A New Kind of Twin Study and the Heritability Fraud

In my post on Psychology Today, "Scientific Fraud in the Nature versus Nurture Debate," I discussed the disturbing tendency of psychiatric researchers to use the term heritability as a synonym for genetic, which it certainly is not. The heritability statistic is a measure of phenotype, not genotype, meaning it is a measure of the final outcome of the influence of the interactions between genes and the environment on such things as certain personality characteristics or psychiatric symptoms.

The statistic is derived from twin studies in which fraternal and identical twins who were raised together are compared to each other and to those raised apart on various traits. It is not a measure of purely genetic influences but instead a measure of a mix of purely genetic influences plus gene-environment interactional influences. 

There is no way to tell how much of each is present in the statistic. The determination of heritability can also be manipulated in a number of ways, such as by setting the bar for saying that a symptom is present or absent at different levels.

Interestingly, a recent study employing a very different type of twin study has been getting a fair amount of press (Thalia C. Eley, Tom A. McAdams, Fruhling V. Rijsdijk, et. al., "The Intergenerational Transmission of Anxiety: A Children-of-Twins Study," American Journal of Psychiatry, 172 [7], pp. 630-637, 2015).

Rather than comparing twins with each other, the authors compared the children of twins with one another. The subjects were anxiety and a dimension of normal personality known as neuroticism - a measure of emotional reactivity. People with higher neuroticism scores tend to get more anxious and/or depressed in reaction to negative environmental stimuli, and remain dysregulated longer, than those with lower scores.

By comparing the extent to which correlations between children and their twin uncle/aunt (avuncular correlations) differ for monozygotic (identical) and dizygotic (fraternal) twin families, the authors were able to infer the extent to which genetic and environmental factors influence transmission from one generation to another. Children share a greater level of genetic influence with their uncle/aunt when in monozygotic families than when in dizygotic families.

Thus, if children resemble their uncle/aunt to a greater extent in monozygotic families than in dizygotic families, this implies a genetic influence on transmission of the trait of interest. In contrast, if these two sets of correlations are similar, and are significantly lower than the parent-child correlations, this is indicative of an environmental mode of transmission.

The results of the new study showed almost the opposite of the usual results of heritability studies on neuroticism: environmental factors came out very much more important than genetic ones! Living with one's parents was found to be far more influential than merely inheriting 50% of their genes.

It appeared that children and adolescents learned anxious behavior from their parents rather than inheriting a tendency towards it from their parents genetically.

Now, I must say that the authors used a statistical technique to come to their conclusion called "structural equation modeling"—of which I know absolutely nothing. So I am not able to say if the methodological techniques used in traditional twin studies yield more accurate results than those found in this type of study. This may, in fact, be a case of scientists being able to get the results they want to get through statistical manipulation of their study data.

And surely neuroticism must have some significant genetic component. Clearly, some people are naturally more high strung than others.

Nonetheless, I do know from the observation of blatantly obvious behavioral patterns within families and other social groups that anxiety can be highly contagious. Since as of now mental health professionals can't fix your genes but we can fix your relationships, I know on which factors therapists should focus the majority of their attention.

More Surprising Findings from the Psychiatry Literature

As we did on my posts of November 30, 2011 and October 2, 2012, it’s once again time to look over the highlights of the latest issues of my two favorite medical journals, Duh! and No Sh*t, Sherlock. 

As I pointed out in those posts, research dollars are very limited and therefore precious. Why waste good money trying to study new, cutting edge or controversial ideas that might turn out to be wrong, when we can study things that that are already thought to be true but have yet to be "proven"?  Such an approach increases the success rate of studies almost astronomically. And studies with positive results are far more likely to be published than those that come up negative.

So, we have a lot of academics weighing in with studies on the obvious. Literally weighing in. Since academic promotions are often based on the quantity of papers, rather than their quality, schools might measure faculty members' progress towards tenure by calculating the physical weight of the paper on which their authored articles have been written. 

If Albert Einstein had only published his two papers on relativity - which literally changed the entire field of physics forever - that obviously would not have been anywhere near enough for him to get tenure at most universities these days.

So here we go with more fantastic additions to our knowledge base.

 

Early Drinking Associated With Problem Drinking Later

MedPage Today (8/16, Petrochko) reports, "Students who started drinking and getting drunk at an early age were more likely to engage in frequent heavy drinking and associated problems by senior year of college," according to a study published online Aug. 15 in the journal Alcoholism: Clinical and Experimental Research. "A longitudinal analysis of incoming college freshmen showed a significant association not only between younger drinking age and heavy drinking, but also with difficulties in work and school, blackouts, vomiting, and other problems by senior year (P<0.001 for all)," researchers reported.

So self destructive behavior has its roots in childhood experiences, eh?  Someone please tell the psychoanalysts.

And on a related note:

Youth With Conduct Disorder More Likely to Abuse Substances

5/15/13.   A longitudinal study of youth with and without conduct disorder (CD) finds that the former are significantly more likely to abuse substances. The findings are published in the May Journal of the American Academy of Child and Adolescent Psychiatry. Researchers from the University of Colorado prospectively followed 1,165 community-dwelling adolescents without CD, 194 youth in the community with CD, and 268 youth who were in treatment for CD. They were re-interviewed during young adulthood, and self-reports on age of substance initiation for 10 substance classes were analyzed.

Gee, I wonder if family problems and adverse childhood environments lead to both antisocial behavior AND substance abuse? That just never occurred to me before. 

Depression, Mania In Bipolar Disorder Have Differential Social Adjustment Effects

1/23/12.  Medwire (1/23, Cowen) reports, "Results from a UK study show that depression and mania symptoms have specific and differential effects on social adjustment in patients with bipolar disorder (BD). Richard Morriss (University of Nottingham) and team found that depression symptoms have a negative effect on performance and interpersonal behavior, while mania symptoms increase interpersonal friction."

And to think that I used to be under the impression that other people would react to hyperactive, impulsive, hypersexual people in exactly the same way as they would to someone who doesn’t even want to get out of bed or have sex with someone lying naked in the bed next to them.

High Doses of Opioids May Impair Driving

Drivers taking 20 mg of morphine or more per day, or the equivalent, are up to 42% more likely to be involved in road trauma than drivers taking the lowest doses of opioids, according to a new study from the Keenan Research Center of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.

Higher doses of intoxicants lead to more impairment than lower doses?  Who knew?

Anger Due To Delusions May Explain Violent Behavior In Patients With Psychosis

In print and in its "Well" blog, the New York Times (3/11/13) reports that "a new study finds that anger, coupled with psychotic delusions, may be the most significant factor in violence committed by people with mental illness." Medwire (3/12, Piper) reports, "Anger due to delusions appears to be a key factor explaining violent behavior in patients with acute psychosis," according to the results of the 458-patient East London First Episode Psychosis Study published online March 6 in JAMA Psychiatry.  

So people with paranoid delusions that make them feel angry or threatened are more likely to become violent than when they are not experiencing those reactions. So are such people actually psychotic if they act just like everyone else would?

Handling Stress Poorly May Increase Long-Term Risk For Anxiety/Mood Disorders

USA Today (4/4/13) reports that handling "stress poorly...may put you at greater risk for anxiety disorders and other mental health issues 10 years later," according to a study published online in the journal Psychological Science. Researchers from the University of California-Irvine "analyzed data on 711 men and women, ages 25 to 74, who were interviewed two times 10 years apart." Investigators found that "people who responded to stress with more anxiety and sadness than the average person were much more likely to have self-reported anxiety/mood disorders and psychological distress 10 years later."

Oh I get it now! Anxiety is caused by stress. That’s a remarkable insight.

And on a related note:

Association Between Mood and Alcoholism

The Los Angeles Times (5/2/13) A study that was published May 1 in JAMA Psychiatry, found that individuals "who drank 'to alleviate mood symptoms' were three times more likely to become dependent on alcohol than were those who did not use alcohol to calm themselves down or improve their mood."

And mood symptoms are also related to stress, leading to abuse of a psychoactive substance!?!  Even more remarkable.

.................

And we also just learned that actively trying to solve problems rather than just ignoring them is the better way to go. Now that’s counter-intuitive:

Small Study: Way Of Dealing With Emotions Linked To Anxiety Levels

The Time (5/13/14) "Healthland" blog reports, "When faced with a challenge, whether you deny the problems it poses or dive in to solve them in a positive way may determine how much anxiety you feel overall," according to research published in Emotion. The investigators "found that the participants who regularly reframed what was happening to them to view their situation in a better light reported less severe anxiety than the participants who suppressed their emotions in trying situations."

And finally, the question of whether or not the prospect of dying or of someone you love dying leads to psychological distress has at long last been settled by two recent studies.

Parents of Children with Cancer Show High Psychological Distress

5/17/13. A group of researchers associated with several pediatric oncology treatment facilities has published one of the first studies to describe the experience of distress in parents of children with advanced cancer. The researchers found that psycho­logical distress was associated with par­ent perceptions of prognosis, goals of therapy, their child's symptoms/suffer­ing, and financial hardship.

 

   Anxiety May Be Common Among Cancer Patients, Spouses

7/12/13.  The New York Times (7/12, Hoffman) “Well” blog reports that an analysis published in the Lancet Oncology indicates that “within two years of a cancer diagnosis, the pervasiveness of depression in patients and their spouses tends to drop back to roughly the same levels as in the general population, only to be replaced by another mind-demon: anxiety, which can even intensify as time passes.”

Yet Another Case of Glorified Dope Dealing

My perfect trifecta
Is perfect no more
Trifecta means three
But now there are four

The U.S. Department of Justice just announced that they have fined AstraZeneca $520 million for off-label marketing of its atypical antipsychotic drug, Seroquel. Seroquel is a highly sedating and powerful "atypical" antipsychotic medication that is the second worst offender of all antipsychotic medications for causing a dangerous side effect called metabolic syndrome. Metabolic syndrome leads to an increase in sugar, cholesterol, and/or triglycerides (fat)in the patient's blood. It can lead to actual diabetes.

AstraZeneca is the fourth drug company recently made subject to huge fines for phony marketing schemes for their psychiatric drugs (the other three were the subjects of previous posts).

Among the "conditions" that Seroquel was touted for, beside schizophrenia and mania for which it is indicated, were aggression, Alzheimer’s disease, anger management, anxiety, ADHD, depression, post-traumatic stress disorder, and - get this - insomnia. I have personally seen several patients given the drug by other docs who were prescribing it for sleep. It works, but there are much safer alternatives in most cases.

According to the Justice Department official website, "The United States contends that AstraZeneca promoted the unapproved uses by improperly and unduly influencing the content of, and speakers, in company-sponsored continuing medical education programs. The company also engaged doctors to give promotional speaker programs on unapproved uses for Seroquel and to conduct studies on unapproved uses of Seroquel. In addition, the company recruited doctors to serve as authors of articles that were ghostwritten by medical literature companies and about studies the doctors in question did not conduct. AstraZeneca then used those studies and articles as the basis for promotional messages about unapproved uses of Seroquel.

The United States also contends that AstraZeneca violated the federal Anti-Kickback Statute by offering and paying illegal remuneration to doctors it recruited to serve as authors of articles written by AstraZeneca and its agents about the unapproved uses of Seroquel. AstraZeneca also offered and paid illegal remuneration to doctors to travel to resort locations to "advise" AstraZeneca about marketing messages for unapproved uses of Seroquel, and paid doctors to give promotional lectures to other health care professionals about unapproved and unaccepted uses of Seroquel. The United States contends that these payments were intended to induce the doctors to prescribe Seroquel for unapproved uses in violation of the federal Anti-Kickback Statute."

Of course, a half billion dollar fine is chicken feed for the company, which made billions off of this drug. It is just a cost of doing business for them.