Family history study of anorexia nervosa and bulimia

The 420 first-degree relatives of 14 patients with anorexia nervosa, 55 patients with bulimia, and 20 patients with both disorders were evaluated for the presence of psychiatric illness, using DSM-III criteria, by the family history method. The morbid risk for affective disorder in the families of the eating disorder probands was similar to that found in the families of patients with bipolar disorder; but was significantly greater than that found in the families of patients with schizophrenia or borderline personality disorder. These results add to the growing evidence that anorexia nervosa and bulimia are closely related to affective disorder.

Conduct disorder and affective disorder among the offspring of patients with Huntington's disease

The rate of occurrence of conduct disorder and affective illness was studied for a sample of 112 offspring of 34 Huntington's Disease (HD) patients. Psychiatric disorder in the offspring was assessed as a function of: (1) age of the parent at the onset of symptoms of HD; (2) family disorganization; and (3) psychiatric disorder in either parent. The findings indicated an increased frequency of conduct disorder in disrupted families, most especially in those where the HD parent had an early onset of symptoms and the non-HD parent showed psychiatric disorder. Affective disorder in the offspring was most strongly associated with the presence of similar symptoms in the HD parent. Affective disorder, but not conduct disorder, may be an early manifestation of the HD gene. The implication of these findings for genetic counselling is discussed.

[Comparative study of the clinical features of the schizophrenic process among relatives and children taking the sex factor into account]

The author studied the regular patterns of the clinical manifestations of schizophrenic process in families with affected parents and children and also possible correlation between some parameters of this disease in parents and children with regard to their sex. A comparative analysis of the clinical characteristics of schizophrenia in parents-children pairs showed quite definitely that with further selection of general signs reflecting the most essential characteristics of disease, their homogeneity (homo-type) within the family becomes increasingly evident. A high degree of similarity in a number of clinical characteristics in parents-children pairs associated with their sex was also demonstrated.

Polarity and sex effect in genetic transmission of affective disorders. The single major locus hypothesis

A single major locus model of inheritance that incorporates polarity (bipolar-unipolar distinction) and sex effect was applied to family study data on bipolar and unipolar affective disorders. In the model tested, clinical polarity and sex-related thresholds determined a differential liability to major affective illness, whereby unipolar females and bipolar males represented two extremes on a genetic-environmental continuum. Bipolar males were more deviant, and unipolar females were less deviant genetically than bipolar females and unipolar males. The major locus hypothesis did not provide an acceptable fit to the data. The implications of these findings for genetic and biological research in affective disorders are discussed.

Amish Study, II: Consensus diagnoses and reliability results

Reliability of diagnosis is central to genetic research on mental illness. In the Amish Study of affective disorders, consensus diagnoses were derived by a psychiatric board using the Research Diagnostic Criteria (RDC). To verify the reliability of diagnoses, the authors 1) studied how well board members followed RDC procedures, 2) compared diagnoses based on abstracted medical records with those based on full medical records, 3) compared diagnoses based on the two data sources--abstracted medical records and the Schedule for Affective Disorders and Schizophrenia-Lifetime Version--and 4) studied diagnostic stability to determine validity of diagnosis. The results of these substudies demonstrate a high concordance of diagnosis.

Amish Study, I: Affective disorders among the Amish, 1976-1980

The authors review the goals, methods, sample, and selected epidemiologic findings from a collaborative study of affective disorders among the Amish. This culturally and genetically homogeneous population (N = 12,500) constitutes an excellent research setting for psychiatric epidemiologic and genetic study. Alcoholism, drug abuse, and sociopathy did not complicate the study because they are culturally prohibited. During 1976-1980, 112 active cases of mental illness were identified; 71% received diagnoses of major affective disorder. Equal numbers of men and women received diagnoses of unipolar illness, and slightly more men than women were diagnosed as having bipolar illness.

Psychiatric disorders in the families of borderline patients

The prevalence of psychiatric disorders was studied among the families of hospitalized borderline patients, defined by Gunderson and Singer's criteria, and compared with the families of schizophrenic and depressed control patients. Among borderline probands, 38.3% have a first-degree relative with depression, 25.5% had one with pathological mood swings, and 23.4% had one with "eccentric or peculiar behavior." There was no significant increase in the prevalence of schizophrenia among the relatives of borderline patients. Depression was more prevalent in the families of schizotypal borderlines compared with unstable or mixed-pattern patients. There were no schizophrenic diagnoses among the impaired relatives of schizotypal borderlines. A relationship is suggested between affective disorder and criteria-defined borderline disorders.

Unipolar vs. bipolar mania: a review of 247 patients

Previous studies attempting to support unipolar mania as an entity distinct from bipolar disorder, have produced conflicting results. The present study reports on a chart review of 247 patients admitted to the University of Iowa with a history of at least one manic episode; 87 of these had apparently never experienced a depression. A subgroup of 92 patients, who met DSM III diagnostic criteria and had a history of at least two episodes of affective disorder, were also examined. There were few clinically meaningful differences between patients with unipolar mania and bipolar disorder on demographic, symptomatic, or familial variables. An earlier report that unipolar manics were more likely to be male and have a family history of unipolar depression was not confirmed. Unipolar mania is not supported as a separate entity from bipolar disorder.

Prevalence of affective disorder in a sample of young men

To evaluate the prevalence of depression among young men and the relationship between affective disturbances and drug- or alcohol-use patterns, the author mailed a questionnaire to male students and nonacademic staff, aged 21-25 years, at the University of California, San Diego. Of the 964 men responding, 173 (18%) reported a history of depression, including 69 (7%) whose depressions were serious enough to result in a major life upset. The 318 respondents with some alcohol- or drug- related life impairment (33%) were unevenly distributed among the three depressive history groups, with 44% to 48% of those with depressions also reporting substance problems while the same was true for only 30% of the depression-free men. The author advises clinicians to consider the possibility that a depressive disturbance in young populations may occur in relation to substance intake.

Prevalence of additional psychiatric syndromes among male alcoholics

The prevalence of psychiatric syndromes among 565 male alcoholic VA inpatients was examined using the structured Psychiatric Diagnostic Interview (PDI). Almost two-thirds fulfilled criteria for one or more additional psychiatric syndromes. Subjects positive only for alcoholism reported a significantly later onset of problem drinking and fewer first-degree relatives who abused alcohol than those positive for one or more additional syndromes. The most frequent additional syndromes were affective disorders and antisocial personality. The possible significance of subtyping alcoholics by the presence or absence of coexisting psychiatric syndromes is discussed.

The importance of family history of affective disorder in a group of young men

This study used a structured questionnaire to identify a family history of affective disorder (AD) with associated impairment in life functioning in 8.5 per cent of a group of young men. Those individuals with and without family histories of AD were demographically similar, but the former demonstrated higher rates of having received counseling (28 per cent vs. 7 per cent). A family history of AD was not associated with an increased alcohol or drug problem pattern, but alcoholism was significantly more likely in the fathers and maternal grandfathers of those men with AD family histories. Preliminary evidence suggests that assortative mating and misdiagnoses of AD in individuals demonstrating alcohol or drug problems may help explain the increased prevalence of alcoholism in these families.

Risk factors for suicide in psychiatric patients

In a matched controlled study of 90 psychiatric patient suicides, I found that significantly more of the suicides suffered from chronic schizophrenia (33.3%) or recurrent affective disorder (18.8%) and had made a previous suicide attempt (46.6%). The suicides were young and significantly more were unmarried (84.5%), unemployed (66%), living alone, (55.5%) and depressed (65.5%), and 44.4% had a primary diagnosis of depressive disorder. Of the 75 outpatient suicides, 58% had seen a psychiatrist within the previous week, 61 of the 75 (81.3%) had been admitted in their last episode of contact, and 44% of these suicided within a month of discharge.

Prevalence and characteristics of mania in Chinese inpatients: a prospective study

Of 1,730 consecutive admissions to an acute inpatient psychiatric unit in China, 155 (8.9%) satisfied two sets of research diagnostic criteria for mania, a figure significantly greater than those previously reported in China. The authors studied 108 of these patients and found that their clinical characteristics were similar to those of Western patients; their response to treatment was excellent and their course benign. Their first-degree relatives had a high morbidity risk for affective disorder and a low morbidity risk for schizophrenia. The authors discuss the implications of their findings in China, where the use of lithium is uncommon because of the impression that mania is rare in China.

Schizophrenia's classical subtypes. A family heredity study

A genetic family study of the classical schizophrenic subgroups (33 hebephrenics, 38 catatonics, 69 paranoid schizophrenics) demonstrated a tendency towards differences in the global morbidity risk of schizophrenia (greatest in the relatives of catatonics) and a tendency towards a predominance of homotypical secondary cases. However, as these results are statistically not significant, they cannot be used as arguments in discussing the genetic separation of schizophrenic subtypes.

Failure to find evidence of schizophrenia in first-degree relatives of schizophrenic probands

The first-degree relatives (N = 199) of DSM-III schizophrenic probands (N = 39) were diagnosed from chart data by a rater who was blind to proband diagnosis. No cases of even "possible" schizophrenia were found. This augments the growing evidence that the genetic component in schizophrenia may be less than was formerly suspected.

A study of young men with alcoholic close relatives

In this first stage of a prospective investigation, the author found that 14% of 304 male university students and employees responding to a questionnaire had alcoholic first-degree relatives. While these 44 men had demographic and alcohol-intake characteristics similar to those of the other subjects, they had significantly more alcohol, drug, and psychiatric problems. These findings are consistent with reports of an enhanced risk for future alcoholism in young men with alcoholic relatives. This study demonstrates the feasibility of surveying populations of young men to identify individuals at hypothesized risk for alcoholism and reinforces the need for prospective studies of alcoholism in different groups.

Schizoaffective illness, schizophrenia and affective disorders: morbidity risk and genetic transmission

Data on schizoaffective illness, schizophrenia and affective disorders were gathered on first-degree relatives of schizoaffective probands and matched controls (bipolars, unipolars and schizophrenics). The familial pattern of affective and schizophrenic subtypes of schizoaffective disorder resembled the familial pattern of affective and schizophrenic probands, respectively. The overall risk for the spectrum of schizoaffective and affective disorders was higher among relatives of schizoaffective-manic as compared to relatives of schizoaffective-depressive probands, although the difference fell short of significance. When tested for consistency with multiple threshold hypotheses of genetic transmission, schizoaffective illness did not qualify as either a more extreme form of affective illness nor as a disorder that occupies an intermediate position between bipolar and unipolar disorders or is genetically milder than affective disorder. The implications of diagnostic subtyping for genetic research in the major psychoses were discussed.

Segregation and linkage studies of plasma dopamine-beta-hydroxylase (DBH), erythrocyte catechol-O-methyltransferase (COMT), and platelet monoamine oxidase (MAO): possible linkage between the ABO locus and a gene controlling DBH activity

Measurements of dopamine-beta-hydroxylase (DBH), catechol-O-methyltransferase (COMT), and monoamine oxidase (MAO) along with 27 polymorphic marker phenotypes were available for 162 patients with major affective disorders and 1,125 of their relatives. Levels of enzymes were previously found not to be associated with illness. Pedigree analysis methods for quantitative traits are used to test single-gene hypotheses for segregation of DBH in 32 families with 411 individuals. COMT in 30 families with 351 individuals, and MAO in 50 families with 309 individuals. The familial distribution of both DBH and COMT are consistent with two codominant alleles at the same locus that account for 56% and 59% of the total variance, respectively. MAO activity cannot be shown to be segregating as a single major gene, but a purely nongenetic hypothesis is also rejected. A possible linkage of a locus for DBH to the ABO locus is indicated by a maximum lod score of 1.82 at 0% and 10% recombination fractions for males and females, respectively. A lod score of 0.61 at 0% recombination for a similar analysis in a single large pedigree was reported by Elston et al., making the combined lod score for the two studies equal to 2.32 at 0% recombination.

Family history of suicidal behavior among suicide attempters

Efforts to predict suicide and attempted suicide are hampered by their relative rarity on the one hand and the inadequate specificity of clinical characteristics and relevant antecedent events on the other; that is, these features are found widely among the nonsuicidal as well. In an effort to further understand these phenomena, the authors studied family history of suicidal behaviors (suicide, attempted suicide, and suicide threats) in 127 patients hospitalized following a suicide attempt. Patients with personality disorders (antisocial personality disorder, alcoholism, somatization disorder, and narcotic addiction), comprising 45 per cent of the sample, frequently reported a family history of these behaviors, most notably attempted suicide. Patients with primary affective disorder reported a family history of suicidal behaviors somewhat less often. The diagnoses grouped here as personality disorders (excepting alcoholism) contribute little to the suicide rate, while primary affective disorder contributes substantially. Although further data are needed, it is suggested that a family history of suicidal behavior in primary affective disorder should alert the clinician to heightened suicide risk, while a similar history in nonalcoholics with other psychiatric diagnoses is not particularly significant.

Neurochemical and genetic bases of psychopathology: current status

A review, which does not attempt to be exhaustive, is presented. Evidence for the operation of genetic factors in the etiology of mental disorders, including studies of natural families, twins, and adoptees and their biological and adoptive relatives, is briefly summarized and discussed. Environmental influences are also clearly involved, and observations bearing on their nature are described. Certain neurochemical correlates of psychopathology, particularly those related to chemical neurotransmitters, are discussed. Since schizophrenia and the affective disorders are phenomenological syndromes, it is likely that they represent heterogeneous collections of more specific disorders with common symptomatic features. Attempts to delineate more homogeneous subgroups in these disorders on the basis of morphological or biochemical features have achieved some success, and an example of each approach is described.

Longitudinal, prospective evaluations of intelligence in children at risk

Data are presented from the intellectual assessment of 153 children at two test periods in the St. Louis Risk Research Project. At phase I (1967-72) the Wechsler tests of intelligence were administered to offspring in families with one schizophrenic parent, one parent with affective disorder, one parent with schizoaffective disorder, one physically ill parent, or to offspring with two normal parents (mean age, 8 years). At phase II (1975-78) the intelligence of offspring was tested again at a mean age of 16 years. Differences between children as a function of parental diagnoses were assessed using a repeated measures analysis of covariance. The analyses yielded significant time effects. A time-by-parental-diagnosis effect was found for Verbal IQ, with children of parents with schizophrenia, affective disorder, or physical illness all showing a greater decrease in their scores at the second testing than offspring in the other groups. Offspring of psychotic mothers had lower IQ scores than those of psychotic fathers. Children of schizophrenics and children of schizoaffectives had the lowest stability in IQ scores from the first to the second testing.