IMPORTANCE Complex disorders, such as bipolar disorder (BD), likely result from the influence of both common and rare susceptibility alleles. While common variation has been widely studied, rare variant discovery has only recently become feasible with next-generation sequencing. OBJECTIVE To utilize a combined family-based and case-control approach to exome sequencing in BD using multiplex families as an initial discovery strategy, followed by association testing in a large case-control meta-analysis. DESIGN, SETTING, AND PARTICIPANTS We performed exome sequencing of 36 affected members with BD from 8 multiplex families and tested rare, segregating variants in 3 independent case-control samples consisting of 3541 BD cases and 4774 controls. MAIN OUTCOMES AND MEASURES We used penalized logistic regression and 1-sided gene-burden analyses to test for association of rare, segregating damaging variants with BD. Permutation-based analyses were performed to test for overall enrichment with previously identified gene sets. RESULTS We found 84 rare (frequency <1%), segregating variants that were bioinformatically predicted to be damaging. These variants were found in 82 genes that were enriched for gene sets previously identified in de novo studies of autism (19 observed vs. 10.9 expected, P = .0066) and schizophrenia (11 observed vs. 5.1 expected, P = .0062) and for targets of the fragile X mental retardation protein (FMRP) pathway (10 observed vs. 4.4 expected, P = .0076). The case-control meta-analyses yielded 19 genes that were nominally associated with BD based either on individual variants or a gene-burden approach. Although no gene was individually significant after correction for multiple testing, this group of genes continued to show evidence for significant enrichment of de novo autism genes (6 observed vs 2.6 expected, P = .028). CONCLUSIONS AND RELEVANCE Our results are consistent with the presence of prominent locus and allelic heterogeneity in BD and suggest that very large samples will be required to definitively identify individual rare variants or genes conferring risk for this disorder. However, we also identify significant associations with gene sets composed of previously discovered de novo variants in autism and schizophrenia, as well as targets of the FRMP pathway, providing preliminary support for the overlap of potential autism and schizophrenia risk genes with rare, segregating variants in families with BD.

Objective: Suicide death is a highly preventable, yet growing, worldwide health crisis. To date, there has been a lack of adequately powered genomic studies of suicide, with no sizeable suicide death cohorts available for study. To address this limitation, we conducted the first comprehensive genomic analysis of suicide death, using a previously unpublished suicide cohort. Methods:The analysis sample consisted of 3,413 population-ascertained cases of European ancestry and 14,810 ancestrally matched controls. Analytical methods included principle components analysis for ancestral matching and adjusting for population stratification, linear mixed model genome-wide association testing (conditional on genetic relatedness matrix), gene and gene set enrichment testing, polygenic score analyses, as well as SNP heritability and genetic correlation estimation using LD score regression.Results: GWAS identified two genome-wide significant loci (6 SNPs, p<5x10 -8 ). Gene-based analyses implicated 19 genes on chromosomes 13, 15, 16, 17, and 19 (q<0.05). Suicide heritability was estimated h 2 =0.2463, SE = 0.0356 using summary statistics from a multivariate logistic GWAS adjusting for ancestry. Notably, suicide polygenic scores were robustly predictive of out of sample suicide death, as were polygenic scores for several other psychiatric disorders and psychological traits, particularly behavioral disinhibition and major depressive disorder. Conclusions:In this report, we identify multiple genome-wide significant loci/genes, and demonstrate robust polygenic score prediction of suicide death case-control status, adjusting for ancestry, in independent training and test sets. Additionally, we report that suicide death cases have increased genetic risk for behavioral disinhibition, major depression, autism spectrum disorder, psychosis, and alcohol use disorder relative to controls. Results demonstrate the ability of polygenic scores to robustly, and multidimensionally, predict suicide death case-control status..

Context The single-nucleotide polymorphism rs1344706 in the gene ZNF804a has been associated with schizophrenia and with quantitative phenotypic features, including brain structure volume and the core symptoms of schizophrenia. Objective To evaluate associations of rs1344706 with brain structure and the core symptoms of schizophrenia. Design Case-control analysis of covariance. Setting University-based research hospital. Participants Volunteer sample of 335 individuals with schizophrenia spectrum disorders (306 with core schizophrenia) and 198 healthy volunteers. Main Outcome Measures Cerebral cortical gray matter and white matter (WM) volumes (total and frontal, parietal, temporal, and occipital lobes), lateral ventricular cerebrospinal fluid volume, and symptom severity from the Scale for the Assessment of Negative Symptoms and the Scale for the Assessment of Positive Symptoms divided into 3 domains: psychotic, negative, and disorganized. Results The rs1344706 genotype produced significant main effects on total, frontal, and parietal lobe WM volumes (F =3.98, P=.02; F =4.95, P=.007; and F =3.08, P =.05, respectively). In the schizophrenia group, rs1344706 produced significant simple effects on total (F =3.93, P=.02) and frontal WM volumes (F =7.16, P < .001) and on psychotic symptom severity (F =6.07, P=.003); the pattern of effects was concordant with risk allele carriers having larger volumes and more severe symptoms of disease than nonrisk homozygotes. In the healthy volunteer group, risk allele homozygotes had increased total WM volume compared with nonrisk allele carriers (F =4.61, P=.03), replicating a previously reported association. Conclusions A growing body of evidence suggests that the risk allele of rs1347706 is associated with a distinctive set of phenotypic features in healthy volunteers and individuals with schizophrenia. Our study supports this assertion by finding that specific genotypes of the polymorphism are associated with brain structure volumes in individuals with schizophrenia and healthy volunteers and with symptom severity in schizophrenia.