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Endophenotypes of Social Anxiety Disorder: Can We Detect Them and Are They Useful in Clinical Practice?
Lorentz Workshop “Endophenotypes of Social Anxiety Disorder: Can we detect them and are they useful in clinical practice”
From December 14th to 18th, 24 national and international experts in genetics, brain imaging, psychiatry and clinical and developmental psychology came together in Leiden to discuss possible endophenotypes of social anxiety disorder. Social anxiety disorder is characterized by a strong fear of being evaluated by others in a social situation. Previous research has shown that social anxiety runs in families. Although this suggests that genes are involved, there is no single social anxiety gene. The disorder seems to result from the interplay of many different genes, together with life experiences. Because genes are difficult to relate to symptoms, scientists are currently focusing at an intermediate step on their way to unravel the causes of the disorder: the endophenotype. An endophenotype is a heritable characteristic related to the disease, more strongly present in patients’ relatives than in non-relatives and stronger in relatives that are more affected by the disorder.
This Lorentz-workhop aimed to gain more insight into candidate endophenotypes of SAD and their potential relevance for clinical practice. We discussed the definition of endophenotypes, and debated on, for example, the question whether a characteristic may be responsive to treatment or has to be present throughout a person’s life to qualify as an endophenotype. The fact that participants from various scientific backgrounds shared their views on this topic has led to interesting and inspiring discussions throughout the week.
After discussing endophenotypes and the reasons for suspecting their presence in social anxiety disorder on Monday, the workshop continued by examining candidate endophenotypes proposed in different fields for the next three days. These fields included the functioning of various brain regions and circuits, as measured by MRI, patterns of electrical activity of the brain (EEG, registered by placing electrodes on the head), hormones involved in the regulation of social behaviour, and biases in information processing. On Thursday, the workshop addressed development, while family factors that contribute to social anxiety were also discussed. The final day of the workshop focused on treatment of social anxiety disorder. The programme ended with a public keynote lecture by prof. Marcus Munafň, who discussed the utility of endophenotypes and offered recommendations to further improve the reproducibility of endophenotype research.
The output of the workshop-days will be published as a position paper that sets out the research agenda for the field of endophenotypes for social anxiety disorder. A synopsis for this paper, with the eye-catching title “Taking Social Anxiety Disorder Seriously: Out of the shadows and into the spotlight” has been written and is currently under review by a prestigious scientific journal.
We highly appreciated the multidisciplinary and interactive nature of the workshop. Compared with large-scale conferences, there was more time to hear about the details of each other’s work and to receive feedback from experts. The time reserved for discussion offered ample opportunity to exchange ideas, set-up new collaborations and start working on a joint paper. Furthermore, the workshop was an excellent opportunity to build an international network of social anxiety researchers that may be successful at raising awareness of the disorder and obtaining funding for further research. Social anxiety disorder is highly prevalent, difficult to treat and often precedes mood and substance abuse disorders. It is detrimental to the quality of life of individuals and costly to society. Yet, the results presented during the workshop stem hopeful: they suggest several possible targets for intervention. It would be a missed opportunity not to invest in research exploring these possibilities.
The workshop was organized by the Leiden Family Study-team, including researchers from Leiden University (LU) and the Leiden University Medical Center (LUMC). This team is currently conducting a multigenerational family study to detect endophenotypes of social anxiety (see: www.leidenfamilylab.nl and www.facebook.com/FamilieOnderzoekExtremeVerlegenheid). The scientific organizers were Janna Marie Bas-Hoogendam (LU), Jennifer Lau (King’s College London, UK), Nic van der Wee (LUMC) and Michiel Westenberg (LU). The workshop has been sponsored by the Leiden University Fund/Den Dulk-Moermans, the Institute of Psychology (LU), the department of Psychiatry (LUMC), and the Leiden University Research Profile Health, Prevention and the Human Life Cycle.