1
|
Gulsuner S, Stein DJ, Susser ES, Sibeko G, Pretorius A, Walsh T, Majara L, Mndini MM, Mqulwana SG, Ntola OA, Casadei S, Ngqengelele LL, Korchina V, van der Merwe C, Malan M, Fader KM, Feng M, Willoughby E, Muzny D, Baldinger A, Andrews HF, Gur RC, Gibbs RA, Zingela Z, Nagdee M, Ramesar RS, King MC, McClellan JM. Genetics of schizophrenia in the South African Xhosa. Science 2020; 367:569-573. [PMID: 32001654 PMCID: PMC9558321 DOI: 10.1126/science.aay8833] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 12/18/2019] [Indexed: 07/20/2023]
Abstract
Africa, the ancestral home of all modern humans, is the most informative continent for understanding the human genome and its contribution to complex disease. To better understand the genetics of schizophrenia, we studied the illness in the Xhosa population of South Africa, recruiting 909 cases and 917 age-, gender-, and residence-matched controls. Individuals with schizophrenia were significantly more likely than controls to harbor private, severely damaging mutations in genes that are critical to synaptic function, including neural circuitry mediated by the neurotransmitters glutamine, γ-aminobutyric acid, and dopamine. Schizophrenia is genetically highly heterogeneous, involving severe ultrarare mutations in genes that are critical to synaptic plasticity. The depth of genetic variation in Africa revealed this relationship with a moderate sample size and informed our understanding of the genetics of schizophrenia worldwide.
Collapse
Affiliation(s)
- S Gulsuner
- Department of Medicine, Department of Genome Sciences, and Department of Psychiatry, University of Washington, Seattle, WA, USA
| | - D J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - E S Susser
- Mailman School of Public Health, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - G Sibeko
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - A Pretorius
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - T Walsh
- Department of Medicine, Department of Genome Sciences, and Department of Psychiatry, University of Washington, Seattle, WA, USA
| | - L Majara
- Division of Human Genetics, University of Cape Town, Cape Town, South Africa
| | - M M Mndini
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - S G Mqulwana
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - O A Ntola
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - S Casadei
- Department of Medicine, Department of Genome Sciences, and Department of Psychiatry, University of Washington, Seattle, WA, USA
| | - L L Ngqengelele
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - V Korchina
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - C van der Merwe
- Division of Human Genetics, University of Cape Town, Cape Town, South Africa
| | - M Malan
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - K M Fader
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - M Feng
- Mailman School of Public Health, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - E Willoughby
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - D Muzny
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - A Baldinger
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - H F Andrews
- Mailman School of Public Health, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - R C Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - R A Gibbs
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - Z Zingela
- Department of Psychology, Rhodes University, Makhanda (Grahamstown), South Africa
- Department of Psychiatry and Human Behavioral Sciences, Walter Sisulu University, Mthatha, South Africa
| | - M Nagdee
- Department of Psychology, Rhodes University, Makhanda (Grahamstown), South Africa
- Department of Psychiatry and Human Behavioral Sciences, Walter Sisulu University, Mthatha, South Africa
| | - R S Ramesar
- Division of Human Genetics, University of Cape Town, Cape Town, South Africa
| | - M-C King
- Department of Medicine, Department of Genome Sciences, and Department of Psychiatry, University of Washington, Seattle, WA, USA.
| | - J M McClellan
- Department of Medicine, Department of Genome Sciences, and Department of Psychiatry, University of Washington, Seattle, WA, USA
| |
Collapse
|
3
|
Abstract
Subjects admitted 12 months or more previously to two child and adolescent psychiatric units in New Zealand and the United States with a diagnosis of non-organic, nonautistic psychosis, were contacted and those who received a DSM-III-R diagnosis of schizophrenia were studied (n = 33 [New Zealand] and n = 24 [United States]). Premorbid and first-episode data were obtained from the admission record using global clinical measures of moderate reliability, outcome diagnosis and status by interviews, and professional and family reports. Mean ages at onset were 13.9 (New Zealand) and 15.6 (United States). Premorbid and clinical features resembled those in adult schizophrenia, though there were probable quantitative differences. At outcome (mean interval = 4 years) few subjects were symptom-free or independent, and mean global assessment of functioning had fallen from 55 to 40. Outcome was much worse in schizophrenia than bipolar disorder. Despite a 59 percent attrition rate and higher rates of initial misdiagnosis in the United States, and some demographic differences, New Zealand and United States samples resembled each other clinically and in outcome. Initial misdiagnosis of bipolar disorder as schizophrenia was not due to minimizing mood symptoms, which were common in both disorders. Within this age range (mostly 11-17), age at onset had only minor effects. Outcome was best predicted by premorbid personality.
Collapse
Affiliation(s)
- J S Werry
- Department of Psychiatry and Behavioural Science, School of Medicine, University of Auckland, New Zealand
| | | | | | | |
Collapse
|
4
|
McClellan JM, Werry JS, Ham M. A follow-up study of early onset psychosis: comparison between outcome diagnoses of schizophrenia, mood disorders, and personality disorders. J Autism Dev Disord 1993; 23:243-62. [PMID: 8331046 DOI: 10.1007/bf01046218] [Citation(s) in RCA: 94] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
This study examined the outcome of youth previously diagnosed with psychotic disorders at a public-sector tertiary care hospital. Of 95 children and adolescents retrospectively identified, follow-up information (mean interval 3.9 years) was obtained on 24 subjects with an outcome diagnosis of schizophrenia, 9 with psychotic mood disorders, 5 with personality disorders (antisocial or borderline), and 1 with schizo-affective disorder. The schizophrenic group was more often odd premorbidly and functioned worse at outcome, while the mood-disordered group had a shorter follow-up period and was more often anxious or dysthymic premorbidly. The personality-disordered group resembled the schizophrenics in their degree of impairment and chronicity. All three groups had high rates of family disruption, low SES, substance abuse, and chronicity, and were similar in their degree of premorbid impairment, length of prodrome, age of onset, initial diagnosis, and family psychiatric history. Misdiagnosis at onset was quite common and highlights the need for systematic longitudinal assessment of early onset psychotic disorders.
Collapse
Affiliation(s)
- J M McClellan
- Department of Psychiatry, University of Washington, Seattle 98109
| | | | | |
Collapse
|
5
|
McClellan JM, Werry JS. Schizophrenia. Psychiatr Clin North Am 1992; 15:131-48. [PMID: 1347937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Schizophrenia occurring in childhood and adolescence has similar diagnostic, prognostic, and treatment ramifications as those noted with adult-onset schizophrenia. In assessing a child or adolescent suspected of having schizophrenia, care must be given to document DSM-III-R diagnostic criteria within the developmental framework of the patient's functioning, while thoroughly evaluating for other potentially confounding disorders or conditions. Antipsychotic therapy is the only specific treatment for schizophrenia, and should be a fundamental component with a multimodal treatment program that also addresses the psychological, social, and educational needs of the patient and his or her family. Strategies for medication management vary depending on several factors, including the stage of the disorder, noted or potential side effects, and the response of the patient to treatment, and need to be coordinated for the long term by a child or adolescent psychiatrist familiar with the diagnosis and treatment of schizophrenia in this age group.
Collapse
|
7
|
Abstract
Fifty-nine child and adolescent psychotic patients (mean onset age 13.9, range 7-17, 83% 13 + years) had history and outcome studied using diagnoses confirmed at follow-up after 1 to 16 years (mean, 5 years). There were no differences in sex ratio, socioeconomic status, age of onset, and symptoms, but bipolar patients (N = 23) were often misdiagnosed as schizophrenic, had a better outcome, and a 50% homotypic family history. Schizophrenic subjects (N = 30) were more abnormal premorbidly, and only 17% were well at follow-up. Schizoaffective disorder was unreliable, infrequent, and more severe. Premorbid adjustment and IQ were the best predictors of outcome. Differences from the adult disorders were only quantitative. Careful follow-up of psychotic patients is needed to detect diagnostic errors.
Collapse
Affiliation(s)
- J S Werry
- School of Medicine, University of Auckland, New Zealand
| | | | | |
Collapse
|
8
|
Abstract
The comorbidity between attention deficit disorder (ADD) and anxiety and/or depressive disorders was examined in the children of parents with panic disorder, major depressive disorder, or with no diagnosis. A child received a diagnosis by a self-report, parent report, and by consensus, using a best estimate procedure. The prevalence rates of ADD were significantly greater in offspring of parents with depressive and panic disorder by the parents' report and in children of depressed parents by consensus. A significant relationship between ADD and anxiety and/or depression was found for parent, child, and consensus diagnoses. Higher rates of ADD were reported by children (1% versus 13%), parents (8% versus 31%), and in the consensus diagnoses (13% versus 29%) when anxiety and/or depression was present. These results suggest that in children referred for evaluation of ADD, the possibility of a primary anxiety or depressive disorder should be considered.
Collapse
Affiliation(s)
- J M McClellan
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle
| | | | | | | |
Collapse
|