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Article The Familial Aggregation of Psychotic Symptoms in Bipolar Disorder Pedigrees
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Article The Familial Aggregation of Psychotic Symptoms in Bipolar Disorder Pedigrees

James B Potash, Virginia L Willour, Yen-Feng Chiu, Sylvia G Simpson, Dean F MacKinnon, Godfrey D Pearlson, J. Raymond DePaulo and Melvin G Mclnnis
The Science of Mental Health, pp.48-54
Routledge, 1
2001
DOI: 10.4324/9781315054308-6

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Abstract

Objective Symptomatic overlap between affective disorders and schizophrenia has long been noted. More recently, family and linkage studies have provided some evidence for overlapping genetic susceptibility between bipolar disorder and schizophrenia. If shared genes are responsible for the psychotic manifestations of both disorders, these genes may result in clustering of psychotic symptoms in some bipolar disorder pedigrees. The authors tested this hypothesis in families ascertained for a genetic study of bipolar disorder. Method Rates of psychotic symptoms— defined as hallucinations or delusions— during affective episodes were compared in families of 47 psychotic and 18 nonpsy-chotic probands with bipolar I disorder. The analysis included 202 first-degree relatives with major affective disorder. Results Significantly more families of psychotic probands than families of non-psychotic probands (64% versus 28%) contained at least one relative who had affective disorder with psychotic symptoms. Significantly more affectively ill relatives of psychotic probands than of nonpsy-chotic probands (34% versus 11%) had psychotic symptoms. An analysis of clustering of psychotic subjects across all families revealed significant familial aggregation. Clustering of psychosis was also apparent when only bipolar I disorder was considered the affected phenotype. Conclusions Psychotic bipolar disorder may delineate a subtype of value for genetic and biological investigations. Families with this subtype should be used to search for linkage in chromosomal regions 10p12-13, 13q32, 18p11.2, and 22q11-13, where susceptibility genes common to bipolar disorder and schizo-phrenia may reside. Putative schizophrenia-associated biological markers, such as abnormal evoked response, oculomotor, and neuroimaging measures, could similarly be explored in such families. (Am J Psychiatry 2001; 158:1258–1264) Symptomatic overlap between affective disorders and schizophrenia has long been noted. Even the psychotic, or “positive,” symptoms most closely identified with schizophrenia—Schneider’s first-rank symptoms—also occur in patients with affective disorder. This chapter demonstrates that hallucinations and delusions during affective episodes show familial aggregation in bipolar disorder pedigrees. It suggests the value of using the psychotic bipolar disorder subtype in genetic and biological investigations. Such investigations may inform the discussion about possible étiologie overlap between bipolar disorder and schizophrenia. The chapter assesses the familial aggregation of psychotic symptoms within bipolar disorder pedigrees to determine whether this feature may increase homogeneity and inform the discussion of possible overlap in genetic susceptibility to bipolar disorder and schizophrenia. Pearson’s chi-square analysis, Fisher’s exact test, and Student’s test were used to test differences between the psychotic and nonpsychotic proband groups on diagnostic, demographic, and clinical variables.
 Psychotic Symptoms Psychotic Manifestations Psychotic Affective Disorder Major Depression Schizoaffective Disorder Postcentral Gyrus Data Set Psychotic Bipolar Disorder Vice Versa Affective Episodes Generalized Estimating Equation Approach Symptomatic Overlap Bipolar Disorder D 2 Receptor Major Depressive Episodes Chromosomal Regions 10p12-13 Comorbid Panic Disorder Familial Aggregation Affective Disorder SADS Fisher’s Exact Test Major Affective Disorder Severity Indicators

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