Attention-deficit/hyperactivity disorder genomics: update for clinicians.

Attention deficit, hyperactivity disorder (ADHD) is familial and highly heritable. Several candidate genes involved in neurotransmission have been identified, however these confer minimal risk, suggesting that for the most part, ADHD is not caused by single common genetic variants. Advances in genotyping enabling investigation at the level of the genome have led to the discovery of rare structural variants suggesting that ADHD is a genomic disorder, with potentially thousands of variants, and common neuronal pathways disrupted by numerous rare variants resulting in similar ADHD phenotypes. Heritability studies in humans also indicate the importance of epigenetic factors, and animal studies are deciphering some of the processes that confer risk during gestation and throughout the post-natal period. These and future discoveries will lead to improved diagnosis, individualized treatment, cures, and prevention. These advances also highlight ethical and legal issues requiring management and interpretation of genetic data and ensuring privacy and protection from misuse.

The impact of mood disorders and their treatment on the pregnant woman, the fetus, and the infant.

Treatment of mood disorders in pregnant or nursing women can carry significant risks for the mother and the developing infant. For patients and physicians, it may be difficult to obtain current information to make the proper decisions regarding pharmacologic and alternative treatments. Thus, this paper discusses the risks and benefits of pharmacologic treatment and the risks of not treating depression and bipolar disorder in the pregnant woman. The safety of treatment options is reviewed. Alternative treatment options are also discussed.

Selective serotonin reuptake inhibitor use during pregnancy and possible neonatal complications.

This paper reviews the risks and benefits of using selective serotonin reuptake inhibitors (SSRIs) in pregnant women. The effects of SSRI use on pregnant women and fetuses are discussed, and the need for SSRI treatment is explained. Persistent pulmonary hypertension of the newborn, teratogenic risks of SSRI treatment during pregnancy, neonatal adaptations, and long-term outcomes for children whose mothers used SSRIs during pregnancy are specifically considered. Due to conflicting results from current studies, there are no clear guidelines for SSRI treatment in pregnancy. Patients and doctors must discuss together the risks and benefits of SSRI use during pregnancy and decide on a course of treatment. Potential risks must be balanced against the effects of untreated maternal depression.