Intermediate phenotypes are traits positioned somewhere between genetic variation and disease. They represent a target for attempts to find disease-associated genetic variants and elucidation of mechanisms. Psychiatry has been particularly enamored with intermediate phenotypes, due to uncertainty about disease etiology, inconclusive results in early psychiatric genetic studies, and their appeal relative to traditional diagnostic categories. Here, we argue that new genetic findings are relevant to the question of the utility of these constructs. In particular, results from genomewide association studies of psychiatric disorders now allow an assessment of the potential role of particular intermediate phenotypes. Based on such an analysis, as well as other recent results, we conclude that intermediate phenotypes are likely to be most valuable in understanding mechanism.
What's the use of an endophenotype?Until recently, genetic approaches in psychiatric disease had enjoyed limited success, but large-scale collaborative a genome-wide association studies (GWAS) have now begun to identify common and rare variants associated with schizophrenia, bipolar disorder and autism spectrum disorders [1][2][3][4][5][6][7][8][9][10][11]. An alternative to these agnostic, large-scale approaches is to focus instead on phenotypes thought to reflect disease processes. In this review we refer to these phenotypes as intermediate phenotypes, rather than endophenotypes. Definitions of 'endophenotype' grace every review of this area (see Box 1 for some examples), and they are not all alike. For our purposes, the critical distinction is between definitions in which an endophenotype is considered to lie on the causal pathway to disease, and those in which it is more generally an index of the likelihood that a subject has the disease (and could serve as a biomarker). This distinction, noted by Walters and Owen [12], has been treated in detail by Kendler and Neale [13]. Here we distinguish two ways in which intermediate phenotypes could be used in genetic studies, and review their utility in genetic analysis of psychiatric disease.Correspondence to Jonathan Flint: jf@well.ox.ac.uk. The first use of intermediate phenotypes is to aid gene discovery. For example, if a genetic study of major depression fails to identify a signal, then researchers may decide to focus their attention on cognitive variables instead, reasoning that individual differences in the processing of stimuli representing negative affect (such as a bias in the interpretation of sad or happy faces [14]) might be an important mechanistic pathway, better reflecting the underlying biology, and therefore more genetically tractable. In addition, they might include data indicating activity in brain areas involved in processing affective or motivational stimuli (such as the amygdala and nucleus accumbens). With results in hand, researchers can combine the additional phenotypes with the diagnostic information, searching for a subgroup in their data in which the genetic signal i...