Etiologie en psychiatrie: embrasser la réalité de la causalité poly-génétique-environnementale de la maladie mentale

Aperçu: G.M.

Les résultats intrigants sur la causalité génétique et environnementale suggèrent un besoin de recadrer l'étiologie des troubles mentaux.

La génétique moléculaire montre que des milliers de variantes génétiques communes et rares contribuent à la maladie mentale. Des études épidémiologiques ont identifié des dizaines d'expositions environnementales associées à la psychopathologie. 

Les analyses intégratives de la co-causalité, y compris l'interaction génique-environnement et les interactions environnement-environnement, permettent de découvrir des types et mécanismes de causalité susceptibles de générer de nouveaux outils préventifs et thérapeutiques. 

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World Psychiatry. 2017 Jun;16(2):121-129. doi: 10.1002/wps.20436.

Etiology in psychiatry: embracing the reality of poly-gene-environmental causation of mental illness

Uher R¹, Zwicker A¹.

Author information

1

Departments of Psychiatry and Pathology, Dalhousie University, Halifax, B3H 2E2, Nova Scotia, Canada.

Abstract

Intriguing findings on genetic and environmental causation suggest a need to reframe the etiology of mental disorders. Molecular genetics shows that thousands of common and rare genetic variants contribute to mental illness. Epidemiological studies have identified dozens of environmental exposures that are associated with psychopathology. The effect of environment is likely conditional on genetic factors, resulting in gene-environment interactions. The impact of environmental factors also depends on previous exposures, resulting in environment-environment interactions. Most known genetic and environmental factors are shared across multiple mental disorders. Schizophrenia, bipolar disorder and major depressive disorder, in particular, are closely causally linked. Synthesis of findings from twin studies, molecular genetics and epidemiological research suggests that joint consideration of multiple genetic and environmental factors has much greater explanatory power than separate studies of genetic or environmental causation. Multi-factorial gene-environment interactions are likely to be a generic mechanism involved in the majority of cases of mental illness, which is only partially tapped by existing gene-environment studies. Future research may cut across psychiatric disorders and address poly-causation by considering multiple genetic and environmental measures across the life course with a specific focus on the first two decades of life. Integrative analyses of poly-causation including gene-environment and environment-environment interactions can realize the potential for discovering causal types and mechanisms that are likely to generate new preventive and therapeutic tools.

© 2017 World Psychiatric Association.

PMID:28498595

PMCID:PMC5428165   [Available on 2017-06-01]

DOI:10.1002/wps.20436

Prévalence de la psychopathologie chez les enfants de parents atteints de maladie mentale et/ou d'addiction

Aperçu: G.M.

Les enfants de parents avec une maladie mentale et / ou toxicomanes courent un risque élevé de développer eux-mêmes une maladie mentale.

Dans le monde, 15-23% des enfants vivent avec un parent atteint d'une maladie mentale. Ces enfants ont jusqu'à 50% de chances de développer une maladie mentale. Le trouble d'anxiété parentale confère aux enfants un risque plus spécifique de développer un trouble anxieux eux-mêmes, où les enfants de parents ayant d'autres maladies mentales courent un risque élevé d'une grande variété de maladies mentales. Bien que les interventions préventives chez les enfants de parents atteints de maladie mentale puissent réduire de 40% le risque de développement de problèmes, ces enfants ne sont actuellement pas identifiés automatiquement ou ne se voient pas proposer d'aide.  

Curr Opin Psychiatry. 2017 Apr 22. doi: 10.1097/YCO.0000000000000341.

Prevalence of psychopathology in children of parents with mental illness and/or addiction: an up to date narrative review

Leijdesdorff S¹, van Doesum K, Popma A, Klaassen R, van Amelsvoort T.

Author information

1

aDepartment of Psychiatry and Psychology, Maastricht University, Maastricht bMindfit, Zwolle cDepartment of Child and Adolescent Psychiatry, Duivendrecht dDepartment of Child and Adolescent Psychiatry, VU University Medical Center, Amsterdam, The Netherlands.

Abstract

PURPOSE OF REVIEW:

Children of parents with a mental illness and/or addiction are at high risk for developing a mental illness themselves. Parental mental illness is highly prevalent leading to a serious number of children at high risk. The aim of this review is to give an up-to-date overview of psychopathology in children of parents with various mental illnesses and/or addiction, based on recent literature.

RECENT FINDINGS:

Worldwide, 15-23% of children live with a parent with a mental illness. These children have up to 50% chance of developing a mental illness. Parental anxiety disorder sets children at a more specific risk for developing anxiety disorder themselves, where children of parents with other mental illnesses are at high risk of a large variety of mental illnesses. Although preventive interventions in children of mentally ill parents may decrease the risk of problem development by 40%; currently, these children are not automatically identified and offered help.

SUMMARY:

This knowledge should encourage mental health services to address the needs of these children which requires strong collaboration between Child and Adolescent Mental Health Services and Adult Mental Health Services. Directions for further research would be to include both parents, allow for comorbidity and to look deeper into a broader variety of mental illnesses such as autism and personality disorder other than borderline.

PMID: 28441171

DOI: 10.1097/YCO.0000000000000341