Læknablaðið : fylgirit - 01.08.2003, Blaðsíða 12

■ ABSTRACTS / 27TH NORDIC PSYCHIATRIC CONGRESS
soni, Ómar Hjaltasoni, Helgi Jónsson1, Vala G. Guðnadóttir2, Elsa Guðmundsdóttir^,
Brynjólfur Ingvarsson^, Andrés Ingason2, Sigmundur Sigfússon^, Hrönn Harðardóttir1,
Jeffrey R. Gulcher2, Kári Stefánsson2
• Division of Psychiatry, Landspítali University Hospital, Reykjavík Iceland. 2deCode
Genetics, Sturlugötu 8, 101 Reykjavfk, Iceland. ^Department of Psychiatry, Akureyri
Hospital, Iceland.
Seven schizophrenia susceptibility genes have been reported re-
cently. These genes are Neuregulin 1 (NRGl), G72, D-aminoacid
oxidase (DAAO), dysbindin (DTNBPl), G-protein signalling-4
(RGS4), proline dehydrogenase (PRODH) and catechol-O-
methyltransferase (COMT).
Replication studies include the NRGl at risk haplotype being
found in excess in Scottish schizophrenia patients as well as in
Icelandic patients. In some instances replication studies have found
other at-risk haplotypes within the same gene or have failed to find
a significant association. NRG 1 promotes neuronal migration and
cellular differentiation as well as modulating synaptic plasticity and
thus has a clear role in neurodevelopment. NRG 1 is expressed at
synapses in the central nervous system and elsewhere. In common
with the other genes NRGl has an important role in the expression
and activation of neurotransmitter receptors, including glutamate
receptors.
A behavioural phenotype that overlaps with mouse models for
schizophrenia is demonstrated by mutant mice heterozygous for
either NRG 1 or its receptor ErbB4. NRGl hypomorphs also have
fewer functional NMDA receptors than wild type mice. Abnorma-
lities of sensorimotor gating have also been reported with inacti-
vated PRODH. With the possible exception of COMT a clear func-
tional polymorphism has not been demonstrated. Single SNP's are
rarely found to be highly significantly associated with the risk for
schizophrenia. Thus associations are presently identified by haplo-
types.
Although the present findings are promising it is prudent to urge
caution and further research to establish unequivocal replications.
Attempts at replication may be confounded by the finding of diffe-
rent alleles or haplotypes. It is imperative to continue the search for
other schizophrenia susceptibility genes. The study of potential
endophenotypes as well as the overlap between schizophrenia and
bipolar disorders may provide further clues to the pathophysiology
of schizophrenia and related disorders.
Pl - 3 Thursday 14/8,10:00-10:30
Consultation-Liaison (C-L) psychiatry: An update with
clinical implications for general psychiatry
Ulrik Frcdrik Malt. Professor, Rikshospitalet, Psykosomatisk avdeling, NO-0027 Oslo,
Norway
u.f.malt@psykiatri. uio. no
C-L psychiatry has become a subspecialty within psychiatry in the
US, but not in European countries. C-L psychiatry is important for
recognition and acceptance of psychiatry among somatic colleagues
and in the society as such, but requires knowledge of psychology and
medicine in addition to psychiatric experience and clinical wisdom.
Psychiatric interventions may improve psychiatric symptoms in
the medically ill. Prophylactic intervention may reduce the risk of
developing depression in somatic treatments. However, uncritical
application of psychotherapy to medically ill patients may worsen the
prognosis of the somatic disorder. Nevertheless, C-L research shows
that general psychiatrists often recommend psychotherapy for ideo-
logical reasons or choose treatment based on personal preference.
Ongoing studies show that temporal brain dysfunctions (PET,
EEG, qEEG, ERP) may present as regular chronic psychiatric dis-
orders (e.g. dysthymia). Psychiatrists may falsely label the patients
as “treatment-resistant” or suffering from an “unstable personality
disorder” requiring long-term psychotherapeutic treatment.
In particular bipolar II disorders may be referred to somatic
hospitals with psychosomatic complaints only (e.g. functional
dyspepsia, chronic fatigue, “burn-out”). Co-morbid anxiety may
preclude correct diagnosis and treatment. Panic disorder may pre-
sent as fibromyalgia.
Classic conditioning may lead to chronic and functional incapa-
citating somatic complaints without somatic findings and lack of
ongoing psychosocial conflicts or problems. But classic conditioning
may also be used to enhance the effect of somatic treatment (e.g.
cancer treatment).
The lack of medical knowledge among many psychiatrists may
hamper adequate diagnosis and treatment of psychiatric disorders
and represent a long-term threat to psychiatry as such.
Pl — 4 Friday 15/8, 09:00-9:30
Controversies in the aetiology of schizophrenia
Robin M. Murray, Professor of Psychiatry, Box No 63, Institute of Psychiatry, De
Crespigny Park, London SE5 8AF
robin.murray@iop.kcl.ac.uk
This paper will discuss whether research into schizophrenia has
now reached a sufficient level of maturity to allow us to leave
behind the ideological debates of the past. A model will be pro-
posed which encompasses the importance of both biological and
social factors, and integrates factors as disparate as susceptibility
genes and social discrimination.
Pl - 5 Friday 15/8, 09:30-10:00
The pathogenesis of borderline pathology
John Livesley, Professor, Department of Psychiatry, University of British Columbia,
2250 Wesbrook Mall, Vancouver, BC, Canada, V6T1W6
The evidence suggests that borderline palhology is influenced by a
complex interaction of biological and psychosocial factors. Genetic
and environmental factors contributing to the development of
borderline personality disorder will be discussed. It will be argued
that behavioral-genetic studies suggest that the traits delineating
the disorder have a strong heritable component and that the
covariation among these traits is influenced by genetic as opposed
to environmental factors. Psychosocial factors also exert a powerful
influence. Multiple forms of adversity seem to increase the risk of
developing borderline personality disorder. None is necessary and
sufficient to cause the condition and each form of adversity appears
12 L/EKNABLAÐIÐ / FYLGIRIT 48 2003/89