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Bipolar disorder and schizophrenia: Risk factors for autism?

Posted on: July 14, 2012   by  John Cannell, MD

Bipolar disorder and schizophrenia: Risk factors for autism?

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Bipolar disorder, schizophrenia and autism directly affect the lives of tens of millions of people in the USA. Even if you are free of them, chances are that you know someone with one of the disorders.

Living in our world makes it easy to conclude that the incredible prevalence of these disorders is simply the way it has always been. However, substantial evidence indicates that all three disorders are rapidly increasing and that all three were rare two and a half centuries ago.

E. Fuller Torrey Invisible Plague: The Rise of Mental Illness from 1750 to the Present [Paperback]

Is it possible that one factor is at work in all three disorders? Dr. Patrick Sullivan of my alma mater, the UNC School of Medicine, and 12 colleagues from around the world collaborated on the largest study to date that links the three disorders.

Sullivan PF, Magnusson C, Reichenberg A, Boman M, Dalman C, Davidson M, Fruchter E, Hultman CM, Lundberg M, Långström N, Weiser M, Svensson AC, Lichtenstein P. Family History of Schizophrenia and Bipolar Disorder as Risk Factors for Autism; Family History of Psychosis as Risk Factor for ASD. Arch Gen Psychiatry. 2012 Jul 2:1-5. doi: 10.1001/archgenpsychiatry.2012.730. [Epub ahead of print]

Previous work has shown a common factor is at work in schizophrenia and bipolar disorder. The authors wanted to know if that factor is also at work in autism. Indeed that is just what they found, in over 30,000 patients, mainly in Sweden. In the largest of their three samples, the odds ratio was 2.6 for schizophrenia and 2.5 for bipolar disorder; meaning that if you have one of the disorders, your sibling is more likely afflicted with one of the other two disorders. “The presence of schizophrenia or bipolar disorder in first degree relatives was a consistent and significant risk factor for autism spectrum disorder in all three samples.”

They concluded, “Our findings indicate that autism, schizophrenia, and bipolar disorder share etiological risk factors.” The authors state this factor could be genetic, an environmental risk factor or a gene-environment interaction.

Of course, vitamin D is a premier candidate for a gene-environment interaction, as the vitamin D steroid interacts specifically with genes by turning them on or off. Moreover, the rise of these plagues over two and a half centuries correlates well with our moving indoors. (Imagine where you’d spend your daylight hours if you had no electricity.)

Is it possible that vitamin D deficiency is wreaking such devastation?

3 Responses to Bipolar disorder and schizophrenia: Risk factors for autism?

  1. Andre Tomlin

    Thanks for sharing this study John, it’s an interesting piece of research.

    Coincidentally, I blogged today about a study highlighting the links between autistic traits in childhood and psychotic experiences in adolescence: http://www.thementalelf.net/populations-and-settings/child-and-adolescent/childhood-autistic-traits-are-associated-with-psychotic-experiences-in-adolescence/

    I wasn’t aware until recently that autism was previously known as childhood schizophrenia until its introduction as a distinct diagnostic category in DSM-III in 1980. There’s clearly a long and no doubt complex relationship between the two conditions.

    Whether vitamin D deficiency is involved in the increased incidence of these mental health conditions is very much up for debate. For me, one important change in the last couple of hundred years is the increasing medicalisation of society. I’m not sure whether there was less mental illness in the 18th century, or if we simply have more diagnostic criteria and stigmatised compartments into which we can place people who are not ‘normal’.

    Cheers, Andre

    • Brant Cebulla

      Andre,
      How much research is there in this realm, that attempts to quantify the contribution of new diagnostic criteria toward incidence of mental illness vs a “true” outbreak in mental illness?

      Cheers,
      Brant

  2. Andre Tomlin

    Hi Brant,

    It’s not really my specific field of expertise. I look at a lot of mental health research as I run a blog that features around 5 articles each week, but this particular question about the incidence and prevalence of mental health conditions is not my strong point.

    There’s certainly a lot of research about the medicalisation of what you might call the milder mental health conditions, which 20 years ago may have been thought of as eccentric personality traits by most of us, but nowadays are often ‘diagnosed’ and ‘treated’ with medication.

    There are also numerous examples of drug companies ‘inventing’ new health conditions and then conveniently discovering revolutionary new treatments that can help patients (at a cost). It’s easy to be cynical!

    The huge debate over DSM-V that is ongoing at present is well worth delving into for anyone interested in this field. This opinion piece in the British Medical Journal is a good place to start:
    http://www.bmj.com/content/344/bmj.e3135/rr/584154

    Cheers, Andre

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