title: Neuropsychiatric conditions among patients with dyskeratosis congenita: a link with telomere biology?
abstract: BACKGROUND
  Dyskeratosis congenita (DC), an inherited bone marrow failure syndrome (IBMFS), is caused by defects in telomere biology, which result in very short germline telomeres. Telomeres, long nucleotide repeats and a protein complex at chromosome ends, are essential for chromosomal stability. Several association studies suggest that short telomeres are associated with certain psychiatric disorders, including mood disorders and schizophrenia. There are two cases in the literature of schizophrenia and DC occurring as co-morbid conditions. We noted that many patients with DC in our cohort had neuropsychiatric conditions.
  
  
  METHODS
  Subjects were participants in NCI's IBMFS prospective cohort study. Psychiatric evaluation was incorporated into our clinical assessment in January 2009. Fourteen DC or DC-like patients, including six children, were evaluated in this study through in person interview by either a psychiatrist specialized in psychosomatic medicine or a child and adolescent psychiatrist.
  
  
  RESULTS
  Three of the six pediatric subjects and five of the eight adults had a neuropsychiatric condition such as a mood, anxiety, or adjustment disorder, intellectual disability, attention deficit hyperactivity disorder, or pervasive developmental disorders. The lifetime occurrence of any of these disorders in our study was 83% in pediatric subjects and 88% in adults. Notably, the literature reports neuropsychiatric conditions in 25% and 38% in chronically ill children and adults, respectively.
  
  
  CONCLUSIONS
  This pilot study suggests that patients with DC may have higher rates of neuropsychiatric conditions than the general population or other chronically ill individuals. This potential link between very short telomeres and neuropsychiatric conditions warrants further study.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Children's National Medical Center, Washington, DC, USA.
authors.forename: Sandra
authors.initials: S
authors.lastname: Rackley
authors.forename: Maryland
authors.initials: M
authors.lastname: Pao
authors.forename: Guillermo F
authors.initials: GF
authors.lastname: Seratti
authors.forename: Neelam
authors.initials: N
authors.lastname: Giri
authors.forename: J J
authors.initials: JJ
authors.lastname: Rasimas
authors.forename: Blanche P
authors.initials: BP
authors.lastname: Alter
authors.forename: Sharon A
authors.initials: SA
authors.lastname: Savage
mesh_terms: D000293:Adolescent; D000328:Adult; D000741:Anemia, Aplastic; D001855:Bone Marrow Diseases; D000080983:Bone Marrow Failure Disorders; D002648:Child; D015897:Comorbidity; D039721:Diagnostic and Statistical Manual of Mental Disorders; D019871:Dyskeratosis Congenita / Q000453:epidemiology* / Q000235:genetics / Q000523:psychology; D042241:Early Diagnosis; D018095:Germ-Line Mutation / Q000235:genetics; D006457:Hemoglobinuria, Paroxysmal / Q000453:epidemiology* / Q000235:genetics; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D016615:Telomere / Q000201:enzymology / Q000235:genetics*; D055815:Young Adult