Incidence of Guillain-Barré Syndrome Rising As Zika Spreads

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MedicalResearch.com Interview with:

Dr. Kenneth C. Gorson, MD President Elect GBS|CIDP Foundation International Global Medical Advisory Board

Dr. Ken Gorson

Dr. Kenneth C. Gorson, MD
President Elect GBS|CIDP Foundation International Global Medical Advisory Board
Guillain-Barre syndrome (GBS)
Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)

Medical Research: What is Guillain-Barré Syndrome? What are the main symptoms?

Dr. Gorson: Guillain-Barré Syndrome (GBS) is an immune mediated disorder affecting the peripheral motor and sensory nerves and nerve roots, and is the most common cause of rapidly progressive generalized paralysis in western countries. It is characterized by acute or subacute, progressive, symmetrical limb weakness with distal numbness or tingling in the arms and legs, and reduced or absent deep tendon reflexes in previously healthy patients. Patients notice the sudden onset of difficulty walking, climbing stairs, carrying objects and impaired fine motor skills. Balance is impaired due to sensory loss or weakness and a minority of patients develop facial weakness, trouble speaking and swallowing, and double vision. Severely affected patients may require ventilator support due to respiratory muscle weakness. Symptoms worsen over days to weeks, and most patients reach a maximum deficit (nadir) by 4 weeks, followed by a plateau phase for weeks to months, and then a recovery phase over additional weeks to months. Approximately 80 percent of patients recover to walk with minimal or no residual symptoms or functional disability. Maximal improvement usually occurs by one year, but more severely affected patients may continue to observe subtle improvements for several years after symptom onset.

In approximately two thirds of affected patients there is some preceding triggering event, classically a viral syndrome manifest as a transient upper respiratory or gastrointestinal illness with fever that resolves uneventfully prior to the onset of the neuropathy. Current evidence indicates the pathophysiology of GBS is related to molecular mimicry, where the patient’s antibody response to the preceding infection interacts with a variety of antigens on peripheral nerve myelin or axons producing a generalized but multifocal inflammatory demyelinating process and associated axonal loss in some instances.

The diagnosis is established with nerve conduction studies and electromyography, which shows features indicative of a demyelinating neuropathy affecting multiple motor nerves in the arms and legs. The cerebrospinal fluid protein level is elevated without a cellular response (cyto-albuminological dissociation) in up to 80 percent of patients when performed in the first week of the illness.

Treatment is directed toward the immune response, and several large randomized controlled trials have demonstrated that intravenous immunoglobulin and plasma exchange hasten recovery, and both treatments have similar efficacy.

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Is the Evidence for the Anticoagulant Rivaroxaban Valid?

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MedicalResearch.com Interview with:

Dr. Deborah Cohen

Dr. Deborah Cohen

Dr. Deborah Cohen
Associate Editor BMJ
BMA House, Tavistock Square
London

Medical Research: What is the background for this study? What are the main findings?

Dr. Cohen: Anyone familiar with warfarin understands the critical role of INR values in determining the proper dose for warfarin patients. The INR value in an individual patient is the most important piece of information a doctor considers when determining the warfarin dose. If the doctor gives too little warfarin then the patient may be at undue risk of stroke; if too much, the patient may be at undue risk of a major bleed.

The BMJ investigation revealed that the INR device used to manage the ~7,000 warfarin patients in the ROCKET trial (which served as the basis for approval of the non-valvular atrial fibrillation indication) was defective.

As such – doctors were relying upon a defective device in determining the dose of the warfarin patients – which has a direct influence on the stroke and bleeding risk in that patient. Since this was a comparative trial – any deficiency in the performance of the comparator arm (warfarin) would skew the results in favour of the study drug (rivaroxaban).

Since INR directly influences strokes and bleeds – the primary efficacy and safety endpoints – it very much questions, if not undermines, the overall results of this trial.

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Internet Delivered Cognitive Behavior Therapy Helps Some With Body Dysmorphic Disorder

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Dr. Jesper Enander Department of Clinical Neuroscience Karolinska Institutet

Dr. Jesper Enander

MedicalResearch.com Interview with:
Dr. Jesper Enander
Department of Clinical Neuroscience
Karolinska Institutet

MedicalResearch: What is the background for this study?

Dr. Enander: Body dysmorphic disorder (BDD) is a common anxiety disorder affecting about 2% of the general population, and is associated with hospitalization, substance dependence and suicidality. The disorder is characterized by a intense preoccupation with perceived defects in physical appearance, despite looking perfectly normal. It is common for people with BDD to seek non-psychiatric care, such as dermatological treatment or plastic surgery, however, such treatments rarely work, and can even lead to a deterioration of symptoms.

The National Institute for Health and Clinical Excellence (NICE) in the UK recommends that patients with Body dysmorphic disorder should be offered cognitive behavior therapy (CBT), however, there is a gap between supply and demand of CBT. One way of increasing access to CBT is to deliver it using the Internet. In this randomized clinical trial we tested the efficacy of a Internet based CBT program for Body dysmorphic disorder called BDD-NET and compared it to supportive therapy.

MedicalResearch: What are the main findings?

Dr. Enander: Our study shows that BDD-NET was associated with large and significant improvements in  Body dysmorphic disorder symptom severity. 56% of those receiving BDD-NET were responders (defined as at least a 30% reduction in symptoms), compared to 13% of those receiving supportive therapy. At the six months follow-up, 39% of those who received BDD-NET no longer met diagnostic criteria for Body dysmorphic disorder. No serious adverse events were reported, and most participants were satisfied with BDD-NET, despite no face-to-face contact with a therapist, and deemed the treatment as highly acceptable.

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Sitting Time Raises Risk of Type II Diabetes

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MedicalResearch.com Interview with:
Julianne van der Berg  PhD candidate
Social Medicine
Universiteitssingel Maastricht
The Netherlands 

Medical Research: What is the background for this study? What are the main findings?

Response: The study investigated in data from The Maastricht Study, a large study in the Netherlands, associations of total duration and patterns of sedentary behavior with type 2 diabetes.
We show that participants with type 2 diabetes spent the most time of day sedentary, 26 min more than participants without diabetes.
Each additional hour of sedentary time was associated with a 22% increased risk of type 2 diabetes.
Important is that these results were independent of high-intensity physical activity.

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Some Tyrosine Kinase Inhibitors Risk Greater Cardiovascular Events

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MedicalResearch.com Interview with:

Jonathan Douxfils Pharm.D. - Ph.D. Research assistant Faculty of Medicine - Department of Pharmacy NAmur Research Institute for LIfe Sciences (NARILIS) Namur Thrombosis and Hemostasis Center (NTHC)

Dr. Jonathan Douxfils

Jonathan Douxfils Pharm.D. – Ph.D.
Research assistant
Faculty of Medicine – Department of Pharmacy
NAmur Research Institute for LIfe Sciences (NARILIS)
Namur Thrombosis and Hemostasis Center (NTHC)

Medical Research: What is the background for this study? What are the main findings?

Dr. Douxfils: We decided to perform this study based on the release of the FDA regarding the risk of arterial occlusive events associated with ponatinib. We then hypothesize that the risk was not only restricted to ponatinib but also to other TKIs. This study shows that dasatinib, nilotinib and ponatinib increase the risk of vascular occlusive events compared to imatinib.

Medical Research: What should clinicians and patients take away from your report?

Dr. Douxfils: We suggest that patients treated with these molecules should be more frequently monitored, i.e. by an intensive support of associated comorbidities. In addition, even if they appear to have a better efficacy in terms of molecular response, new generation TKIs does not improve the overall survival at one year.

As we have not access to individual data, it was impossible to clearly identify categories of patients for whom the risk of cardiovascular occlusive events is predominant. Therefore, the intensive monitoring proposed should be applied to all patients treated with these molecules. Regarding the choice of the therapy, the physician should certainly consider the goals of the treatment. For elderly patients, improving survival is the main objective and in this context, imatinib remains an excellent choice. For patients with a life expectancy greater than 10 years in whom we aim to achieve a deep molecular response to potentially reach a point of treatment cessation, dasatinib and nilotinib could be preferred. However, the choice of dasatinib or nilotinib as first-line treatments should involve a screening for potential risk factors such as diabetes, prior vascular occlusive events or any risk that could increase these adverse events.

For second- and third-line treatments, the choice of the treatment has to be based on mutational analysis, previous adverse events, and the medical condition of the patient. Thus, in case of intolerance or resistance, the switch to one of the other TKIs approved for first-line therapy is an option. If treatment failure still occurs, a more potent TKI, i.e. bosutinib, is preferred. Importantly, ponatinib is reserved to patients with the T315I mutation and must be avoided in patients with good prognosis.
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Wrestlers Face High Risk of Skin Infections

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MedicalResearch.com Interview with:

High School Wrestling Wikipedia

High School Wrestling
Wikipedia Image

Kurt Ashack
Fourth year medical student at Michigan State University, Michigan
Kyle Burton
University of Central Florida College of Medicine, Orlando, Florida

Medical Research: What is the background for this study? What are the main findings?

Response: Skin infections associated with high school athletics have been reported in literature since the late 20th century and while many skin infections are relatively minor, others can cause serious morbidity. Prior reports on skin infections among high school athletes have focused on specific sports or have evaluated relatively small numbers of athletes. No prior report has evaluated skin infections in a large national sample of United States (US) high school athletes across multiple sports.

During the study period, 474 skin infections were reported among 20,858,781 athlete exposures (AE); a rate of 2.27 infections per 100,000 AE. The largest number of skin infections occurred in wrestlers (73.6%), followed by boys’ football (17.9%) and boys’ basketball (1.9%). Baseball and swimming had much fewer cases. The most common infections were bacterial (60.6%), tinea (28.4%) and herpetic (5.2%) infections. Body parts most often affected were the head/face (25.3%), forearm (12.7%) and upper arm (8%). The average time for return to play was 3-6 days (45.5%). It was also interesting to note how many more infections there were in boys than girls. Girls’ volleyball had the most of girls’ sports, but all girl reports did not near the boy’s number.

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Video Interaction Project Improved School Readiness In Impoverished Children

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MedicalResearch.com Interview with:

Alan Mendelsohn, MD Associate professor, Departments of Pediatrics and Population Health

Dr. Alan Mendelsohn

Alan Mendelsohn, MD
Associate professor, Departments of Pediatrics and Population Health

Adriana Weisleder, PhD

Adriana Weisleder, PhD Research scientist, Department of Pediatrics NYU Langone Medical Center

Dr. Adriana Weislander

Research scientist,
Department of Pediatrics
NYU Langone Medical Center

Medical Research: What is the background for this study? What are the main findings?

Response: In the last decade, scientists have begun to understand the mechanisms by which poverty can cause changes in brain development that can lead to higher rates of behavior problems and lower educational achievement for disadvantaged children. This study shows that pediatric-based programs that promote reading aloud and play can help prevent these problems before they arise.

The Video Interaction Project (VIP) – the main program studied in the research – takes place at regular pediatric check-ups starting at birth. A trained parenting coach meets with the family at each visit and records the parent and child playing and reading together with materials provided by the program. The coach then reviews the video with the parent to identify and reinforce positive interactions and encourage strong parent-child relationships. The second intervention program, Building Blocks, is a lower-intensity option in which families receive parenting pamphlets and learning materials monthly by mail to facilitate reaching specific developmental goals.

The results of the three-year randomized-controlled trial showed notable benefits for children’s social and emotional development. Children of families who participated in the Video Interaction Project had better attention and play skills as toddlers and reduced hyperactivity and aggression at three years, compared to children in a control group. For the highest risk families, hyperactivity was reduced by more than half.  These findings are important because a child’s ability to control or regulate his or her behavior is a critical factor in their learning and success at school.

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Which Fruits and Vegetables Are Better For Lowering Blood Pressure?

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MedicalResearch.com Interview with:
Lea Borgi, MD
Joint Fellowship
Program in Nephrology
Brigham and Women’s/ Massachusetts General

Medical Research: What is the background for this study? What are the main findings?

Dr. Borgi: Hypertension is one of the most common diseases in the United States and in the world. It is a known risk factor for cardiovascular disease. Even when hypertension is well-controlled with anti-hypertensives, these individuals are at an increased cardiovascular risk. Therefore, a healthy lifestyle is critical for normotensive individuals. This usually includes dietary patterns. However, if we could restrict dietary patterns to specific foods, then we would be able to provide better advice to our patients.

In this study, we analyzed the association of fruits and vegetables with the incidence of hypertension. We were also interested in studying the change in consumption of fruits and vegetables over time and the incidence of hypertension. We used data from 3 large prospective cohort studies: the Nurses’ Health Study, the Nurses’ Health Study II and the Health Professional Follow-up study (total of 187,453 participants). Information about health and food intake was updated every 2 and 4 years, respectively.

We found that participants who consumed ≥4 servings/day of fruits (not including fruit juice) had a lower risk of developing hypertension (follow-up was more than 20 years), when compared to participants whose consumption was ≤4 servings/weeks (Hazard ratio=0.92; 95%CI= 0.87-0.97). However, the association of vegetable intake with hypertension was different; indeed, we found no significant association with a HR of 0.95(0.86-1.04).

To better understand these associations, we further analyzed individual fruits and vegetables with the incidence of hypertension. We found lower risks of developing hypertension when these individual fruits and vegetables were consumed ≥4 servings/week as compared to <1 serving/month: broccoli, carrots, tofu or soybeans, raisins and apples. In contrast, we found that eating more string beans or brussel sprouts was associated with an increased risk of hypertension with HRs of 1.11(1.05-1.17) and 1.23(1.04-1.46), respectively. In all of our analyses, we adjusted for potential cofounders (such as age, gender, body mass index and more).

Finally, we also found that increasing total fruit (but not total vegetable) consumption by ≥7servings/week in the preceding 8 years was associated with a lower risk of hypertension with a pooled HR 0.94(0.90-0.97).

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Improving Transfusion Practice May Reduce Mortality From Hemorrhage

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MedicalResearch.com Interview with:

Dr Ross Davenport PhD Post doctoral clinical academic working at the Royal London Hospital Queen Mary University of London

Dr. Ross Davenport

Dr Ross Davenport PhD
Post doctoral clinical academic working at the Royal London Hospital
Queen Mary University of London

MedicalResearch: What is the background for this study? What are the main findings?

Dr. Davenport: Bleeding is the leading cause of preventable death in trauma. Globally, bleeding following injury is estimated to be responsible for over two million deaths per year. Current treatment strategies focus on the rapid delivery of red blood cells, plasma and other clotting products. However, the logistics of providing the correct quantities in the right proportion during the first minutes and hours of emergency care can be extremely challenging.

Our UK NIHR-funded study, conducted at the Centre for Trauma Sciences – Queen Mary University of London, estimates that nearly 5,000 trauma patients sustain major haemorrhage in England and Wales each year and that one-third of those die. The research spotlights how delays in blood transfusion practices may contribute to this high death rate.

The rapid and consistent delivery of blood, plasma, platelets and other clotting products to trauma patients is essential to maintain clotting during haemorrhage, and in previous research from both civilian and military studies, has been shown to halve mortality. Overall, only two per cent of all patients with massive haemorrhage received what might be considered the optimal transfusion of a high dose of clotting products in conjunction with red blood cells during the first hour of arrival within the Emergency Department.

The study, published this week in the British Journal of Surgery, is the first to describe patterns of blood use and outcomes from major trauma haemorrhage on a national level. Looking at 22 hospitals in England and Wales, our research team studied 442 patients who had experienced major trauma haemorrhage as a result of their injuries.

Mortality from bleeding tended to occur early, with nearly two-thirds of all deaths in the first 24 hours. An unexpectedly high number of deaths (7.9 per cent) occurred once the patient left hospital, the reasons for which are unclear.

The average time to transfusion of red blood cells was longer than expected, at 41 minutes. Administration of specific blood components to aid with blood clotting such as plasma, platelets and cryoprecipitate was significantly delayed, on average 2-3 hours after admission.

The incidence of major haemorrhage increased markedly in patients over 65 years, who were twice as likely to suffer massive haemorrhage as a result of an injury compared to younger groups. The causes for this increased incidence were unclear and the researchers say further investigation is needed to examine the role of associated medical problems and prescribed medication. Transfusion procedures may also need to be adapted for older patients.

Study limitations include the data not being complete for all patients, such as timings of transfusions. The study was also undertaken at an early stage in national trauma network reorganization.

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Is Low Dose Radiation Exposure Really Harmful?

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MedicalResearch.com Interview with:
Jeffry A. Siegel, PhD
President & CEO, Nuclear Physics Enterprises, Marlton, NJ
Charles W. Pennington, MS, MBA
NAC International, Norcross, GA, Retired; Executive Nuclear Energy Consultant
Bill Sacks, PhD, MD
Emeritus Medical Officer, FDA Center for Devices and Radiological Health
Silver Spring, MD
James S. Welsh, MS, MD, FACRO
Department of Radiation Oncology
Stritch School of Medicine Loyola University Chicago, Maywood, IL

Medical Research: What is the background for this study? What are the main findings?

Response: The background is the falsity of the widespread claim that all ionizing (high energy) radiation is harmful regardless of how low the dose.  This claim is expressed in the official policies of almost all radiation regulatory agencies around the world, as well as in many scientific journal papers.  It has been responsible for a common fear of radiation (radiophobia) among the public and members of the medical profession, including even most radiologists and nuclear medicine physicians.

The radiophobia resulting from this false allegation has been instrumental in the forced evacuations of hundreds of thousands of people near nuclear energy plants at Chernobyl and Fukushima that have produced thousands of deaths from the evacuations themselves of sick and/or elderly people, from consequent suicides, alcoholism, heart attacks, and strokes, as well as other health destroying reactions to the loss of homes, possessions, jobs, and communities.

This erroneous belief has acted to prevent many people from getting needed CT scans and x-ray studies, and to prevent many parents from permitting their children to get such imaging studies, with consequences such as surgical explorations that might have been otherwise unnecessary and carry risks of injury and mortality, or such as the foregoing of treatment that would otherwise be health restoring.

This unfounded proclamation and its resultant radiophobia have acted as obstacles to the development of clean and sustainable nuclear energy, and have underlain widespread irresponsible propaganda by all sorts of would-be anti-nuclear gurus.  There are other harmful effects of this unwarranted contention, including severe limitations on funding for further research into the beneficial effects of low-dose radiation.

The main findings in this article are that the very scientists whose experimental work gave rise to this false claim in the 1940s – Hermann Muller and Curt Stern and their colleagues – in fact demonstrated the exact opposite, namely that below certain threshold radiation doses there were no harmful effects at all and possible beneficial effects.  Even more importantly, there were no scientists at the time who realized that Muller and Stern’s conclusions flew in the face of their actual experimental results.  Or at least there were none who were inclined to point out the falsity of Muller and Stern’s unwarranted conclusions, perhaps intimidated by Muller’s status as a Nobel Prize winner (1946, for his earlier work on radiation-caused mutations in fruit flies).

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Single Gene Rearrangement Uses Three Paths To Cause Rare Brain Tumor

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MedicalResearch.com Interview with:

Dr. Adam C. Resnick, Ph.D Assistant Professor of Neurosurgery Faculty, Abramson Cancer Center Director of Children's Brain Tumor Tissue Consortium Division of Neurosurgery Director, CHOP/PENN Department of Neurosurgery Brain Tumor Tissue BiorepositoryDirector for Neurosurgical Translational Research, Division of Neurosurgery Children's Hospital of Philadelphia

Dr. Adam Resnick

Dr. Adam C. Resnick, Ph.D
Assistant Professor of Neurosurgery
Faculty, Abramson Cancer Center
Director of Children’s Brain Tumor Tissue Consortium
Division of Neurosurgery
Director, CHOP/PENN Department of Neurosurgery Brain Tumor Tissue BiorepositoryDirector for Neurosurgical Translational Research, Division of Neurosurgery
Children’s Hospital of Philadelphia

 

Payal Jain, PhD Candidate Division of Neurosurgery, Children's Hospital of Philadelphia Department of Neurosurgery Cell and Molecular Biology Graduate Group Gene Therapy and Vaccines Program Perelman School of Medicine University of Pennsylvania Philadelphia, Pennsylvania

Payal Jain

Payal Jain, PhD Candidate
Division of Neurosurgery, Children’s Hospital of Philadelphia
Department of Neurosurgery
Cell and Molecular Biology Graduate Group
Gene Therapy and Vaccines Program
Perelman School of Medicine
University of Pennsylvania Philadelphia, Pennsylvania

 

Medical Research: What is the background for this study? What are the main findings?

Response: This study originates from our long-standing interest in studying pediatric low-grade gliomas (PLGGs), which are the most commonly diagnosed brain tumor in children. While several PLGGs have been found to harbor mutations/gene fusions driving the mitogen-associated protein kinase (MAPK) pathway leading to clinical trials testing MAPK inhibitors, these tumors remain poorly categorized and not enough is known about specific genetic mutations driving different tumor sub-types and the potential for specific targeted therapeutics.

Our current study encompasses analysis of the largest combined genomic dataset of pediatric low-grade gliomas samples.  In doing this we, identified the MYB-QKI gene fusion, a non-MAPK related event, as the common genetic event driving a rare PLGG sub-type, called angiocentric gliomas. We have reported a novel tri-partite mechanism by which MYB-QKI mediates its oncogenic effect, this being the first report of a single gene rearrangement utilizing three different paths to cause cancer.

  • First, this gene rearrangement activates MYB, which is a proto-oncogene that is normally not expressed in the developed brain.
  • Second, we found that the rearrangement leads to translocation of QKI-related enhancers close to MYB’s promoters, thereby driving MYB-QKI expression in these tumors. Furthermore, MYB-QKI can also regulate its expression in a positive feedback loop.
  • Third, the tumor suppressor activities of QKI are disrupted in MYB-QKI. Such collaboration of genetic and epigenetic dysregulation in a single genetic rearrangement has previously not been reported.

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Study Links Schizophrenia Genetic Risk with Psychopathology During Adolescence

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MedicalResearch.com Interview with:

Hannah J. Jones, PhD Centre for Academic Mental Health, School of Social and Community Medicine, 2Medical Research Council (MRC) Integrative Epidemiology Unit University of Bristol, Bristol, England

Dr. Hannah Jones

Hannah J. Jones, PhD
Centre for Academic Mental Health, School of Social and Community Medicine,
Medical Research Council (MRC) Integrative Epidemiology Unit
University of Bristol, Bristol, England

MedicalResearch: What is the background for this study? What are the main findings?

Dr. Jones: Schizophrenia is a highly heritable condition characterised by relatively diverse symptoms and frequent comorbid disorders. However, at present we don’t know how genetic risk for schizophrenia is expressed in children/adolescents in the general population.

To investigate this, we studied data from individuals within the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort which consists of approximately 14,000 children born to women living in the former Avon Health Authority area in England with an expected delivery date from April 1, 1991, to December 31, 1992.

We used genetic data from approximately 5,000 ALSPAC children and measures from adolescence relating to psychopathology to determine whether genetic risk for schizophrenia is associated with variation in psychotic experiences (e.g. delusions, hallucinations), negative symptoms (e.g. apathy, withdrawal), depressive disorder and anxiety disorder during this developmental period.

We derived a score of genetic risk for schizophrenia in each individual within our study. This score is normally distributed such that most people have some genetic risk and a few people have very high or very low genetic risk.

We found very weak evidence of an association between genetic risk for schizophrenia and psychotic experiences in adolescence and no evidence of an association with depressive disorder. However, we found strong evidence of association between genetic risk for schizophrenia and negative symptoms and anxiety disorder.  Continue reading

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