Dr Salvador Miret IRBlleida, 06/06/2007

Transcription

1 IDENTIFICACIÓ DE GENOTIPS DE RISC PER A L ESQUIZOFRÈNIA I ALTRES PSICOSIS: REDEFINICIÓ PSICOPATOLÒGICA DELS FENOTIPS I APROXIMACIÓ ALS MODELS ETIOPATOGÈNICS ACTUALS Dr Salvador Miret IRBlleida, 06/06/2007 Dra. L. Fañanás (U. Antropologia, Dpt de Biologia Animal, Fac. de Biologia. UB) Dra. R. Miró (Fac. de Medicina. UAB) La Marató de TV-3 (014430/31)

2 SCHIZOPHRENIA SCHIZOPHRENIA: : DIAGNOSTIC CRITERIA (DSM( DSM-IV-TR). TR).- A) Characteristic symptoms: Two or more of the following, each present for a significant portion of time during a one-month period (or less, if successfully treated) delusions hallucinations disorganized speech (e.g., frequent derailment or incoherence) grossly disorganized behavior (e.g. dressing inappropriately, crying frequently) or catatonic behavior negative symptoms, i.e., affective flattening (lack or decline in emotional response), alogia (lack or decline in speech), or avolition (lack or decline in motivation). B) Social/occupational dysfunction: For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care, are markedly below the level achieved prior to the onset. C) Duration: pervasive developmental disorder are present. Additionally a diagnosis of schizophrenia is excluded if the symptoms are the direct result of a substance (e.g., abuse of a drug, medication) or a general medical condition. Continuous signs of the disturbance persist for at least six months. This six-month period must include at least one month of symptoms (or less, if successfully treated) that meet Criterion A. Additional criteria (D, E and F) are also given that exclude a diagnosis of schizophrenia if symptoms of mood disorder or schizoaffective disorder

3 ESTRUCTURA DIMENSIONAL DE LES PSICOSIS

4 FASES DE LA MALALTIA: CONCEPTES DE DUP I DUI DUI (Duration of Untreated Illness) DUP (Duration of Untreated Psychosis) Illness duration Psychotic episode duration Illness onset 1er síntoma signiicativo Episode onset 1er síntoma psicótico First treatment Inicio tratamiento FASE PREMÓRBIDA SÍNTOMAS PRODRÓMICOS SÍNTOMAS PSICÓTICOS PRIMER TRATAMIENTO SÍNTOMAS RESIDUALES DUP DUI t

5 GENÈTICA DE L ESQUIZOFRÈNIA MALALTIES GENÈTICAMENT COMPLEXES Fenotip Ambient Factors Epigenètics Representació Mental del Món Complexitat Simbòlica Genotip ESQUIZOFRÈNIA Complexitat clínicofenomenològica Complexitat Neurobiològica Complexitat Genètica Continuum? F i l o g è n i a N

6 E S Q U I Z O F R È N I A NEUROFISIOLÒGICS Eye-tracking dysfunction Cognitive ERPs ( P 300) NEUROANATÒMICS MarcadorsNEUROPSICOLÒGICS neurobiològics Esquizotípia V subst. grisa cortical V ventricles laterals V amígdala-hipocamp i tàlem Working memory Sensory motor gating BIOQUÍMICS DA ENDOFENOTIPS GENS CANDIDATS ALTRES Endocrins SNM MPA

7 DISSENY ESTUDI Ajuste Premórbido PAS (Premorbid Adjustment Scale, Cannon-Spoor 1982) Síndrome Deficitario SDS (Schedule for the Deficit Syndrome, Kirkpatrick 1989) Evaluación psicopatológica CASH (Comprehensive Assessment of Symptoms and History, Andreasen 1992) Entrevista Hª Clínica Datos sócio-demogràficos Otros datos clínicos Edad de inicio Tipo de inicio Funcionamiento (GAF) CASH 1 CASH 2 FASE PREMÓRBIDA SÍNTOMAS PRODRÓMICOS SÍNTOMAS PSICÓTICOS PRIMER TRATAMIENTO SÍNTOMAS RESIDUALES DUI DUP Determinación inicio enfermedad SOS (Symptom Onset Schizophrenia Inventory, Perkins 2000)

8 UNA PERSPECTIVA ETIOPATOGÈNICA NICA-CLÍNICO- EVOLUTIVA DE LES PSICOSIS ASPECTES FAMILIARS Desviación en el desarrollo neurocognitivo Fase de pródomos Prefase psicótica FACTORS PRONÒSTICS ,3 5.0 años 1.2 años 0.2 años. síntomas negativos síntomas positivos Disminución en el rendimiento cognitivo ( Factor de riesgo inespecífico?) primer signo de trastorno mental (negativo o inespecífico) primer síntoma positivo máximo síntomas positivos Ingreso FACTORS GENÈTICS FACTORS PERINATALS I DEL NEURODESENVOLUPAMENT ASPECTES PREMÒRBIDS ASPECTES PSICOPATOLÒGICS ASPECTES NEUROPSICOLÒGICS

9 DE LA RECERCA A L APLICACIÓ CLÍNICA I PREVENTIVA...

10 COMUNICACIONS DADES PRELIMINARS: CONGRESSOS INTERNACIONALS - Association analysis of serotonin HTR2A and dopamine DRD2 genes and schizophrenia. Fatjó-Vilas M, Arias B, Rosa A, Miret S, Domènech C, Arrufat F, Fañanás L. American Journal of Medical Genetics. Part B- Neuropsychiatric Genetics 122B (1): Vulnerability markers of schizophrenia: a familial analysis of neurological soft signs and minor physical anomalies. Fatjó-Vilas M, Miret S, Campanera S, Navarro ME, Muñoz MJ, Martín M, Tort V, Guerra A, Fañanás L. Schizophrenia Research 67 (1): , Suppl. S - A family-based association study of the BDNF and DRD3 genes in schizophrenia spectrum disorders. Fatjó-Vilas M, Rosa A, Arias B, Peralta V, Cuesta M, Miret S, Navarro ME, Martín M, Muñoz MJ, Fañanás L. American Journal of Medical Genetics. Part B- Neuropsychiatric Genetics 130B (1): Neurological soft signs in schizophrenia spectrum disorders as an intermediate phenotype: a family-based study. Fatjó-Vilas M, Miret S, Campanera S, Navarro ME, Martín M, Muñoz MJ, Guerra A, Illa JM, Miralles ML, Barrantes- Vidal N, Fañanás L. American Journal of Medical Genetics. Part B- Neuropsychiatric Genetics 130B (1): Neurocognitive deficits in healthy siblings of schizophrenic patients. Barrantes-Vidal N, Aguilera M, Fatjó-Vilas M, Muñoz MJ, Campanera S, Miret S, Navarro ME, Fañanás L. Schizophrenia Bulletin 31 (2): Theory of Mind and schizotypy profiles in schizophrenia-spectrum patients from a family based study: preliminary results. Miret S Fatjó-Vilas M, Aguilera M, Barrantes-Vidal N, Campanera S, Fañanás L. Schizophrenia Research 81: Suppl S - Neurocognitive functions in well parents of schizophrenia patients: verbal working memory deficits as a putative endophenotype of schizophrenia. Barrantes-Vidal N, Aguilera M, Fatjó-Vilas M, Campanera S, Muñoz MJ, Miret S, Guerra A, Fañanás L. Schizophrenia Research 81: Suppl S Neurological soft signs: is early-onset psychosis different from adult onset?. Fatjó-Vilas M, Miret S, Navarro ME, Guerra A, Martín M, Miralles ML, Illa JM, Fañanás L. Schizophrenia Research 81: Suppl S - Schizotypy profiles in parents of schizophrenia-spectrum patients and duration of untreated psychosis: preliminary results from a family based study. Fatjó-Vilas M, Miret S, Navarro ME, Martín M, Illa JM, Miralles ML, Barrantes- Vidal N, Fañanás L. Schizophrenia Research 81: Suppl. S - Development of cartoons for prompting self-recognition of psychotic-like experiences: a psychoeducational program for normal adolescents. Miret S, Barrantes-Vidal N, Fatjó-Vilas M, Abella F, Tolsà A, Fañanás L. Schizophrenia Research 86: Suppl - Impaired neurodevelopment and its impact on Duration of Untreated Psychosis. Fatjó-Vilas M, Barrantes-Vidal N, Miret S, Campanera S, Homs N, Navarro ME, Fañanás L. Schizophrenia Research 86: Suppl. - Relationship between DUP and DUI and clinical features in first episode of schizophrenia-spectrum disorders. Miret S, Fatjó-Vilas M, Barrantes-Vidal N, Peralta V, Fañanás L. Schizophrenia Research 86: Suppl - Association analysis of neuregulin 1 gene variants with schizophrenia in a Spanish family sample. Rosa A, Gardner M, Cuesta MJ, Peralta V, Fatjó-Vilas M, Navarro ME, Miret S, Fañanás L. American Journal of Medical Genetics. Part B- Neuropsychiatric Genetics 141B (7): Co-aggregation of cognitive, personality and genetic risk indicators of schizophrenia in a ongoing catalan family study. Barrantes-Vidal N, Fatjó-Vilas M, Aguilera M, Miret S, Navarro ME, Campanera S, Muñoz MJ, Fañanás L. European Psychiatry 22: S19 Suppl. 1

11 PUBLICACIONS Rosa A, Gardner M, Cuesta MJ, Peralta V, Fatjó-Vilas M, Miret S, Navarro ME, Comas D, Fañanás L, Family-based association study of neuregulin-1 gene and schizophrenia in a Spanish sample: results suggestive of association at the 3 end of the gene. Am J Med Genet B Neuropsychiatr Genet 144B (5) Miret S, Fatjó-Vilas M, Peralta V, Cuesta MJ, Campanera S, Fañanás L, (2007) Relevancia clínica de la duración de la psicosis y de la enfermedad no tratadas (DUP y DUI) en primeros episodios psicóticos: nuevas aportaciones. En La sfases tempranas de las psicosis. Vázquez-Barquero JL (eds) Masson (in press) Barrantes-Vidal N, Aguilera M, Campanera S, Fatjó-Vilas M, Guitart M, Miret S, Valero S, Fañanás L, (2007). Neurocognitive deficits as suitable endophenotypes in well siblings of schizophrenic patients. Schizophrenia Research (submitted) Fatjó-Vilas M, Gourion D, Campanera S, Navarro ME, Chayet M, Miret S, Krebs MO, Fañanás L, (2007)New evidences of early prenatal disturbances in schizophrenia: a dermatoglyphic study based on a European sample. Schizophrenia Research (submitted)

12 Salvador Miret Sílvia Campanera Montse Andreu Lourdes Fañanás Araceli Rosa Bárbara Arias Neus Barrantes-Vidal Sergi Papiol Mar Fatjó-Vilas Mari Aguilera Víctor Peralta Manuel J. Cuesta...aprendre a veure les formes velles amb ulls nous, enlloc de las formes noves amb ulls vells... GUSTAV MEYRINK