Post-partum psychosis and its association with bipolar disorder in the UK: a case-control study using polygenic risk scores
Post-partum psychosis and its association with bipolar disorder in the UK: a case-control study using polygenic risk scores
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DOI：
10.1016/s2215-0366(21)00253-4
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发表时间：
2021-12-01
影响因子：
64.3
通讯作者：
Jones, Ian
中科院分区：
文献类型：
--
作者：
Di Florio, Arianna;Yang, Jessica Mei Kay;Jones, Ian
背景150多年来，关于产后精神病状态的争议阻碍了研究，并给临床医生和妇女造成了相当大的困惑，并带来了潜在的负面后果。我们的目的是探讨遗传易感性在首发产后精神病妇女和双相情感障碍妇女之间存在差异的假设。方法在这项关于英国首发产后精神病和双相情感障碍的病例对照研究中，我们纳入了203名首发产后精神病妇女（定义为在分娩后6周内出现躁狂、混合型或精神病性抑郁发作，无精神病史）和1225名有双相情感障碍病史的经产妇。关于双相情感障碍女性的信息来自双相情感障碍研究网络数据库，参与者是通过英国各地的社区精神卫生团队以及媒体和患者支持组织招募的。所有人都使用半结构化的面对面精神病学访谈和精神病学病例记录审查进行评估。通过英国国家血液服务中心和1958年出生队列（英国国家儿童发育研究）从普通人群中招募了2809名妇女作为对照，并根据遗传血统与病例匹配。所有人都自称是白色种族，并从英国各地招募。多基因风险评分（PRS）是从精神分裂症、双相情感障碍和重性抑郁症的全基因组关联研究中发现的。Logistic回归分析用于模拟每个PRS对诊断的影响，并对遗传变异的10个主要成分调整RR和OR，以解释人群分层。（面试时的年龄中位数：46岁[IQR 37 - 55]）和1225例双相情感障碍女性患者在1991年9月至2013年5月期间招募了49岁[41 - 58]的受试者，以及2809名对照。产后首发精神病患者的双相情感障碍和精神分裂症的PRS与双相情感障碍患者相似，均显著高于对照组。与对照组相比，首次发病的产后精神病妇女双相情感障碍PRS的校正相对危险比（RR）为1.71（95%CI 1.56 - 1.86，p
Background For more than 150 years, controversy over the status of post-partum psychosis has hindered research and caused considerable confusion for clinicians and women, with potentially negative consequences. We aimed to explore the hypothesis that genetic vulnerability differs between women with first-onset post-partum psychosis and those with bipolar disorder more generally.Methods In this case-control study on first-onset post-partum psychosis and bipolar disorder in the UK, we included 203 women with first-onset post-partum psychosis (defined as a manic, mixed, or psychotic depression episode within 6 weeks of delivery without a psychiatric history) and 1225 parous women with a history of bipolar disorder. Information on women with bipolar disorder was obtained from the Bipolar Disorder Research Network database, and participants were recruited through screening community mental health teams across the UK and via the media and patient support organisations. All were assessed using a semistructured face-to-face psychiatric interview and psychiatric case note review. 2809 women from the general population were recruited via the national UK Blood Services and the 1958 Birth Cohort (UK National Child Development Study) as controls and matched to cases according to genetic ancestry. All self reported their ethnicity as White and were recruited from across the UK. Polygenic risk scores (PRSs) were generated from discovery genome-wide association studies of schizophrenia, bipolar disorder, and major depression. Logistic regression was used to model the effect of each PRS on diagnosis, and the RRs and ORs presented were adjusted for ten principal components of genetic variation to account for population stratification.Findings 203 women with first-onset post-partum psychosis (median age at interview: 46 years [IQR 37-55]) and 1225 women with bipolar disorder (49 years [41-58]) were recruited between September, 1991, and May, 2013, as well as 2809 controls. Women with first-onset post-partum psychosis had similar bipolar disorder and schizophrenia PRSs to women with bipolar disorder, which were significantly higher than those of controls. When compared with controls, women with first-onset post-partum psychosis had an adjusted relative risk ratio (RR) for bipolar disorder PRSs of 1.71 (95% CI 1.56-1.86, p