Cieslak Kristina, Pato Michelle, Buckley Peter, Pato Carlos, Sobell Janet L, Medeiros Helena, Zhao Yuan, Ahn Hongshik, Malaspina Dolores
Department of Psychiatry, New York University School of Medicine, Social, and Psychiatric Initiative (InSPIRES), New York.
Department of Psychiatry, Keck School of Medicine of USC, Los Angeles, California.
Am J Med Genet B Neuropsychiatr Genet. 2016 Jun;171(4):506-12. doi: 10.1002/ajmg.b.32350. Epub 2015 Jul 29.
Approximately three million individuals in the United States sustain traumatic brain injury (TBI) every year, with documented impact on a range of neurological and psychiatric disturbances including mania, depression, and psychosis. Identification of subsets of individuals that may demonstrate increased propensity for posttraumatic symptoms and who may share genetic vulnerabilities for gene-environment interactions can enhance efforts to understand, predict, and prevent these phenomena. A sample of 11,489 cases from the Genomic Psychiatry Cohort (GPC), a NIMH-managed data repository for the investigation of schizophrenia and bipolar disorder, was used for this study. Cases were excluded if TBI was deemed causal to their mental illness. A k-means clustering algorithm was used to probe differences between schizophrenia and bipolar disorder associated with variables including onset age, hallucinations, delusions, head injury, and TBI. Cases were separated into an optimum number of seven clusters, with two clusters including all cases with brain injury. Bipolar disorder with psychosis and TBI were significantly correlated in one cluster in which 72% of cases were male and 99.2% sustained head injury. This cluster also carried the longest average period of unconsciousness. This study demonstrates an association of TBI with psychosis in a subset of bipolar cases, suggesting that traumatic stressors may have the ability to impact gene expression in a vulnerable population, and/or there is a heightened occurrence of TBI in individuals with underlying psychosis. Further studies should more closely examine the interplay between genetic variation in bipolar disorder and susceptibility to psychosis following TBI. © 2015 Wiley Periodicals, Inc.
在美国，每年约有300万人遭受创伤性脑损伤（TBI），这已被证明会对一系列神经和精神障碍产生影响，包括躁狂症、抑郁症和精神病。识别出可能表现出创伤后症状倾向增加且可能在基因 - 环境相互作用方面存在共同遗传易感性的个体亚组，有助于加强对这些现象的理解、预测和预防。本研究使用了来自基因组精神病学队列（GPC）的11489例样本，GPC是美国国立精神卫生研究所（NIMH）管理的用于研究精神分裂症和双相情感障碍的数据储存库。如果创伤性脑损伤被认为是导致其精神疾病的原因，则将这些病例排除。使用k均值聚类算法来探究精神分裂症和双相情感障碍之间与发病年龄、幻觉、妄想、头部受伤和创伤性脑损伤等变量相关的差异。病例被分为最佳数量的七个聚类，其中两个聚类包含所有有脑损伤的病例。患有精神病和创伤性脑损伤的双相情感障碍在一个聚类中显著相关，该聚类中72%的病例为男性，99.2%曾遭受头部受伤。这个聚类还具有最长的平均昏迷期。这项研究表明，在一部分双相情感障碍病例中，创伤性脑损伤与精神病有关联，这表明创伤性应激源可能有能力影响易感人群的基因表达，和/或在患有潜在精神病的个体中创伤性脑损伤的发生率更高。进一步的研究应更密切地检查双相情感障碍的基因变异与创伤性脑损伤后精神病易感性之间的相互作用。© 2015威利期刊公司。
