Kendler K S, Walters E E, Neale M C, Kessler R C, Heath A C, Eaves L J
Department of Psychiatry, Medical College of Virginia/Virginia Commonwealth University, Richmond, USA.
Arch Gen Psychiatry. 1995 May;52(5):374-83. doi: 10.1001/archpsyc.1995.03950170048007.
Although prior family and twin studies have examined the relationship between the genetic and environmental risk factors for pairs of psychiatric disorders, the interrelationship between these classes of risk factors for a broad range of psychiatric disorders remains largely unknown.
An epidemiologic sample of 1030 female-female twin pairs with known zygosity, ascertained from the Virginia Twin Registry, were evaluated by a personal interview conducted by mental health professionals, assessing lifetime history of phobia, generalized anxiety disorder, panic disorder, bulimia nervosa, major depression, and alcoholism.
A multivariate twin analysis suggested the following. First, genetic, familial-environmental, and individual-specific environmental risk factors each cause a unique pattern of comorbidity among the six disorders. Second, genetic influences on these disorders are best explained by two factors, the first of which loads heavily on phobia, panic disorder, and bulimia nervosa and the second, on major depression and generalized anxiety disorder. Third, unlike other disorders, genetic influences on alcoholism are largely disorder specific. Fourth, familial-environmental influences on these disorders are best explained by a single factor that substantially influenced liability to bulimia nervosa only. Fifth, individual-specific environmental influences on the risk for these psychiatric disorders are best explained by a single factor, with highest loadings on generalized anxiety disorder and major depression and with large-disorder-specific loadings, especially on phobias, panic disorder, and alcoholism.
These results support the following hypotheses: First, each major risk factor domain (genes, family environment, and individual-specific environment) influences comorbidity between these disorders in a distinct manner. Second, genetic influences on these six disorders are neither highly specific nor highly nonspecific. Neither a model that contains a discrete set of genetic factors for each disorder nor a model in which all six disorders results from a single set of genes is well supported. Third, the anxiety disorders are not, from a genetic perspective, etiologically homogeneous. Fourth, most of the genetic factors that influence vulnerability to alcoholism in women do not alter the risk for development of other common psychiatric disorders. These results should be interpreted in the context of both the strengths and limitations of multivariate twin analysis.
尽管先前的家族和双胞胎研究已经考察了成对精神疾病的遗传和环境风险因素之间的关系，但这些类别风险因素在广泛精神疾病中的相互关系在很大程度上仍然未知。
从弗吉尼亚双胞胎登记处确定的1030对已知合子性的女性双胞胎组成的流行病学样本，由心理健康专业人员进行个人访谈评估，以了解恐惧症、广泛性焦虑症、惊恐障碍、神经性贪食症、重度抑郁症和酒精中毒的终生病史。
多变量双胞胎分析表明如下情况。第一，遗传、家庭环境和个体特异性环境风险因素各自导致六种疾病之间一种独特的共病模式。第二，对这些疾病的遗传影响最好由两个因素来解释，第一个因素在恐惧症、惊恐障碍和神经性贪食症上负荷很重，第二个因素在重度抑郁症和广泛性焦虑症上负荷很重。第三，与其他疾病不同，对酒精中毒的遗传影响在很大程度上是疾病特异性的。第四，对这些疾病的家庭环境影响最好由一个仅对神经性贪食症易感性有实质性影响的单一因素来解释。第五，对这些精神疾病风险的个体特异性环境影响最好由一个单一因素来解释，在广泛性焦虑症和重度抑郁症上负荷最高，并且有较大的疾病特异性负荷，尤其是在恐惧症、惊恐障碍和酒精中毒上。
这些结果支持以下假设：第一，每个主要风险因素领域（基因、家庭环境和个体特异性环境）以独特方式影响这些疾病之间的共病情况。第二，对这六种疾病的遗传影响既不是高度特异性的也不是高度非特异性的。既没有一个为每种疾病包含一组离散遗传因素的模型，也没有一个所有六种疾病都由一组单一基因导致的模型得到充分支持。第三，从遗传角度来看，焦虑症在病因学上并非同质。第四，大多数影响女性酒精中毒易感性的遗传因素不会改变其他常见精神疾病的发病风险。这些结果应在多变量双胞胎分析的优势和局限性的背景下进行解释。
