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Psychiatric disorders and type 2 diabetes mellitus (T2DM) are heritable, polygenic, and often comorbid conditions, yet knowledge about their potential shared familial risk is lacking. We used family designs and T2DM polygenic risk score (T2DM-PRS) to investigate the genetic associations between psychiatric disorders and T2DM.
Methods
We linked 659 906 individuals born in Denmark 1990–2000 to their parents, grandparents, and aunts/uncles using population-based registers. We compared rates of T2DM in relatives of children with and without a diagnosis of any or one of 11 specific psychiatric disorders, including neuropsychiatric and neurodevelopmental disorders, using Cox regression. In a genotyped sample (iPSYCH2015) of individuals born 1981–2008 (n = 134 403), we used logistic regression to estimate associations between a T2DM-PRS and these psychiatric disorders.
Results
Among 5 235 300 relative pairs, relatives of individuals with a psychiatric disorder had an increased risk for T2DM with stronger associations for closer relatives (parents:hazard ratio = 1.38, 95% confidence interval 1.35–1.42; grandparents: 1.14, 1.13–1.15; and aunts/uncles: 1.19, 1.16–1.22). In the genetic sample, one standard deviation increase in T2DM-PRS was associated with an increased risk for any psychiatric disorder (odds ratio = 1.11, 1.08–1.14). Both familial T2DM and T2DM-PRS were significantly associated with seven of 11 psychiatric disorders, most strongly with attention-deficit/hyperactivity disorder and conduct disorder, and inversely with anorexia nervosa.
Conclusions
Our findings of familial co-aggregation and higher T2DM polygenic liability associated with psychiatric disorders point toward shared familial risk. This suggests that part of the comorbidity is explained by shared familial risks. The underlying mechanisms still remain largely unknown and the contributions of genetics and environment need further investigation.
Numerous island species have gone extinct and many extant, but threatened, island endemics require ongoing monitoring of their conservation status. The small tree Vachellia anegadensis was formerly thought to occur only on the limestone island of Anegada in the British Virgin Islands and was categorized as Critically Endangered. However, in 2008 it was discovered on the volcanic island of Fallen Jerusalem, c. 35 km from Anegada, and in 2018 it was recategorized as Endangered. To inform conservation interventions, we examined the species’ distribution, genetic population structure, dependency on pollinators and preferred habitat, and documented any threats. We found V. anegadensis to be locally widespread on Anegada but uncommon on Fallen Jerusalem and established that geographical location does not predict genetic differentiation amongst populations. Vachellia anegadensis produces the highest number of seed pods when visited by animal pollinators, in particular Lepidoptera. Introduced animals and disturbance by humans appear to be the main threats to V. anegadensis, and in situ conservation is critical for the species’ long-term survival.
An association between psychiatric disorders in childhood and the later development of major depressive disorders (MDD) has been suggested. However, no prospective population-based cohort study has been able to directly compare the risks of MDD following a broad spectrum of child and adolescent psychiatric disorders.
Aims
To use a large, register-based cohort to establish whether or not psychiatric disorders in childhood lead to a higher risk of later MDD and, if so, which disorders are associated with the highest risks.
Objectives
To estimate and compare the risk of later MDD in children diagnosed with one of ten psychiatric disorders
Methods
Using Danish population-based registers all persons born in Denmark from 1990 through 2000 were identified and followed from their 5<sup>th</sup> birthday through 2012. Cumulative incidences and incidence rate ratios of MDD following each of ten exposure disorders were calculated
Results
We followed 960,026 persons, contributing 8,778,331 person-years. Among these 7,787 were diagnosed with MDD (incidence=1.7/1000 pyrs).
Diagnosis of any psychiatric disorder led to an absolute risk of MDD within eight years of 1.6% in males and 4.98% in females with early onset (ages 0-14) and 7.02% in males and 15.98% in females with late onset (ages 14-18).
For all groups, anxiety and eating disorders were associated with the highest risks of MDD.
Conclusions
Most disorders were associated with a significantly increased risk of later MDD and children with anxiety and eating disorders carry the greater risk. Future research should focus on common pathways between depression and other psychiatric disorders.
To estimate the risk of schizophrenia in adulthood among children and adolescents with ADHD compared to the background population.
Subjects/materials and methods:
Two hundred and eight youths with ADHD (183 boys; 25 girls) were followed prospectively. Diagnoses of schizophrenia were obtained from The Danish Psychiatric Central Register. The relative risk (RR) of schizophrenia for cases with ADHD, compared to the normal population, was calculated as risk ratios. Hazard ratios (HR's) by Cox regression were calculated in the predictor analyses.
Results:
Mean age for ADHD cases at follow-up was 31.1 years. Schizophrenia diagnoses were given to 3.8% of these cases. Compared to the general population, RR of schizophrenia in cases with ADHD was 4.3 (95% CI 1.9–8.57).
Discussion and conclusion:
This prospective follow-up study found children with ADHD to be at higher risk of later schizophrenia than controls. If replicated, these results warrant increased focus on the possible emergence symptoms of schizophrenia or schizophreniform psychosis during clinical follow-up of patients with ADHD.
In addition to problems with inattention and hyperactivity, children with ADHD show poor organizational skills required for managing time and materials in academic projects. Poor organizational skills are associated with academic underachievement as well as psychosocial, occupational and economic difficulties. Behavioral approaches for ADHD are effective in reducing hyperactivity symptoms and behavioral problems, but the effects on academic functioning have been modest. An increasing emphasis on treatment of organizational skills has emerged in recent years, as difficulties with time management and organization of materials tend to persist and increase with age despite medication and behavioral treatments.
Objectives
The primary objective is to investigate whether organizational skills training has a positive effect on organizational skills. The secondary and exploratory objectives are to investigate the effect on ADHD symptoms, adaptive functioning, academic performance and cognitive functions with a 24 weeks follow up.
Aims
Our goal is to provide cost-effective group-based treatment for children with ADHD and their parents. This will be the first randomized and controlled trial of organizational skills in Denmark.
Methods
Participants are included in two sites in Southern Denmark and will be randomized to Organizational skills training or treatment as usual. Organizational skills training will be provided in a group format for children and parents over 10 weeks.
Perspectives Given the strong association between organizational skills and functional outcome, it is very important to address organizational skills in children and adolescents with ADHD as organizational skills deficits hinder the academic performance of even gifted students with ADHD and increase with age.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Norovirus (NoV) infections occur very frequently yet are rarely diagnosed. In Denmark, NoV infections are not under surveillance. We aimed to collect and describe existing laboratory-based NoV data. National NoV laboratory data were collected for 2011–2018, including information on patient identification number, age and sex, requesting physician, analysis date and result. We defined positive patient-episodes by using a 30-day time window and performed descriptive and time series analysis. Diagnostic methods used were assessed through a survey. We identified 15 809 patient-episodes (11%) out of 142 648 tested patients with an increasing trend, 9366 in 2011 vs. 32 260 in 2018. This corresponded with a gradual introduction of polymerase chain reaction analysis in laboratories. The highest positivity rate was in patients aged <5 years (15%) or >85 years (17%). There was a large difference in test performance over five Danish geographical regions and a marked seasonal variation with peaks from December to February. This is the first analysis of national NoV laboratory data in Denmark. A future laboratory-based surveillance system may benefit public health measures by describing trend, burden and severity of seasons and possibly pinpoint hospital outbreaks.
Cannabis use and cannabis use disorder (CUD) is increased in patients with schizophrenia. It is important to establish if this is explained by non-causal factors, such as shared genetic vulnerability. We aimed to investigate whether the polygenic risk scores (PRS) for schizophrenia and other psychiatric disorders would predict CUD in controls, patients with schizophrenia, and patients with other psychiatric disorders.
Methods
We linked nationwide Danish registers and genetic information obtained from dried neonatal bloodspots in an observational analysis. We included people with schizophrenia, other psychiatric disorders, and controls. The exposures of interest were the PRS for schizophrenia, attention-deficit hyperactivity disorder (ADHD) autism spectrum disorder, and anorexia nervosa. The main outcome of interest was the diagnosis of CUD.
Results
The study included 88 637 individuals. PRS for schizophrenia did not predict CUD in controls [hazard ratio (HR) = 1.16, 95% CI 0.95–1.43 per standard-deviation increase in PRS, or HR = 1.47, 95% CI 0.72–3.00 comparing highest v. remaining decile], but PRS for ADHD did (HR = 1.27, 95% CI 1.08–1.50 per standard-deviation increase, or HR = 2.02, 95% CI 1.27–3.22 for the highest decile of PRS). Among cases with schizophrenia, the PRS for schizophrenia was associated with CUD. While CUD was a strong predictor of schizophrenia (HR = 4.91, 95% CI 4.36–5.53), the inclusion of various PRS did not appreciably alter this association.
Conclusion
The PRS for schizophrenia was not associated with CUD in controls or patients with other psychiatric disorders than schizophrenia. This speaks against the hypothesis that shared genetic vulnerability would explain the association between cannabis and schizophrenia.
Thomas Pynchon has so carefully guarded his privacy that relatively little is known for certain about his personal life. He evidently prefers to have readers focus on his fiction rather than on himself. His principled determination to avoid personal publicity has led to his routinely, but inaccurately, being described as a recluse, has sparked some bizarre rumors – that he was J. D. Salinger, or the Unabomber – and has provoked some spiteful and self-serving revelations. After defying the norms of celebrity culture for decades, Pynchon does seem to have let down his guard a bit: In 2004 he mocked his own reputation as a “reclusive author” by voicing a caricature of himself with a brown paper bag over his head in two episodes of The Simpsons, and in 2009 he narrated a promotional video for his novel Inherent Vice.
A famous image from The Crying of Lot 49 (1966) – in which Oedipa Maas compares the concealed communication of a suburban “sprawl of houses” to that of a “printed circuit” board (CL 24) – sets the tone for Thomas Pynchon’s writing on real estate as much as on computing. Both these fields have grown during Pynchon’s writing career; both have come to represent systems of control throughout his writing. In his latest novel, Bleeding Edge (2013), real estate and urban planning along with the integration of computing into personal and relational spaces reappear, two twenty-first-century digital natives (sons of the female protagonist Maxine Tarnow) merging the fields at a deeper level than Oedipa’s superficial pattern recognition had done. In Pynchon’s latest analysis of human agency, both urban planning and IT infrastructure remain central; they become either loci of control, contested spaces, or places of resistance, depending on who builds, buys, uses, or reclaims the city – be it real or virtual.
During the family reunion in Vineland (1990) that resolves the novel’s action, protagonist daughter Prairie Wheeler notes she is “[f]eeling totally familied out” (VL 374). After finishing Pynchon’s novels, especially those after Gravity’s Rainbow (1973), readers, too, could feel totally familied out. The adventures of a variety of families and family-like groups are important in each novel. However, this significance has been overlooked by scholarly readers – understandably, with so much else of academic interest to puzzle out in the books. Pynchon’s “decentered subjectivity,” well described by McHale, has caused readers to attend to unusual, “postmodern” aspects of Pynchon’s fiction at the expense of traditional aspects such as families. Yet the early novels feature children and neglectful parents, and in the novels after Gravity’s Rainbow, families become increasingly central and noticeable. The action from Vineland on often illustrates troubled families remedying their troubles. Families or family-like groups (such as cults) appear in all Pynchon’s main plots, even when family members are conspicuous by various forms of absence. Ongoing thematic concerns of Pynchon’s like alienation, the attraction to death, the perils of science, the power of history, and the limits of knowledge are expressed through parents and children. The following reviews the secondary literature on families in Pynchon, surveys specific instances of families, considers the significance of Pynchon’s families for his vision of American culture, and examines families in relation to pedagogy.
Thomas Pynchon has long had a place in the pantheon of Great American Writers. His status lies in the scope of his work – the number of publications, the prodigious detail and expansiveness of his topics – as well as the sheer quality of his writing, all of which quickly led to comparisons with Herman Melville and James Joyce. His writing is widely taught (as part of required literature survey courses at universities, for example), and remains the subject of many scholarly articles, dissertations, and monographs not just in the United States and other English-speaking countries, as one might expect, but also across Europe and Asia. According to the database of publications compiled on Vheissu.net, more than 400 doctoral dissertations have been accepted and more than 100 monographs and essay collections published on his writing already, mostly in English but also in other languages such as Spanish, Italian, and German, with a handful from publishers in Korea, China, and Japan. However, Pynchon is not just a canonical writer within scholarly research and teaching communities. Because of their scope and imaginative richness, his novels also have great appeal outside academia, and many devoted readers share their interest in his novels on websites dedicated to exploring his work. It is to help all such readers and students that Thomas Pynchon in Context brings together forty-four essays by some of the foremost specialists in the field, providing the most comprehensive resource yet published on the many ways in which his writing engages the wider world.
“Narratology” is a term coined by Tzvetan Todorov for the structuralist brand of narrative theory he and various Parisian colleagues started developing in the mid-1960s. “Classical narratology,” as it has now come to be called, primarily searched for narrative universals, but in the process it also provided critics with a handy toolkit for the study of any literary narrative. Thanks to the work of Gérard Genette, for instance, the concept of “focalization” now helps us to be precise when describing the (possibly varying) perspective on characters and events in a story. More recent work in “postclassical narratology” (a term proposed by David Herman in 1999) tries to overcome the flaws of its predecessor by paying attention “to the historicity and contextuality of modes of narrative representation as well as to its pragmatic function across various media, while research into narrative universals has been extended to cover narrative’s cognitive and epistemological functions.” As a result, the classical toolkit is also under scrutiny, but it does still keep the proliferation of new approaches to narrative together. If, for instance, the notion of the narrator has to be adjusted for the medium of film, that does not mean it simply goes out of the window.
Persons diagnosed with attention-deficit hyperactivity disorder (ADHD) have been found to have an increased risk of suicidal behaviour, but the pathway remains to be thoroughly explored.
Aims
To determine whether persons with ADHD are more likely to present with suicidal behaviour (i.e. suicide attempts and deaths by suicide) if they have a comorbid psychiatric disorder.
Method
Using nationwide registers covering the entire population of Denmark, this cohort study of 2.9 million individuals followed from 1 January 1995 until 31 December 2014, covers more than 46 million person-years. All persons aged ≥10 years with Danish-born parents were identified and persons with a diagnosis of ADHD were compared with persons without. Incidence rate ratios (IRRs) were calculated by Poisson regression, with adjustments for sociodemographics and parental suicidal behaviour.
Results
Persons with ADHD were followed for 164 113 person-years and 697 suicidal outcomes were observed. This group was found to have an IRR of suicidal behaviour of 4.7 (95% CI, 4.3–5.1) compared with those without ADHD. Persons with ADHD only had a 4.1-fold higher rate (95% CI, 3.5–4.7) when compared with those without any psychiatric diagnoses. For persons with ADHD and comorbid disorders the IRR was higher yet (IRR: 10.4; 95% CI, 9.5–11.4).
Conclusions
This study underlines the link between ADHD and an elevated rate of suicidal behaviour, which is significantly elevated by comorbid psychiatric disorders. In sum, these results suggest that persons with ADHD and comorbid psychiatric disorders are targets for suicide preventive interventions.