Wilson D R
The Lewis Centre, Cincinnati, OH 45237, USA.
Br J Med Psychol. 1998 Dec;71(4):375-95. doi: 10.1111/j.2044-8341.1998.tb00999.x.
The reformulation of epidemiological prevalence rates as evolutionary frequency rates puts medical genetics within an explicit framework of Darwinian theory. Yet an enduring and still current assumption of genomic medicine is that genes associated with disease are necessarily maladapted. Indeed, it seems it could hardly be otherwise. However, evolutionary epidemiology has begun to uncover important and surprising counter-exemplary case-studies. Thus, the present aim is to first outline this emerging sub-discipline of 'evolutionary epidemiology'. Then, a major psychopathological syndrome--manic-depression--is examined in some detail within the purview of evolutionary epidemiology. Its medical genetics are those of an adaptive polymorphism in the human genome. Hence, genes associated with what is now a major public health problem accrued as they conferred selective advantage in phylogeny. Why should manic-depressive etiogenes have been selected? A preliminary anatomic-functional model, assembled from facts of human paleoneuropsychiatry, more adequately contextualises manic-depressive genomics and phenotypy. In this model, manic-depression finds its heuristic origins in a hierarchy of behavioural strategies stabilised in phylogeny and embedded at serial levels in the brain (Hawk-Dove ESS). A proportion of the population has variant genotypy which appears to have been favoured in social competition phylogenetically but express more pathogenic phenotypy in the current environment. The paper closes with a brief consideration of clinical practices and ethical issues as alternative considerations emerge with the syndrome recast in a more positive Darwinian light.
将流行病学患病率重新表述为进化频率，这使得医学遗传学处于达尔文理论的明确框架内。然而，基因组医学一个持久且至今仍然存在的假设是，与疾病相关的基因必然是适应不良的。的确，似乎很难有其他情况。然而，进化流行病学已经开始揭示重要且令人惊讶的反例研究。因此，当前的目标首先是概述“进化流行病学”这一新兴的子学科。然后，在进化流行病学的范围内，对一种主要的精神病理综合征——躁郁症——进行了详细研究。其医学遗传学是人类基因组中一种适应性多态性的遗传学。因此，与现在一个主要公共卫生问题相关的基因在系统发育过程中积累，是因为它们赋予了选择优势。为什么躁郁症的致病基因会被选择？一个由人类古神经精神病学事实拼凑而成的初步解剖功能模型，更充分地将躁郁症的基因组学和表型置于情境之中。在这个模型中，躁郁症在系统发育中稳定下来并在大脑中按序列层次嵌入的行为策略层次结构中找到了其启发式起源（鹰鸽ESS）。一部分人群具有变异的基因型，这些基因型在系统发育的社会竞争中似乎受到青睐，但在当前环境中表现出更具致病性的表型。随着该综合征以更积极的达尔文视角重新审视，替代考虑因素出现，本文最后简要考虑了临床实践和伦理问题。
