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Yıl:2005; Cilt: 1; Sayı: 12>> Özet
Türkiye Klinikleri Dahili Tıp Bilimleri Dergisi Psikiyatri; 2005;1(12):24-34
Şizotipi ve Şizofrenide Genetik Belirleyiciler ( Endofenotipler)
S Özer
Psikiyatri AD, Hacettepe Üniversitesi Tıp Fakültesi, ANKARA
Moleküler genetikteki ilerlemelere rağmen, ruhsal hastalıkların çoğunda olduğu gibi henüz şizofreninin genetik temelleri de tam olarak açıklığa kavuşturulamamıştır. Bunun nedenleri arasında fenotip tanımlamaları ile ilgili sorunlar ve hastalıkların kalıtım kalıpları ile ilgili farklı mekanizmalar sayılabilir. Fenotip tanımlamaları ile ilgili sorunların aşılabilmesi ve risk artırıcı ya da koruyucu etkisi bulunan genlerin belirlenmesi için endofenotip yaklaşımı önerilmektedir. Eşik-altı yatkınlık belirleyicileri olarak tanımlanabilecek endofenotipler, hasta olma ve olmama durumundan bağımsız olarak genetik alt yapıyı anlamayı kolaylaştırabilirler. Endofenotip yaklaşımında şizofreni tanısına kıyasla, patofizyoloji ve genetik etiyoloji ile daha yakından ilişkili, daha basit genetik temelleri olan ve daha iyi tanımlanmış fenotiplerin bulunması amaçlanmaktadır. Endofenotipler kalıtsal nörofizyolojik, nöropsikolojik, bilişsel, nöroanatomik, biyokimyasal ya da endokrinolojik özellikler olabilir. İlk öne sürülen genetik belirleyicilerden biri klinik bir endofenotip olan şizotipidir. Endofenotip yaklaşımı çok genli/çok etkenli bir hastalık olan şizofrenide genetik analizlerin gücünü artırmak dışında, sınıflandırma sistemlerinin ve tanı kategorilerinin yeniden şekillendirilebilmesini sağlayabilir. Bu yazıda şizofreni ile ilgili genetik çalışmalarda endofenotip yaklaşımına gereksinim yaratan öğeler ile klinik bir genetik belirleyici olan şizotipi ve bilgi-işleme sürecindeki bozuklukla ilişkili olabilecek işlevsel (elektrofizyolojik ve nöropsikolojik) ve yapısal aday endofenotipler gözden geçirilerek şizofrenide şu ana kadar bu yaklaşım ile saptanabilen bulgular aktarılmıştır.
Schizotypy and Genetic Markers In Schizophrenia (endophenotypes)
Despite the progress in molecular genetics, the genetic background of schizophrenia is not clarified yet. This failure can be attributed to ambiguous phenotypic description and several variations on genetic transmission of the disorder. There is a growing consensus that endophenotype approach may be utilized to overcome the diffuculties regarding the phenotypic description and facilitate the identification of the susceptibility or protective genes. The subclinical vulnerability markers namely endophenotypes may assist in the identification of the genetic underpinnings of schizophrenia regardless of the disease status. This approach may provide well defined phenotypes having a stronger relationship with the pathopysiology and genetic etiology than the diagnostic category itself. An endophenotype may be an inherited neurophysiological, neuropsychological, cognitive, neuroanatomical, biochemical or endocrinological trait. The initial proposed genetic marker in schizophrenia is schizotypy which was proposed to be the pure expression of schizotaxia, the genetic predisposition for schizophrenia. Besides increasing the power of genetic analysis in schizophrenia, endophenotype approach may help reshaping of the classical nosological systems and diagnostic categories. In this article the rationale for the use of endophenotypes in the genetic studies of schizophrenia is discussed and the proposed candidate endophenotypes for this disorder including schizotypy are reviewed.

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