Trans-ancestral GWAS of alcohol dependence reveals common genetic underpinnings with psychiatric disorders

Liability to alcohol dependence (AD) is heritable, but little is known about its complex polygenic architecture or its genetic relationship with other disorders. To discover loci associated with AD and characterize the relationship between AD and other psychiatric and behavioral outcomes, we carried...

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Veröffentlicht in:Nature neuroscience 2018-11, Vol.21 (12), p.1656-1669
Hauptverfasser: Walters, Raymond K., Polimanti, Renato, Johnson, Emma C., McClintick, Jeanette N., Adams, Mark J., Adkins, Amy E., Aliev, Fazil, Bacanu, Silviu-Alin, Batzler, Anthony, Bertelsen, Sarah, Biernacka, Joanna M., Bigdeli, Tim B., Chen, Li-Shiun, Clarke, Toni-Kim, Chou, Yi-Ling, Degenhardt, Franziska, Docherty, Anna R., Edwards, Alexis C., Fontanillas, Pierre, Foo, Jerome C., Fox, Louis, Frank, Josef, Giegling, Ina, Gordon, Scott, Hack, Laura M., Hartmann, Annette M., Hartz, Sarah M., Heilmann-Heimbach, Stefanie, Herms, Stefan, Hodgkinson, Colin, Hoffmann, Per, Hottenga, Jouke Jan, Kennedy, Martin A., Alanne-Kinnunen, Mervi, Konte, Bettina, Lahti, Jari, Lahti-Pulkkinen, Marius, Lai, Dongbing, Ligthart, Lannie, Loukola, Anu, Maher, Brion S., Mbarek, Hamdi, McIntosh, Andrew M., McQueen, Matthew B., Meyers, Jacquelyn L., Milaneschi, Yuri, Palviainen, Teemu, Pearson, John F., Peterson, Roseann E., Ripatti, Samuli, Ryu, Euijung, Saccone, Nancy L., Salvatore, Jessica E., Sanchez-Roige, Sandra, Schwandt, Melanie, Sherva, Richard, Streit, Fabian, Strohmaier, Jana, Thomas, Nathaniel, Wang, Jen-Chyong, Webb, Bradley T., Wedow, Robbee, Wetherill, Leah, Wills, Amanda G., Boardman, Jason D., Chen, Danfeng, Choi, Doo-Sup, Copeland, William E., Culverhouse, Robert C., Dahmen, Norbert, Degenhardt, Louisa, Domingue, Benjamin W., Elson, Sarah L., Frye, Mark A., Gäbel, Wolfgang, Hayward, Caroline, Ising, Marcus, Keyes, Margaret, Kiefer, Falk, Kramer, John, Kuperman, Samuel, Lucae, Susanne, Lynskey, Michael T., Maier, Wolfgang, Mann, Karl, Männistö, Satu, Müller-Myhsok, Bertram, Murray, Alison D., Nurnberger, John I., Palotie, Aarno, Preuss, Ulrich, Räikkönen, Katri, Reynolds, Maureen D., Ridinger, Monika, Scherbaum, Norbert, Schuckit, Marc A., Soyka, Michael, Treutlein, Jens, Witt, Stephanie
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container_end_page 1669
container_issue 12
container_start_page 1656
container_title Nature neuroscience
container_volume 21
creator Walters, Raymond K.
Polimanti, Renato
Johnson, Emma C.
McClintick, Jeanette N.
Adams, Mark J.
Adkins, Amy E.
Aliev, Fazil
Bacanu, Silviu-Alin
Batzler, Anthony
Bertelsen, Sarah
Biernacka, Joanna M.
Bigdeli, Tim B.
Chen, Li-Shiun
Clarke, Toni-Kim
Chou, Yi-Ling
Degenhardt, Franziska
Docherty, Anna R.
Edwards, Alexis C.
Fontanillas, Pierre
Foo, Jerome C.
Fox, Louis
Frank, Josef
Giegling, Ina
Gordon, Scott
Hack, Laura M.
Hartmann, Annette M.
Hartz, Sarah M.
Heilmann-Heimbach, Stefanie
Herms, Stefan
Hodgkinson, Colin
Hoffmann, Per
Hottenga, Jouke Jan
Kennedy, Martin A.
Alanne-Kinnunen, Mervi
Konte, Bettina
Lahti, Jari
Lahti-Pulkkinen, Marius
Lai, Dongbing
Ligthart, Lannie
Loukola, Anu
Maher, Brion S.
Mbarek, Hamdi
McIntosh, Andrew M.
McQueen, Matthew B.
Meyers, Jacquelyn L.
Milaneschi, Yuri
Palviainen, Teemu
Pearson, John F.
Peterson, Roseann E.
Ripatti, Samuli
Ryu, Euijung
Saccone, Nancy L.
Salvatore, Jessica E.
Sanchez-Roige, Sandra
Schwandt, Melanie
Sherva, Richard
Streit, Fabian
Strohmaier, Jana
Thomas, Nathaniel
Wang, Jen-Chyong
Webb, Bradley T.
Wedow, Robbee
Wetherill, Leah
Wills, Amanda G.
Boardman, Jason D.
Chen, Danfeng
Choi, Doo-Sup
Copeland, William E.
Culverhouse, Robert C.
Dahmen, Norbert
Degenhardt, Louisa
Domingue, Benjamin W.
Elson, Sarah L.
Frye, Mark A.
Gäbel, Wolfgang
Hayward, Caroline
Ising, Marcus
Keyes, Margaret
Kiefer, Falk
Kramer, John
Kuperman, Samuel
Lucae, Susanne
Lynskey, Michael T.
Maier, Wolfgang
Mann, Karl
Männistö, Satu
Müller-Myhsok, Bertram
Murray, Alison D.
Nurnberger, John I.
Palotie, Aarno
Preuss, Ulrich
Räikkönen, Katri
Reynolds, Maureen D.
Ridinger, Monika
Scherbaum, Norbert
Schuckit, Marc A.
Soyka, Michael
Treutlein, Jens
Witt, Stephanie
description Liability to alcohol dependence (AD) is heritable, but little is known about its complex polygenic architecture or its genetic relationship with other disorders. To discover loci associated with AD and characterize the relationship between AD and other psychiatric and behavioral outcomes, we carried out the largest GWAS to date of DSM-IV diagnosed AD. Genome-wide data on 14,904 individuals with AD and 37,944 controls from 28 case/control and family-based studies were meta-analyzed, stratified by genetic ancestry (European, N = 46,568; African; N = 6,280). Independent, genome-wide significant effects of different ADH1B variants were identified in European (rs1229984; p = 9.8E-13) and African ancestries (rs2066702; p = 2.2E-9). Significant genetic correlations were observed with 17 phenotypes, including schizophrenia, ADHD, depression, and use of cigarettes and cannabis. The genetic underpinnings of AD only partially overlap with those for alcohol consumption, underscoring the genetic distinction between pathological and non-pathological drinking behaviors.
doi_str_mv 10.1038/s41593-018-0275-1
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Sanchez-Roige, Sandra ; Schwandt, Melanie ; Sherva, Richard ; Streit, Fabian ; Strohmaier, Jana ; Thomas, Nathaniel ; Wang, Jen-Chyong ; Webb, Bradley T. ; Wedow, Robbee ; Wetherill, Leah ; Wills, Amanda G. ; Boardman, Jason D. ; Chen, Danfeng ; Choi, Doo-Sup ; Copeland, William E. ; Culverhouse, Robert C. ; Dahmen, Norbert ; Degenhardt, Louisa ; Domingue, Benjamin W. ; Elson, Sarah L. ; Frye, Mark A. ; Gäbel, Wolfgang ; Hayward, Caroline ; Ising, Marcus ; Keyes, Margaret ; Kiefer, Falk ; Kramer, John ; Kuperman, Samuel ; Lucae, Susanne ; Lynskey, Michael T. ; Maier, Wolfgang ; Mann, Karl ; Männistö, Satu ; Müller-Myhsok, Bertram ; Murray, Alison D. ; Nurnberger, John I. ; Palotie, Aarno ; Preuss, Ulrich ; Räikkönen, Katri ; Reynolds, Maureen D. ; Ridinger, Monika ; Scherbaum, Norbert ; Schuckit, Marc A. ; Soyka, Michael ; Treutlein, Jens ; Witt, Stephanie</creator><creatorcontrib>Walters, Raymond K. ; Polimanti, Renato ; Johnson, Emma C. ; McClintick, Jeanette N. ; Adams, Mark J. ; Adkins, Amy E. ; 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T.</creatorcontrib><creatorcontrib>Maier, Wolfgang</creatorcontrib><creatorcontrib>Mann, Karl</creatorcontrib><creatorcontrib>Männistö, Satu</creatorcontrib><creatorcontrib>Müller-Myhsok, Bertram</creatorcontrib><creatorcontrib>Murray, Alison D.</creatorcontrib><creatorcontrib>Nurnberger, John I.</creatorcontrib><creatorcontrib>Palotie, Aarno</creatorcontrib><creatorcontrib>Preuss, Ulrich</creatorcontrib><creatorcontrib>Räikkönen, Katri</creatorcontrib><creatorcontrib>Reynolds, Maureen D.</creatorcontrib><creatorcontrib>Ridinger, Monika</creatorcontrib><creatorcontrib>Scherbaum, Norbert</creatorcontrib><creatorcontrib>Schuckit, Marc A.</creatorcontrib><creatorcontrib>Soyka, Michael</creatorcontrib><creatorcontrib>Treutlein, Jens</creatorcontrib><creatorcontrib>Witt, Stephanie</creatorcontrib><title>Trans-ancestral GWAS of alcohol dependence reveals common genetic underpinnings with psychiatric disorders</title><title>Nature neuroscience</title><description>Liability to alcohol dependence (AD) is heritable, but little is known about its complex polygenic architecture or its genetic relationship with other disorders. To discover loci associated with AD and characterize the relationship between AD and other psychiatric and behavioral outcomes, we carried out the largest GWAS to date of DSM-IV diagnosed AD. Genome-wide data on 14,904 individuals with AD and 37,944 controls from 28 case/control and family-based studies were meta-analyzed, stratified by genetic ancestry (European, N = 46,568; African; N = 6,280). Independent, genome-wide significant effects of different ADH1B variants were identified in European (rs1229984; p = 9.8E-13) and African ancestries (rs2066702; p = 2.2E-9). Significant genetic correlations were observed with 17 phenotypes, including schizophrenia, ADHD, depression, and use of cigarettes and cannabis. 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Sarah M. ; Heilmann-Heimbach, Stefanie ; Herms, Stefan ; Hodgkinson, Colin ; Hoffmann, Per ; Hottenga, Jouke Jan ; Kennedy, Martin A. ; Alanne-Kinnunen, Mervi ; Konte, Bettina ; Lahti, Jari ; Lahti-Pulkkinen, Marius ; Lai, Dongbing ; Ligthart, Lannie ; Loukola, Anu ; Maher, Brion S. ; Mbarek, Hamdi ; McIntosh, Andrew M. ; McQueen, Matthew B. ; Meyers, Jacquelyn L. ; Milaneschi, Yuri ; Palviainen, Teemu ; Pearson, John F. ; Peterson, Roseann E. ; Ripatti, Samuli ; Ryu, Euijung ; Saccone, Nancy L. ; Salvatore, Jessica E. ; Sanchez-Roige, Sandra ; Schwandt, Melanie ; Sherva, Richard ; Streit, Fabian ; Strohmaier, Jana ; Thomas, Nathaniel ; Wang, Jen-Chyong ; Webb, Bradley T. ; Wedow, Robbee ; Wetherill, Leah ; Wills, Amanda G. ; Boardman, Jason D. ; Chen, Danfeng ; Choi, Doo-Sup ; Copeland, William E. ; Culverhouse, Robert C. ; Dahmen, Norbert ; Degenhardt, Louisa ; Domingue, Benjamin W. ; Elson, Sarah L. ; Frye, Mark A. ; Gäbel, Wolfgang ; Hayward, Caroline ; Ising, Marcus ; Keyes, Margaret ; Kiefer, Falk ; Kramer, John ; Kuperman, Samuel ; Lucae, Susanne ; Lynskey, Michael T. ; Maier, Wolfgang ; Mann, Karl ; Männistö, Satu ; Müller-Myhsok, Bertram ; Murray, Alison D. ; Nurnberger, John I. ; Palotie, Aarno ; Preuss, Ulrich ; Räikkönen, Katri ; Reynolds, Maureen D. ; Ridinger, Monika ; Scherbaum, Norbert ; Schuckit, Marc A. ; Soyka, Michael ; Treutlein, Jens ; Witt, Stephanie</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-pubmedcentral_primary_oai_pubmedcentral_nih_gov_64302073</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Walters, Raymond K.</creatorcontrib><creatorcontrib>Polimanti, Renato</creatorcontrib><creatorcontrib>Johnson, Emma C.</creatorcontrib><creatorcontrib>McClintick, Jeanette N.</creatorcontrib><creatorcontrib>Adams, Mark J.</creatorcontrib><creatorcontrib>Adkins, Amy E.</creatorcontrib><creatorcontrib>Aliev, Fazil</creatorcontrib><creatorcontrib>Bacanu, Silviu-Alin</creatorcontrib><creatorcontrib>Batzler, Anthony</creatorcontrib><creatorcontrib>Bertelsen, Sarah</creatorcontrib><creatorcontrib>Biernacka, Joanna M.</creatorcontrib><creatorcontrib>Bigdeli, Tim B.</creatorcontrib><creatorcontrib>Chen, Li-Shiun</creatorcontrib><creatorcontrib>Clarke, Toni-Kim</creatorcontrib><creatorcontrib>Chou, Yi-Ling</creatorcontrib><creatorcontrib>Degenhardt, Franziska</creatorcontrib><creatorcontrib>Docherty, Anna R.</creatorcontrib><creatorcontrib>Edwards, Alexis C.</creatorcontrib><creatorcontrib>Fontanillas, Pierre</creatorcontrib><creatorcontrib>Foo, Jerome C.</creatorcontrib><creatorcontrib>Fox, Louis</creatorcontrib><creatorcontrib>Frank, Josef</creatorcontrib><creatorcontrib>Giegling, Ina</creatorcontrib><creatorcontrib>Gordon, Scott</creatorcontrib><creatorcontrib>Hack, Laura M.</creatorcontrib><creatorcontrib>Hartmann, Annette M.</creatorcontrib><creatorcontrib>Hartz, Sarah M.</creatorcontrib><creatorcontrib>Heilmann-Heimbach, Stefanie</creatorcontrib><creatorcontrib>Herms, Stefan</creatorcontrib><creatorcontrib>Hodgkinson, Colin</creatorcontrib><creatorcontrib>Hoffmann, Per</creatorcontrib><creatorcontrib>Hottenga, Jouke Jan</creatorcontrib><creatorcontrib>Kennedy, Martin A.</creatorcontrib><creatorcontrib>Alanne-Kinnunen, Mervi</creatorcontrib><creatorcontrib>Konte, Bettina</creatorcontrib><creatorcontrib>Lahti, Jari</creatorcontrib><creatorcontrib>Lahti-Pulkkinen, Marius</creatorcontrib><creatorcontrib>Lai, Dongbing</creatorcontrib><creatorcontrib>Ligthart, Lannie</creatorcontrib><creatorcontrib>Loukola, Anu</creatorcontrib><creatorcontrib>Maher, Brion S.</creatorcontrib><creatorcontrib>Mbarek, Hamdi</creatorcontrib><creatorcontrib>McIntosh, Andrew M.</creatorcontrib><creatorcontrib>McQueen, Matthew B.</creatorcontrib><creatorcontrib>Meyers, Jacquelyn L.</creatorcontrib><creatorcontrib>Milaneschi, Yuri</creatorcontrib><creatorcontrib>Palviainen, Teemu</creatorcontrib><creatorcontrib>Pearson, John F.</creatorcontrib><creatorcontrib>Peterson, Roseann E.</creatorcontrib><creatorcontrib>Ripatti, Samuli</creatorcontrib><creatorcontrib>Ryu, Euijung</creatorcontrib><creatorcontrib>Saccone, Nancy L.</creatorcontrib><creatorcontrib>Salvatore, Jessica E.</creatorcontrib><creatorcontrib>Sanchez-Roige, Sandra</creatorcontrib><creatorcontrib>Schwandt, Melanie</creatorcontrib><creatorcontrib>Sherva, Richard</creatorcontrib><creatorcontrib>Streit, Fabian</creatorcontrib><creatorcontrib>Strohmaier, Jana</creatorcontrib><creatorcontrib>Thomas, Nathaniel</creatorcontrib><creatorcontrib>Wang, Jen-Chyong</creatorcontrib><creatorcontrib>Webb, Bradley T.</creatorcontrib><creatorcontrib>Wedow, Robbee</creatorcontrib><creatorcontrib>Wetherill, Leah</creatorcontrib><creatorcontrib>Wills, Amanda G.</creatorcontrib><creatorcontrib>Boardman, Jason D.</creatorcontrib><creatorcontrib>Chen, Danfeng</creatorcontrib><creatorcontrib>Choi, Doo-Sup</creatorcontrib><creatorcontrib>Copeland, William E.</creatorcontrib><creatorcontrib>Culverhouse, Robert C.</creatorcontrib><creatorcontrib>Dahmen, Norbert</creatorcontrib><creatorcontrib>Degenhardt, Louisa</creatorcontrib><creatorcontrib>Domingue, Benjamin W.</creatorcontrib><creatorcontrib>Elson, Sarah L.</creatorcontrib><creatorcontrib>Frye, Mark A.</creatorcontrib><creatorcontrib>Gäbel, Wolfgang</creatorcontrib><creatorcontrib>Hayward, Caroline</creatorcontrib><creatorcontrib>Ising, Marcus</creatorcontrib><creatorcontrib>Keyes, Margaret</creatorcontrib><creatorcontrib>Kiefer, Falk</creatorcontrib><creatorcontrib>Kramer, John</creatorcontrib><creatorcontrib>Kuperman, Samuel</creatorcontrib><creatorcontrib>Lucae, Susanne</creatorcontrib><creatorcontrib>Lynskey, Michael T.</creatorcontrib><creatorcontrib>Maier, Wolfgang</creatorcontrib><creatorcontrib>Mann, Karl</creatorcontrib><creatorcontrib>Männistö, Satu</creatorcontrib><creatorcontrib>Müller-Myhsok, Bertram</creatorcontrib><creatorcontrib>Murray, Alison D.</creatorcontrib><creatorcontrib>Nurnberger, John I.</creatorcontrib><creatorcontrib>Palotie, Aarno</creatorcontrib><creatorcontrib>Preuss, Ulrich</creatorcontrib><creatorcontrib>Räikkönen, Katri</creatorcontrib><creatorcontrib>Reynolds, Maureen D.</creatorcontrib><creatorcontrib>Ridinger, Monika</creatorcontrib><creatorcontrib>Scherbaum, Norbert</creatorcontrib><creatorcontrib>Schuckit, Marc A.</creatorcontrib><creatorcontrib>Soyka, Michael</creatorcontrib><creatorcontrib>Treutlein, Jens</creatorcontrib><creatorcontrib>Witt, Stephanie</creatorcontrib><collection>PubMed Central (Full Participant titles)</collection><jtitle>Nature neuroscience</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Walters, Raymond K.</au><au>Polimanti, Renato</au><au>Johnson, Emma C.</au><au>McClintick, Jeanette N.</au><au>Adams, Mark J.</au><au>Adkins, Amy E.</au><au>Aliev, Fazil</au><au>Bacanu, Silviu-Alin</au><au>Batzler, Anthony</au><au>Bertelsen, Sarah</au><au>Biernacka, Joanna M.</au><au>Bigdeli, Tim B.</au><au>Chen, Li-Shiun</au><au>Clarke, Toni-Kim</au><au>Chou, Yi-Ling</au><au>Degenhardt, Franziska</au><au>Docherty, Anna R.</au><au>Edwards, Alexis C.</au><au>Fontanillas, Pierre</au><au>Foo, Jerome C.</au><au>Fox, Louis</au><au>Frank, Josef</au><au>Giegling, Ina</au><au>Gordon, Scott</au><au>Hack, Laura M.</au><au>Hartmann, Annette M.</au><au>Hartz, Sarah M.</au><au>Heilmann-Heimbach, Stefanie</au><au>Herms, Stefan</au><au>Hodgkinson, Colin</au><au>Hoffmann, Per</au><au>Hottenga, Jouke Jan</au><au>Kennedy, Martin A.</au><au>Alanne-Kinnunen, Mervi</au><au>Konte, Bettina</au><au>Lahti, Jari</au><au>Lahti-Pulkkinen, Marius</au><au>Lai, Dongbing</au><au>Ligthart, Lannie</au><au>Loukola, Anu</au><au>Maher, Brion S.</au><au>Mbarek, Hamdi</au><au>McIntosh, Andrew M.</au><au>McQueen, Matthew B.</au><au>Meyers, Jacquelyn L.</au><au>Milaneschi, Yuri</au><au>Palviainen, Teemu</au><au>Pearson, John F.</au><au>Peterson, Roseann E.</au><au>Ripatti, Samuli</au><au>Ryu, Euijung</au><au>Saccone, Nancy L.</au><au>Salvatore, Jessica E.</au><au>Sanchez-Roige, Sandra</au><au>Schwandt, Melanie</au><au>Sherva, Richard</au><au>Streit, Fabian</au><au>Strohmaier, Jana</au><au>Thomas, Nathaniel</au><au>Wang, Jen-Chyong</au><au>Webb, Bradley T.</au><au>Wedow, Robbee</au><au>Wetherill, Leah</au><au>Wills, Amanda G.</au><au>Boardman, Jason D.</au><au>Chen, Danfeng</au><au>Choi, Doo-Sup</au><au>Copeland, William E.</au><au>Culverhouse, Robert C.</au><au>Dahmen, Norbert</au><au>Degenhardt, Louisa</au><au>Domingue, Benjamin W.</au><au>Elson, Sarah L.</au><au>Frye, Mark A.</au><au>Gäbel, Wolfgang</au><au>Hayward, Caroline</au><au>Ising, Marcus</au><au>Keyes, Margaret</au><au>Kiefer, Falk</au><au>Kramer, John</au><au>Kuperman, Samuel</au><au>Lucae, Susanne</au><au>Lynskey, Michael T.</au><au>Maier, Wolfgang</au><au>Mann, Karl</au><au>Männistö, Satu</au><au>Müller-Myhsok, Bertram</au><au>Murray, Alison D.</au><au>Nurnberger, John I.</au><au>Palotie, Aarno</au><au>Preuss, Ulrich</au><au>Räikkönen, Katri</au><au>Reynolds, Maureen D.</au><au>Ridinger, Monika</au><au>Scherbaum, Norbert</au><au>Schuckit, Marc A.</au><au>Soyka, Michael</au><au>Treutlein, Jens</au><au>Witt, Stephanie</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Trans-ancestral GWAS of alcohol dependence reveals common genetic underpinnings with psychiatric disorders</atitle><jtitle>Nature neuroscience</jtitle><date>2018-11-26</date><risdate>2018</risdate><volume>21</volume><issue>12</issue><spage>1656</spage><epage>1669</epage><pages>1656-1669</pages><issn>1097-6256</issn><eissn>1546-1726</eissn><abstract>Liability to alcohol dependence (AD) is heritable, but little is known about its complex polygenic architecture or its genetic relationship with other disorders. To discover loci associated with AD and characterize the relationship between AD and other psychiatric and behavioral outcomes, we carried out the largest GWAS to date of DSM-IV diagnosed AD. Genome-wide data on 14,904 individuals with AD and 37,944 controls from 28 case/control and family-based studies were meta-analyzed, stratified by genetic ancestry (European, N = 46,568; African; N = 6,280). Independent, genome-wide significant effects of different ADH1B variants were identified in European (rs1229984; p = 9.8E-13) and African ancestries (rs2066702; p = 2.2E-9). Significant genetic correlations were observed with 17 phenotypes, including schizophrenia, ADHD, depression, and use of cigarettes and cannabis. The genetic underpinnings of AD only partially overlap with those for alcohol consumption, underscoring the genetic distinction between pathological and non-pathological drinking behaviors.</abstract><pmid>30482948</pmid><doi>10.1038/s41593-018-0275-1</doi><oa>free_for_read</oa></addata></record>
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title Trans-ancestral GWAS of alcohol dependence reveals common genetic underpinnings with psychiatric disorders
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