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Studying phenotypic and genetic characteristics of age at onset (AAO) and polarity at onset (PAO) in bipolar disorder can provide new insights into disease pathology and facilitate the development of screening tools.
Aims
To examine the genetic architecture of AAO and PAO and their association with bipolar disorder disease characteristics.
Method
Genome-wide association studies (GWASs) and polygenic score (PGS) analyses of AAO (n = 12 977) and PAO (n = 6773) were conducted in patients with bipolar disorder from 34 cohorts and a replication sample (n = 2237). The association of onset with disease characteristics was investigated in two of these cohorts.
Results
Earlier AAO was associated with a higher probability of psychotic symptoms, suicidality, lower educational attainment, not living together and fewer episodes. Depressive onset correlated with suicidality and manic onset correlated with delusions and manic episodes. Systematic differences in AAO between cohorts and continents of origin were observed. This was also reflected in single-nucleotide variant-based heritability estimates, with higher heritabilities for stricter onset definitions. Increased PGS for autism spectrum disorder (β = −0.34 years, s.e. = 0.08), major depression (β = −0.34 years, s.e. = 0.08), schizophrenia (β = −0.39 years, s.e. = 0.08), and educational attainment (β = −0.31 years, s.e. = 0.08) were associated with an earlier AAO. The AAO GWAS identified one significant locus, but this finding did not replicate. Neither GWAS nor PGS analyses yielded significant associations with PAO.
Conclusions
AAO and PAO are associated with indicators of bipolar disorder severity. Individuals with an earlier onset show an increased polygenic liability for a broad spectrum of psychiatric traits. Systematic differences in AAO across cohorts, continents and phenotype definitions introduce significant heterogeneity, affecting analyses.
Citizenship as Foundation of Rights explores the nature and meaning of American citizenship and the rights flowing from citizenship in the context of current debates around politics, including immigration. The book explains the sources of citizenship rights in the Constitution and focuses on three key citizenship rights - the right to vote, the right to employment, and the right to travel in the US. It explains why those rights are fundamental and how national identification systems and ID requirements to vote, work and travel undermine the fundamental citizen rights. Richard Sobel analyzes how protecting citizens' rights preserves them for future generations of citizens and aspiring citizens here. No other book offers such a clarification of fundamental citizen rights and explains how ID schemes contradict and undermine the constitutional rights of American citizenship.
Because voter-identification laws discourage voter turnout,particularly among identifiable minority groups, theirimplementation abridges a fundamental constitutional right. The U.S.Constitution includes a little-known remedy for denying or abridgingthe right to vote that reduces a state's congressionalrepresentation in proportion to the extent of the abridgements.