Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany; Department of Psychiatry and Psychotherapy, University Hospital Munich, Munich, Germany; International Max Planck Research School for Translational Psychiatry, Munich, Germany.
Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany; Department of Psychiatry and Psychotherapy, University Hospital Munich, Munich, Germany; Centro de Investigación Biomedica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.
J Affect Disord. 2022 Jan 1;296:532-540. doi: 10.1016/j.jad.2021.09.073. Epub 2021 Sep 28.
Bipolar disorder (BD) has a highly heterogeneous clinical course that is characterized by relapses and increased health care utilization in a significant fraction of patients. A thorough understanding of factors influencing illness course is essential for predicting disorder severity and developing targeted therapies.
We performed polygenic score analyses in four cohorts (N = 954) to test whether the genetic risk for BD, schizophrenia, or major depression is associated with a severe course of BD. We analyzed BD patients with a minimum illness duration of five years. The severity of the disease course was assessed by using the number of hospitalizations in a mental health facility and a composite measure of longitudinal illness severity (OPCRIT item 90).
Our analyses showed that higher polygenic scores for BD (β = 0.11, SE = 0.03, p = 1.17 × 10) and schizophrenia (β = 0.09, SE = 0.03, p = 4.24 × 10), but not for major depression, were associated with more hospitalizations. None of the investigated polygenic scores was associated with the composite measure of longitudinal illness severity (OPCRIT item 90).
We could not account for non-genetic influences on disease course. Our clinical sample contained more severe cases.
This study demonstrates that the genetic risk burden for psychiatric illness is associated with increased health care utilization, a proxy for disease severity, in BD patients. The findings are in line with previous observations made for patients diagnosed with schizophrenia or major depression. Therefore, in the future psychiatric disorder polygenic scores might become helpful for stratifying patients with high risk of a chronic manifestation and predicting disease course.
双相情感障碍（BD）具有高度异质性的临床病程，其特征是在很大一部分患者中反复发作和增加医疗保健利用。深入了解影响疾病过程的因素对于预测疾病严重程度和开发靶向治疗至关重要。
我们在四个队列（N=954）中进行了多基因评分分析，以测试 BD、精神分裂症或重度抑郁症的遗传风险是否与 BD 的严重病程相关。我们分析了至少患病五年的 BD 患者。通过精神卫生机构的住院次数和纵向疾病严重程度的综合衡量标准（OPCRIT 项目 90）来评估疾病严重程度。
我们的分析表明，BD（β=0.11，SE=0.03，p=1.17×10）和精神分裂症（β=0.09，SE=0.03，p=4.24×10）的多基因评分较高与更多的住院次数相关，但重度抑郁症的多基因评分则不然。调查的多基因评分均与纵向疾病严重程度的综合衡量标准（OPCRIT 项目 90）无关。
我们无法解释疾病过程中非遗传因素的影响。我们的临床样本包含了更严重的病例。
本研究表明，精神疾病的遗传风险负担与 BD 患者的医疗保健利用率增加有关，这是疾病严重程度的一个替代指标。这些发现与先前对精神分裂症或重度抑郁症患者的观察结果一致。因此，未来精神障碍多基因评分可能有助于对具有慢性表现高风险的患者进行分层，并预测疾病过程。
