Prenatal and Perinatal Risk Factors and the Promise of Birth Cohort Studies: Origins of Obsessive-Compulsive Disorder.
Prenatal and Perinatal Risk Factors and the Promise of Birth Cohort Studies: Origins of Obsessive-Compulsive Disorder.
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产前和围产期危险因素以及出生队列研究的前景：强迫症的起源。
DOI：
10.1001/jamapsychiatry.2016.2092
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发表时间：
2016
期刊：
影响因子：
25.8
通讯作者：
Leckman,JamesF
中科院分区：
文献类型：
--
作者：
Fernandez,ThomasV;Leckman,JamesF
强迫症（OCD）是一种发育性神经精神疾病，通常在青春期或青年期发病。由于严重和慢性病程，它可能导致严重的终身残疾。与大多数复杂的神经精神疾病一样，强迫症的病因和病理生理机制尚不清楚。这限制了我们发现新的治疗方法和干预措施的能力，这些方法和干预措施将减轻全世界数百万患有这种疾病的人的痛苦。很明显，强迫症的风险与遗传有关，现代估计遗传率在40- 50%之间。[1]虽然研究较少，但环境风险因素（如感染，创伤）也被认为与强迫症有关，尽管因果关系不太确定。有很大的希望，继续研究遗传，表观遗传和环境的易感性，在强迫症将提供所需的见解，疾病的机制和危险因素，可以利用预防和intervention.In这个问题的JAMA精神病学，布兰德等人。2目前的数据从瑞典国家登记册调查，前瞻性地，围产期的危险因素，可能与随后的发展强迫症。这项研究的一个巨大优势，除了如此大规模的队列所提供的力量之外，是使用家庭内对照（在同一家庭中长大的全兄弟姐妹，他们对潜在风险因素的暴露程度不同）来减轻不可测量的环境和遗传混杂因素的影响，这可能是兄弟姐妹共有的。这项研究代表了强迫症研究领域的一个重大进展，在校正了未测量的混杂因素和测量的协变量后，确定了与疾病风险增加相关的几个因素。这些风险因素包括：母亲在怀孕期间每天吸烟至少10支，
Obsessive-compulsive disorder (OCD) is a developmental neuropsychiatric illness with onset typically during adolescence or young adulthood. It can cause substantial lifelong disability due to the severe and chronic course of the illness. As with most complex neuropsychiatric disorders, the causes and pathophysiological mechanisms underlying OCD are not well understood. This limits our ability to discover new treatments and interventions that will alleviate suffering for the millions of people worldwide with this disorder. It is clear that there is a genetic contribution to OCD risk, with modern estimates of heritability in the range of 40–50%. 1 While less often studied, environmental risk factors (eg infection, trauma) have also been suggested in OCD, although causal associations are less certain. There is great hope that continued study of genetic, epigenetic, and environmental susceptibility in OCD will provide needed insights into disease mechanisms and risk factors that can be leveraged for prevention and intervention.In this issue of JAMA Psychiatry, Brander et al. 2 present data from Swedish national registers to investigate, prospectively, a number of perinatal risk factors that might be associated with the subsequent development of OCD. A tremendous strength of this study, aside from the power afforded by such a sizable cohort, is the use of within-family controls (full siblings, raised in the same family, who had a different exposure to the potential risk factor) to mitigate the effect of unmeasured environmental and genetic confounders, which would presumably be shared by siblings. This study represents a significant advancement in the field of OCD research by identifying several factors that are associated with increased disease risk after correcting for unmeasured confounders and measured covariates. These risk factors include: maternal smoking of at least 10 cigarettes per day during pregnancy,