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22q11 deletion syndrome is associated with high rates of psychiatric morbidity, especially schizophrenia. If common neurodevelopmental trajectories characterise 22q11 deletion syndrome and idiopathic schizophrenia, then similar ‘premorbid’ features would be predicted.
To define psychopathology in adolescents and young adults with 22q11 deletion syndrome.
Individuals with 22q11 deletion syndrome (n=25) and age- and IQ-matched comparison participants (n=25), along withtheir parents/carers, completed standardised semi-structured assessments.
Psychiatric disorders were more prevalent among those with the syndrome and included attention deficit, depression and anxiety; nearly half reported transient psychotic experiences. Inappropriate emotionality and disrupted social behaviour were also common. Poor functional adjustment was associated with schizotypal symptoms and was more marked in older individuals. Conclusions 22q11 deletion syndrome is associated with significant psychopathology prior to adulthood. Double the proportion expected to develop schizophrenia reported psychotic phenomena. These findings imply a continuum of developmental disruption in 22q11 deletion syndrome, associated with declining mental health in early adulthood.
Cognitive neuropsychiatry was recently defined (Halligan and David 2001) as a ‘systematic and theoretically driven approach to explain clinical psychopathologies in terms of deficits to normal cognitive mechanisms’. The aim of cognitive neuropsychiatry is to identify the neural substrates of cognitive mechanisms that, when impaired, may underlie the phenomenology of psychiatric disorder. Consequently, it is a quintessentially multidisciplinary endeavour, founded in both basic neuroscience and clinical psychiatry. The progress being made in identifying circumscribed brain circuits that are involved in specific cognitive tasks, with the aid of functional neuro-imaging techniques, is remarkable, yet relatively little discussion has been addressed to the issue of the genetic mechanisms that direct the development of these neurocognitive systems. There is increasing convergence between the identification of specific neural substrates and subjective experience, such as the recognition of certain emotions. The addition of genetics and developmental science to the research agenda will increase the power of the discipline to dissect aetiologies and pathological mechanisms.
Approaches to gene-finding in psychiatric research
Most psychiatric genetic research has focused on the hunt for genes that predispose to complex and heterogeneous clinical conditions, such as schizophrenia or manic depression (McGuffin et al. 2001). Additionally, human behavioural genetics has to date focused largely on the identification of genes that contribute to individual phenotypic variance in a trait (see Chapter 1 by Plomin).
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