Exposome and Trans-syndromal Developmental Trajectories Toward Psychosis.
Exposome and Trans-syndromal Developmental Trajectories Toward Psychosis.
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暴露组与走向精神病的跨综合征发展轨迹
DOI：
10.1016/j.bpsgos.2022.05.001
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发表时间：
2022-07
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--
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产前阶段、幼儿期和青春期被视为大脑和行为发育的敏感期，在此期间，环境暴露可能对心理健康产生长期影响。精神病性谱系障碍（PSD）是一种发育性障碍，在被确诊为完全型PSD之前很久，往往就会表现出非特异性的临床表现。遗传因素只能部分解释PSD。多种生命早期的环境暴露与PSD有关。在这篇综述中，我们描述了暴露组的概念框架及其与发育队列及其他方面的PSD研究的相关性，并讨论了该领域在试图从研究环境（从“因为灯下亮所以在灯下找”的意义上来说）转向对环境及其对PSD的贡献进行更全面评估时面临的关键挑战。然后我们建议，该领域应致力于通过关注年轻队列的发育视角以及使用环境的多层次表型分析来研究PSD的环境根源，采用一个包含环境的动态复杂性且承认累加和交互环境暴露以及基因组影响的暴露组框架。此外，我们强调在研究暴露组对精神病理学的影响时需要有发育视角，接受儿童/青少年精神病理学的非特异性，并鼓励对跨综合征表现的研究，将研究范式从分类结果（例如精神分裂症）转变，并超越临床环境去研究风险和适应力的轨迹。
The prenatal period, early childhood, and adolescence are considered sensitive periods for brain and behavior development, when environmental exposures may have long-lasting effects on mental health. Psychosis spectrum disorder (PSD) is a developmental disorder that often manifests with nonspecific clinical presentations long before full-blown PSD is diagnosed. Genetic factors only partly explain PSD. Multiple early-life environmental exposures are associated with PSD. In this review, we describe the conceptual framework of the exposome and its relevance to PSD research in developmental cohorts and beyond and discuss key challenges for the field as it attempts to move beyond studying environment (in the sense of “searching under the lamppost because this is where the light is”) to a more comprehensive assessment of environment and its contribution to PSD. We then suggest that the field should aspire to studying environmental origins of PSD through a developmental lens focusing on young cohorts and using multilevel phenotyping of environment, adopting an exposome framework that embraces the dynamic complex nature of environment and acknowledges the effect of additive and interactive environmental exposures alongside the genome. Furthermore, we highlight the need for a developmental perspective when studying exposome effects on psychopathology, accepting the nonspecificity of child/adolescent psychopathology and encouraging the study of trans-syndromal manifestations, shifting the research paradigm from categorical outcomes (e.g., schizophrenia) and going beyond clinical settings to investigate trajectories of risk and resilience.
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