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The neuropsychiatric phenotype in Darier disease

Authors

  • K. Gordon-Smith,

    1. Department of Psychological Medicine, The Henry Wellcome Building for Biomedical Research in Wales, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4XN, U.K.
    2. Department of Psychiatry, University of Birmingham, National Centre for Mental Health, 25 Vincent Drive, Birmingham, B15 2FG, U.K.
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  • L.A. Jones,

    1. Department of Psychiatry, University of Birmingham, National Centre for Mental Health, 25 Vincent Drive, Birmingham, B15 2FG, U.K.
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  • S.M. Burge,

    1. Department of Dermatology, The Churchill Hospital, Headington, Oxford OX3 7LJ, U.K.
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  • C.S. Munro,

    1. Department of Dermatology, Southern General Hospital, Glasgow, G51 4TF, U.K.
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  • S. Tavadia,

    1. Department of Dermatology, Crosshouse Hospital, Kilmarnock, Ayrshire, KA2 OBE, U.K.
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  • N. Craddock

    1. Department of Psychological Medicine, The Henry Wellcome Building for Biomedical Research in Wales, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4XN, U.K.
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  • Conflicts of interest
    None declared.

Nick Craddock.
E-mail: craddockn@cardiff.ac.uk

Summary

Background  Darier disease (DD) is a rare autosomal dominantly inherited skin disorder in which co-occurrence of neuropsychiatric abnormalities has been frequently reported by dermatologists. It is caused by mutations in a single gene, ATP2A2, which is expressed in the skin and brain.

Objectives  To conduct the first systematic investigation of the neuropsychiatric phenotype in DD.

Methods  One hundred unrelated individuals with DD were assessed using a battery of standardized neuropsychiatric measures. Data were also obtained on a number of clinical features of DD.

Results  Individuals with DD were found to have high lifetime rates of mood disorders (50%), specifically major depression (30%) and bipolar disorder (4%), and suicide attempts (13%) and suicidal thoughts (31%). These were more common in DD when compared with general population data. The prevalence of epilepsy (3%) in the sample was also higher than the prevalence in the general population. There was no consistent association of specific dermatological features of DD and presence of psychiatric features.

Conclusions  These findings highlight the need for clinicians to assess and recognize neuropsychiatric symptoms in DD. The results do not suggest that neuropsychiatric symptoms are simply a psychological reaction to having a skin disease, but are consistent with the pleiotropy hypothesis that mutations in the ATP2A2 gene, in addition to causing DD, confer susceptibility to neuropsychiatric features. Further research is needed to investigate genotype–phenotype correlations between the types and/or locations of pathogenic mutations within ATP2A2 and the expressed neuropsychiatric phenotypes.

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