Past exam of the individual differences and clinical psychology course of the year 2 of the psychology (experimental) course of the University of Oxford / 2022 / 4

Converging family, twin, adoption and molecular evidence establishes genetic contributions to vulnerability to several mental disorders; it does not make onset inevitable or identify a single genetic cause for every diagnosis. The outcome must be specified. Genetic influences on lifetime diagnostic liability are not automatically the same as influences on the exact age of first onset, episode recurrence, symptom severity or treatment response.

Family aggregation provides a starting point. Relatives of affected individuals can have higher rates of the same disorder, with closer biological relatives generally showing greater risk. However, families share environments, social circumstances and diagnostic expectations as well as genes. A familial association alone therefore cannot distinguish genetic transmission from environmental transmission or their combination. Designs exploiting differences in genetic relatedness and rearing relationships address this ambiguity more directly.

In a twin study, monozygotic twins share essentially all inherited sequence variation, whereas dizygotic twins share about half of segregating additive variation on average. Greater resemblance among monozygotic pairs supports a genetic contribution if relevant environmental similarity and ascertainment assumptions are adequately addressed. Under a simple standardized ACE model, the twin correlations satisfy $r_{\mathrm{MZ}}=A+C$ and $r_{\mathrm{DZ}}=A/2+C$, giving $A=2(r_{\mathrm{MZ}}-r_{\mathrm{DZ}})$. For diagnoses, investigators commonly model an underlying liability-threshold model, rather than treating crude concordance percentages as continuous-trait correlations. Patrick F. Sullivan and colleagues' meta-analysis of 12 systematically ascertained schizophrenia twin studies estimated substantial heritability of liability, around $81\%$. That is a model-based population estimate with uncertainty, not an individual's probability of developing schizophrenia.^[ref]

Twin comparisons have limitations. Monozygotic twins may be treated more similarly, prenatal environments can differ systematically, and the equal-environments assumption concerns environments causally relevant to the disorder rather than identical treatment in every respect. Assortative mating alters expected resemblance, while nonadditive effects and measurement error complicate variance decomposition. Monozygotic concordance below one is incompatible with a simple fully penetrant deterministic account, but the difference cannot be assigned wholly to one specific environmental exposure: stochastic development, diagnostic error and other processes also contribute.

Adoption and extended-family data provide a partly independent test. Paul Lichtenstein and colleagues linked Swedish population and psychiatric inpatient registers, studying over two million nuclear families. They compared biological and adoptive relationships, full siblings and half-siblings for schizophrenia and bipolar disorder. Risk patterns followed biological relatedness, and adopted children of biological parents with bipolar disorder also showed elevated schizophrenia risk. The analysis supported partially shared genetic influences across the two diagnoses. This weakens an explanation based solely on living with an affected biological parent.^[ref]

It does not eliminate every environmental explanation. Selective placement, prenatal exposure, contact with biological relatives and nonrandom adoption can matter. Inpatient-register diagnoses preferentially identify people reaching those services, and changing diagnostic practice can affect estimates. Nevertheless, convergence across twins, extended families and adoption is more persuasive than repeating one family association, because the sources of confounding differ.

Molecular evidence measures inherited variation directly. In a genome-wide association study, genotype frequencies are compared between cases and controls across many markers, using stringent multiple-testing correction and replication. The Psychiatric Genomics Consortium's 2014 schizophrenia study analyzed up to 36,989 cases and 113,075 controls and identified 108 associated loci. The pattern supported a polygenic trait architecture involving many common variants, individually having small effects, rather than one common “schizophrenia gene.” Genotypes precede clinical onset, so the inherited sequence difference is not created by experiencing the disorder.^[ref]

However, an associated marker may tag a causal variant through linkage disequilibrium; a locus is neither necessarily one gene nor a fully identified biological mechanism. Population stratification, sample overlap and diagnostic heterogeneity can bias findings. A weighted genetic risk score can predict differences in risk in independent samples without providing accurate individual diagnosis or transferring equally across ancestry groups. Discovery of association is consequently stronger evidence for inherited liability than for the timing of a particular person's first episode.

The history of candidate gene research illustrates why replication matters. Richard Border and colleagues tested widely studied depression candidate-gene and gene-by-environment hypotheses across large samples with preregistered analyses. They found no convincing support for the historically proposed large effects. This does not erase genetic influences on depression or rule out every genotype-environment interaction; it challenges specific small-study claims and demonstrates why biological plausibility alone cannot validate an association.^[ref]

Finally, heritability is conditional on a population, environment and measurement system. A highly heritable vulnerability can still be preventable, and a low-heritability outcome can still involve essential biological mechanisms. Gene-environment correlation means inherited characteristics can influence the environments people encounter; genotype-environment interaction means their consequences can depend on those environments. Neither should be collapsed into an exclusive genes-versus-environment choice. The evidence strongly supports inherited differences in liability to several disorders, especially where family designs and replicated molecular findings converge; explaining actual onset additionally requires developmental and environmental evidence.