdiagnostic influence of SCZ PRS on disease trajectories and treatment responses. As a promising component of precision psychiatry, SCZ PRS holds potential for guiding more targeted and effective interventions. Future research should focus on combining SCZ PRS with multimodal approaches to fully realize its clinical utility.

Polygenic risk scores and help-seeking behaviour in young people with recent onset of mood and psychotic disorders

OBJECTIVES

We examined associations between polygenic risk scores (PRS) for depression (PRS-MDD), psychosis (PRS-SCZ), bipolar disorders (PRS-BD) and neuroticism (PRS-NEU) and (i) help-seeking, and (ii) new onset cases of full-threshold mood or psychotic disorders in youth.

METHODS

Help-seeking for mental health problems was assessed by self-report and mood and psychotic disorders were identified using the Composite International Diagnostic Interview. A principal component analysis of the four selected PRS identified two dimensions (BD-SCZ; MDD-NEU) that accounted for 69.9 % of the explained variance. We explored the associations between these PRS dimensions and help-seeking and diagnostic subgroup using analyses of co-variance (ANCOVA) adjusted for variables of influence (such as age, sex, twin status).

RESULTS

Almost 30 % (409 of 1473) of study participants met CIDI criteria for ≥ 1 mood or psychotic disorder. Overall, 60 % (n = 245) of CIDI cases sought help, ranging from 35 % for psychosis to 77 % for mania. Furthermore, 143 help-seekers did not have a CIDI diagnosis of mood or psychotic disorders. The BD-SCZ dimension showed associations with help-seeking behaviour and diagnostic groups, but the MDD-NEU dimension only showed associations with help-seeking.

LIMITATIONS

Some diagnoses could not be studied in detail (i.e., schizophreniform disorders) due to the small size of subgroups and planned analyses needed to be adjusted for the presence of twins and non-twin siblings.

CONCLUSIONS

Signals of genetic liability are higher in young people who seek help from health services whether or not the problem they are seeking help for meets full-threshold diagnostic criteria for a major mental disorder.

Novel youth mental health services in Australia: What differences are being reported about the clinical needs of those who attend and the outcomes achieved?

Globally, youth mental health services are evolving, with Australia's headspace services presented as a leading exemplar. headspace services were designed as enhanced primary care-based entities and were expected to collaborate with local acute, and specialist clinical and psychosocial services. The lack of large-scale health services trials necessitates understanding their impact through systematic monitoring and evaluation. This paper compares data from differing sources that describe the demographic and clinical features, and functional outcomes, of young people presenting to various headspace services. headspace National reports that care is provided largely to youth with transient distress, minimal clinical disorders, suicidality or comorbidities and limited functional impairment. Almost 50% of clients are reported to have no significant psychological symptoms or risk factors, and less than 30% to have a clinical disorder. Consequently, 36% receive only a single session of care and the median number of clinical sessions provided is three. By contrast, empirically derived estimates, utilising data from an academic centre and its affiliated centres, other independent agencies and more refined analyses of headspace national data variously portray 50-60% of youth as presenting with at least moderate clinical complexity (including at least 20% with high complexity), and with another 27% requiring active clinical intervention. Together, these data suggest approximately 75% of attendees require substantive clinical care. Clinical outcomes data from all sources indicate limited impacts on functional outcomes, with less than a third achieving significant improvement. These data support the original intent of headspace services to focus on equitable access to multidimensional and clinical assessment, evidence-based early interventions for early stages of major anxiety, mood or psychotic disorders. As demand for youth services continues to rise, there is an urgent need to reconfigure our national youth service networks to address the unmet clinical and psychosocial needs of youth presenting in the early stages of major mental disorders.

Factors associated with anxiety disorder comorbidity

BACKGROUND

Anxiety and depressive disorders often co-occur and the order of their emergence may be associated with different clinical outcomes. However, minimal research has been conducted on anxiety-anxiety comorbidity. This study examined factors associated with anxiety comorbidity and anxiety-MDD temporal sequence.

METHODS

Online, self-report data were collected from the UK-based GLAD and COPING NBR cohorts (N = 38,775). Logistic regression analyses compared differences in sociodemographic, trauma, and clinical factors between single anxiety, anxiety-anxiety comorbidity, anxiety-MDD (major depressive disorder) comorbidity, and MDD-only. Additionally, anxiety-first and MDD-first anxiety-MDD were compared. Differences in familial risk were assessed in those participants with self-reported family history or genotype data.

RESULTS

Anxiety-anxiety and anxiety-MDD had higher rates of self-reported anxiety or depressive disorder diagnoses, younger age of onset, and higher recurrence than single anxiety. Anxiety-MDD displayed greater clinical severity/complexity than MDD only. Anxiety-anxiety had more severe current anxiety symptoms, less severe current depressive symptoms, and reduced likelihood of self-reporting an anxiety/depressive disorder diagnosis than anxiety-MDD. Anxiety-first anxiety-MDD had a younger age of onset, more severe anxiety symptoms, and less likelihood of self-reporting a diagnosis than MDD-first. Minimal differences in familial risk were found.

LIMITATIONS

Self-report, retrospective measures may introduce recall bias. The familial risk analyses were likely underpowered.

CONCLUSIONS

Anxiety-anxiety comorbidity displayed a similarly severe and complex profile of symptoms as anxiety-MDD but distinct features. For anxiety-MDD, first-onset anxiety had an earlier age of onset and greater severity than MDD-first. Anxiety disorders and comorbidity warrant further investigation and attention in research and practice.

Early Detection and Prevention of Schizophrenic Psychosis-A Review

Psychotic disorders often run a chronic course and are associated with a considerable emotional and social impact for patients and their relatives. Therefore, early recognition, combined with the possibility of preventive intervention, is urgently warranted since the duration of untreated psychosis (DUP) significantly determines the further course of the disease. In addition to established diagnostic tools, neurobiological factors in the development of schizophrenic psychoses are increasingly being investigated. It is shown that numerous molecular alterations already exist before the clinical onset of the disease. As schizophrenic psychoses are not elicited by a single mutation in the deoxyribonucleic acid (DNA) sequence, epigenetics likely constitute the missing link between environmental influences and disease development and could potentially serve as a biomarker. The results from transcriptomic and proteomic studies point to a dysregulated immune system, likely evoked by epigenetic alterations. Despite the increasing knowledge of the neurobiological mechanisms involved in the development of psychotic disorders, further research efforts with large population-based study designs are needed to identify suitable biomarkers. In conclusion, a combination of blood examinations, functional imaging techniques, electroencephalography (EEG) investigations and polygenic risk scores should be considered as the basis for predicting how subjects will transition into manifest psychosis.