Familial rates of affective disorder. A report from the National Institute of Mental Health Collaborative Study

We examined familial rates of affective disorder and related illness in a cohort of 955 probands studied at five centers in the National Institute of Mental Health Collaborative Study of the Psychobiology of Depression: Boston, Chicago, Iowa City, New York, and St. Louis. Six hundred sixteen of these probands were entered into a family study, and 3423 of their first-degree relatives were evaluated. The probands were divided into five diagnostic groups: schizoaffective-bipolar (n = 37), schizoaffective-depressed (n = 18), bipolar I (n = 151), bipolar II (n = 76), and unipolar (n = 330). The relatives of bipolar I probands had a higher rate of bipolar I illness than the relatives of unipolar probands, but the relatives of unipolar probands did not have a higher rate of unipolar illness than the relatives of bipolar I probands. The relatives of probands with schizoaffective disorder, depressed subtype, had a higher rate of schizophrenia than the relatives of schizoaffective-bipolar probands, suggesting that bipolar schizoaffective disorder may be closer to pure affective disorder while schizoaffective depression may be closer to schizophrenia. An increase in bipolar II illness was also observed in the relatives of bipolar II probands. Overall, these data support the widely accepted distinction between bipolar and unipolar affective disorders.

The antisocial and the nonantisocial alcoholic: clinical distinctions in men with major unipolar depression

Depressed, alcoholic men were divided into those with and those without antisocial personality (ASP). The ASP alcoholics had a more severe, cross-sectional clinical picture; they had a higher rate of drug use disorder and more alcohol-related symptomatology. The medical complications of alcoholism were related to the duration of heavy drinking whereas the nonmedical complications (the psychosocial and pathologic-intake problems) were related to ASP, duration of heavy drinking, and their interaction.

Stress-related immune suppression: health implications

This study used a year-long prospective design to assess linkages among distress, immunity, and illness. Serial blood samples were collected from 40 first-year medical students at the first, third, and fifth examination periods, as well as 1 month before each. There were significant decrements in the production of gamma-interferon by concanavalin A-stimulated lymphocytes obtained at the time of examinations. Antibody titers to Epstein-Barr virus (EBV) increased during examination periods, suggesting reactivation of latent EBV and therefore poorer cellular immune control of latent virus. We obtained data that suggest that T-cell killing by memory T lymphocytes of EBV transformed autologous B lymphocytes also declined during examination periods. The activity of a lymphokine, leukocyte migration inhibition factor, normally suppressed during recrudescence of herpes simplex virus type 2 infections, was altered during examination periods and an increase in both plasma and intracellular levels of cyclic AMP associated with examination stress was observed. An increase in the incidence of self-reported symptoms of infectious illness was also associated with examination periods. The data support the linkage between stress-related immunosuppression and health.

Thermography as a diagnostic measure of vasculogenic impotence

There is no correlation between penile-brachial index (PBI) and thermography. While it has been shown to be of significant value in other areas of medicine, thermography is non-contributory to the diagnosis of vasculogenic impotence.

Age-period-cohort analysis of secular trends in onset of major depression: findings in siblings of patients with major affective disorder

Analyses of data from the NIMH-CRB Collaborative Depression Study on age at onset of Major Depressive Disorder (MDD) in 1144 directly interviewed siblings of patients with major affective disorder show a strong secular trend toward increased lifetime risk and earlier onset in successive cohorts of birth since 1930. The proportionate increases in the instantaneous probabilities (hazard) of onset of MDD for each one year difference in year of birth were 5% for brothers and 7% for sisters. Age-period-cohort analysis suggests a powerful period effect may be responsible for this secular trend in rates of MDD, with rates of onset for siblings between 15 and 50 years of age doubling between the 1960s and 1970s. Possible artifacts are investigated.

The familial transmission of primary major depressive disorder

This is a study of the familial transmission of Primary Major Depressive Disorder in the families of 235 probands with this disorder ascertained as part of the NIMH-CRB Collaborative Depression Program. Eight hundred and twenty-six interviewed first degree relatives and 109 spouses are included. Research Diagnostic Criteria have been used and interviews were done using the SADS-L schedule. Prior analyses of these data have established the presence of strong secular trends in the age-of-onset and prevalence of Major Depressive Disorder in these families. Accordingly, new methods for the analysis of family data which incorporate secular variation were developed. Non-parametric Survival Analysis, using the Cox Proportional Hazards Model, guided the formulation of a quantitative family transmission model. Then a family analysis was conducted with the Multifactorial Model of Disease Transmission and the Tau Path Analytic Model. Using the non-parametric approach, only the sibs birth cohort, sex and affectational status of the mother were significantly related to the time of onset of illness in siblings. Proband sex, age-of-onset, and the presence of illness in the father were not significant. The quantitative analysis confirmed that more recently born cohorts of individuals had an increased expected lifetime prevalence and a decreased age-of-onset of Primary Major Depressive Disorder. Assortative mating was present and environmental factors common to siblings did not make a significant contribution to the phenotypic variance. Sex specific transmissibilities were found and the transmissibility in females (t2 = 0.62) was significantly greater than that of males (t2 = 0.28). There was a trend for the transmissibility of Primary Major Disorder to be greater in more recently born cohorts.

In vitro detection of canine distemper virus nucleic acid with a virus-specific cDNA probe by dot-blot and in situ hybridization

A cDNA library was prepared from canine distemper viral (CDV) messenger RNA (mRNA) derived from Vero cells lytically infected with the Onderstepoort strain (Ond) of CDV. A 300 base pair insert was identified which, by Northern blot analysis and Sanger sequence data, was shown to be specific to the nucleocapsid gene. The nucleocapsid (NC) clone was radiolabelled with 32P using nick translation and used to detect viral RNA in both dot-blot and in situ preparations of Vero cells lytically infected with Onderstepoort CDV (Ond-CDV) and immortalized mink lung cells persistently infected with racoon origin CDV (CCL64-RCDV). Dot-blot hybridization results paralleled immunofluorescent results in the lytically infected cells. In 18 persistently infected cell lines from the RCDV-CCL64 parental stock, 13 lines were positive and two were negative on both immunofluorescence and dot-blot hybridization analysis for CDV antigen and RNA, respectively. Viral nucleic acid was detected in these persistently infected cells, where as few as 1.9% of the members of a line were positive on immunofluorescence. A dot-blot autoradiographic signal was obtained in three lines which were negative for CDV antigen. CDV RNA was detected in both lytically and persistently infected cell lines by in situ hybridization, where decreasing probe length was important in increasing the sensitivity of this assay. Viral RNA was detected in over 90% of the lytically infected cells, where only 70% were positive for viral antigen by immunofluorescence.

Stress depresses interferon production by leukocytes concomitant with a decrease in natural killer cell activity

This study addressed the effects of a commonplace stressful event on interferon production and natural killer (NK) cell activity and numbers. The quantity of interferons (IFN) produced by concanavalin A stimulated leukocytes obtained from 40 medical students during examinations was significantly lower when compared with IFN levels produced by peripheral blood leukocytes (PBLs) taken 6 weeks earlier (baseline). In addition, three different assays measuring NK cells also showed significant decrements during examinations when compared with baseline samples. These assays included lysis of MOLT-4 target cells, percentage of anti-Leu-7+ (NK) cells, and percentage of large granular lymphocytes. Self-report data documented the significantly greater distress associated with examinations in comparison with baseline samples. The data have implications for immunosuppressive disorders and stress-associated illnesses.

Tularemic hepatitis presenting as obstructive jaundice

A 56-yr-old man was admitted for evaluation of fever, chills, jaundice, and alcoholic stools. Laboratory studies suggested a cholestatic process. Ultrasonography, computed tomography, and transhepatic cholangiography failed to reveal any abnormalities. Acute infection with Francisella tularensis was confirmed serologically, and a liver biopsy revealed cholestatic hepatitis with focal coagulative necrosis. Recovery was coincident with antibiotic therapy.

The family history approach to diagnosis. How useful is it?

Determining the rate to which various psychiatric illnesses are familial is one widely used method for validating diagnostic categories and determining the likelihood of genetic or nongenetic patterns of transmission. Data for these studies can be collected through direct interview of all available relatives (the family study method) or by obtaining information indirectly from the patient and other family members (the family history method). Information based on direct interview is usually considered to be more accurate, although the family history method permits collection of data on a larger and more comprehensive group of relatives. We explored the extent to which data collected by these two methods were in agreement. In general, the results confirmed the usefulness of the family history method. Although it has some limitations, such as underreporting, it has respectable sensitivity for many major diagnoses when broad but well-specified criteria are used.

The persistent risk of chronicity in recurrent episodes of nonbipolar major depressive disorder: a prospective follow-up

The authors report on the course of illness in 101 patients who were in an episode (the "index episode") of major depressive disorder when they entered a clinical research study, recovered from that episode, and then relapsed into a new episode (the "first prospective episode") of the disorder. They found a 22% probability that these patients' first prospective episode would last at least 1 year, similar to the 21% rate of chronicity previously reported for the index episode. A long prior episode, older age, and low family income were found to predict chronicity in the first prospective episode.

Stress depresses interferon production by leukocytes concomitant with a decrease in natural killer cell activity

This study addressed the effects of a commonplace stressful event on interferon production and natural killer (NK) cell activity and numbers. The quantity of interferons (IFN) produced by concanavalin A stimulated leukocytes obtained from 40 medical students during examinations was significantly lower when compared with IFN levels produced by peripheral blood leukocytes (PBLs) taken 6 weeks earlier (baseline). In addition, three different assays measuring NK cells also showed significant decrements during examinations when compared with baseline samples. These assays included lysis of MOLT-4 target cells, percentage of anti-Leu-7+ (NK) cells, and percentage of large granular lymphocytes. Self-report data documented the significantly greater distress associated with examinations in comparison with baseline samples. The data have implications for immunosuppressive disorders and stress-associated illnesses.

Alcoholism in antisocial and nonantisocial men with unipolar major depression

Men with primary and secondary unipolar major depression were divided into those with and without antisocial personality (ASP). The ASP depressives had a higher rate of alcoholism than the nonASP depressives, and among the nonASP depressives, those with drug abuse had a higher rate of alcoholism than those without drug abuse. The course of depression appeared to be related to the presence of nonaffective psychopathology. Depressed men with additional nonaffective disorders had fewer, but larger episodes than depressed men without, and depressed men with alcoholism had a higher risk of suicide. Our results confirm the close association of alcoholism and ASP and highlight the importance of recognizing nonaffective syndromes in the depressed patient.

Birth-cohort trends in rates of major depressive disorder among relatives of patients with affective disorder

As part of the National Institute of Mental Health-Clinical Research Branch Collaborative Program on the Psychobiology of Depression Clinical Study, 2,289 relatives of 523 probands with affective disorder were interviewed with the Schedule for Affective Disorders and Schizophrenia and diagnosed for major depressive disorder by the Research Diagnostic Criteria. Data were analyzed using life-table and survival methods. The findings suggest a progressive increase in rates of depression in successive birth cohorts through the 20th century and an earlier age at onset of depression in each birth cohort. A predominance of female depressives was found in all birth cohorts but the magnitude of female-male differences fluctuated over the decades. The existence of these trends is reported to stimulate further research. These findings are discussed in terms of possible gene-environment interactions. However, no conclusive causal inferences can be drawn pending further investigation.

Association of alcoholism with antisocial personality in urban men

The association of alcoholism with antisocial personality is important from a research and a therapeutic standpoint. In a sample of urban black men, it was found that those with antisocial personality had a higher rate of alcoholism than those without. In addition, a family history of problem drinking, low educational level, and excessive irritability were also closely associated with alcoholism. The clinical, genetic, and neurophysiological implications of these findings are discussed.

Familial analysis of qualitative traits under multifactorial inheritance

The analysis of family data is described for qualitative multifactorial traits. For such a trait, affectational status is determined by an underlying liability distribution with one or more thresholds. The distribution of families (either selected at random or through probands) is used to estimate sex-specific parent-offspring and sibling correlations in liability and the prevalence in each sex. In contrast to using pairs of relatives, this approach permits estimation of age-specific population prevalences without a control sample. Moreover, by allowing for sex-specific correlations and a correlation between mates, path analysis can be used to model and test various cultural transmission models in addition to polygenic inheritance. Parameter estimation, hypothesis testing, and a goodness-of-fit test for path analytic models are described, and a computer program implementing these procedures is outlined.

Sex-related differences in depression. Familial evidence

After a description of threshold models of familial transmission based on an underlying continuous liability distribution, family data from the NIMH-CRB Collaborative Psychobiology of Depression Program-Clinical are described. No sex differences are found for bipolar illness, whereas female relatives have an increased rate of primary unipolar illness when compared to male relatives. This effect persists when relatives are classified according to recurrence, current illness, onset within the last 10 years, and treatment. Moreover, a cohort effect is present in the data and indicates a sex ratio close to one in the young cohort (less than or equal to 25). We considered the transmission of illness from parent to offspring by using survival analysis to examine the proportion of ill brothers and sisters of probands according to the affection status of parents. A maternal effect is found, with the mother having a greater influence on the liability of offspring of either sex. This is at odds with the notion that males and females have identical liabilities, but females have a lower threshold reflecting acknowledgement of more symptoms, etc. However, the mean difference in liability between the sexes may be due to systematic biological/cultural differences, with parental transmission contributing to variation about their means.

Cyclophilin: a specific cytosolic binding protein for cyclosporin A

Cyclophilin, a specific cytosolic binding protein responsible for the concentration of the immunosuppressant cyclosporin A by lymphoid cells, was purified to homogeneity from bovine thymocytes. Cation-exchange high-performance liquid chromatography resolved a major and minor cyclophilin species that bind cyclosporin A with a dissociation constant of about 2 X 10(-7) moles per liter and specific activities of 77 and 67 micrograms per milligram of protein, respectively. Both cyclophilin species have an apparent molecular weight of 15,000, an isoelectric point of 9.6, and nearly identical amino acid compositions. A portion of the NH2-terminal amino acid sequence of the major species was determined. The cyclosporin A-binding activity of cyclophilin is sulfhydryl dependent, unstable at 56 degrees C and at pH 4 or 9.5, and sensitive to trypsin but not to chymotrypsin digestion. Cyclophilin specifically binds a series of cyclosporin analogs in proportion to their activity in a mixed lymphocyte reaction. Isolation of cyclophilin from the cytosol of thymocytes suggests that the immunosuppressive activity of cyclosporin A is mediated by an intracellular mechanism, not by a membrane-associated mechanism.

Prenatal diagnosis of asphyxiating thoracic dysplasia

A fetus at risk for asphyxiating thoracic dysplasia was studied with ultrasound examination at 16, 18, and 23 weeks of pregnancy. Definite shortness of fetal femora was observed. Radiographic and histologic examinations after pregnancy termination confirmed the diagnosis. Asphyxiating thoracic dysplasia appears to be one of an increasing number of skeletal dysplasias that can be diagnosed prenatally with ultrasound.

Platelet monoamine oxidase (MAO) activity: evidence for a single major locus

Monoamine oxidase (MAO), a mitochondrial enzyme involved in the degradation of biogenic amines, has been associated with psychiatric morbidity. Although twin and family studies have indicated that MAO activity is familial, the exact mode of transmission is unclear. We performed segregation analysis on 154 nuclear families containing 419 individuals using the mixed model, which allows for a single major locus with a polygenic background. We were able to reject a dominant and additive locus with or without a heritable background and a recessive locus without background. The acceptable models were: (1) a codominant model without background where the mean of the heterozygote distribution was 30% of the distance from the low to the high homozygote distributions, and (2) a recessive locus with heritable background. In both cases, the gene frequency for the high-MAO allele is approximately .25--at odds with suggestions that low-MAO represents a genetic marker for a disorder such as schizophrenia with a lifetime risk of only 0.85%. To ensure that results were not artifacts from a familial, skewed distribution, the data were also analyzed after power transformation. In addition, hypotheses were tested using both the joint and conditional likelihoods to examine for possible misspecification of the model with respect to intergenerational differences. Finally, we allowed for non-Mendelian transmission probabilities to provide another class of alternatives against which to test the hypothesis of a major locus. All these approaches provided additional confirmation for the presence of a major locus segregating within these families.

A defense of path analysis in genetic epidemiology

Contemporary models of multifactorial inheritance are described and justified from the perspective of their intended use in genetic epidemiology and their developmental sequence. Substantial empirical data and statistical theory support the practical adequacy of the assumptions of path analysis for most multifactorial traits that show vertical inheritance. The choice of scale for quantitative traits must be considered on an individual basis. From both biological and statistical perspectives, transformations of scale may be more appropriate for analysis than the measurements are themselves. Recent criticism of contemporary models and computational procedures is based on a caricature of path analysis rather than on the method as it is actually practiced. The utility of path analysis is primarily limited by an investigator's biological insight and analytical skill, not by the method's assumptions. Model-free descriptive statistics are inherently inadequate to characterize the stable and autonomous features of the underlying mechanisms that generate observable variation in multifactorial traits. In contrast, path analysis has led to remarkably stable estimates of structural parameters for a wide variety of important biological traits. While exploratory methods can be useful for preliminary data inspection, they cannot substitute for formal tests of hypotheses based on explicit, falsifiable models.

Diagnostic interactions. Alcoholism and antisocial personality

The association of alcoholism with other psychiatric disorders is important from both a research and a therapeutic point of view. In a medically hospitalized inpatient sample, we found a strong relationship between alcoholism and antisocial personality. Controlling for the overlap of diagnostic symptomatology, antisocial subjects still had a significantly higher prevalence of alcoholism than nonantisocial. The antisocial individual was more likely to be exposed to problem drinking, and once exposed, he tended to be more susceptible to developing the full alcoholism syndrome. Gender and a family history of problem drinking also predicted alcoholism. Characterological and neurophysiological correlates of antisocial personality and their relationship to problem drinking are discussed.

A commingling analysis of platelet monoamine oxidase activity

The distribution of platelet monoamine oxidase (MAO) activity is examined in a large cohort of 18-year-olds from a college setting. A mixture of three distributions is needed to describe the data, even when a power transformation is used to remove skewness in the distribution. This is compatible with MAO activity being controlled by a single major locus with a gene frequency of 0.02 for high-MAO activity. Accordingly, it is unlikely that such a locus could serve as a genetic marker for a disorder which is associated with low activity. However, this finding does not rule out the possibility that MAO activity is an associated risk factor in disease.

Reye's syndrome and medication use

Ninety-seven Reye's syndrome (RS) cases in Ohio children with onsets from December 1978 through March 1980 were studied for medication use during their pre-RS illness. They were matched with 156 control subjects for age, race, sex, geographic location, time, and type of illness. Only the use of aspirin was reported by significantly more cases (97%, 94/97) than controls (71%, 110/156) during the pre-RS matched illness. Using a multiple logistic model to control for the presence of fever, headache, and sore throat statistically, the difference in aspirin use remained significant. Conversely, fewer cases (16%) took medications containing acetaminophen than controls (33%). In 87% of the cases receiving aspirin, their maximum daily dosage did not exceed recommended levels, but their doses were higher than those of controls receiving aspirin. No relationship was found between dosage and stage of RS encephalopathy.

Refutation of the general single-locus model for the etiology of schizophrenia

All published studies on the familial incidence of schizophrenia appropriate for testing the applicability of the general single-locus two-allele model are examined under the assumption of a unitary etiology for all schizophrenia. We show that the single major locus model is inadequate to predict the incidence in four classes of relatives of schizophrenic probands (parents, siblings, monozygotic, and dizygotic cotwins). In addition, the observed proportion of affected offspring from dual matings differ significantly from the model's prediction. The lack of an overall fit between the published familial distributions and the monogenic model suggests that a single major locus is insufficient for the etiology of schizophrenia. Further efforts in examining multifactorial models, mixed models, and other transmission models may be fruitful.

Canine parvovirus infection potentiates canine distemper encephalitis attributable to modified live-virus vaccine

Twelve gnotobiotic dogs from 2 litters were allotted to 3 groups. Group A dogs received a modified-live polyvalent (canine distemper, adenovirus type 2, and parainfluenza virus and Leptospira -canicola-icterohemorrhagiae bacterin) vaccine 3 days prior to oral inoculation with canine parvovirus (CPV). Group B dogs received CPV alone. Group C dogs received 1 dose of vaccine only. In none of the 9 CPV-inoculated dogs did clinical signs of CPV infection develop, although high serum antibody titers for CPV developed in all of them. However, in 2 of the 5 CPV-inoculated vaccinates, canine distemper virus encephalomyelitis subsequently developed. The results suggested that CPV exerts an immunomodulating effect on canine immune responses and may be responsible for vaccination failures in dogs.

Influence of vitamins C and B12 on the survival rate of mice bearing ascites tumor

The survival rate of mice bearing P388 leukemia and Ehrlich carcinoma was increased after treatment with a mixture of vitamins C and B₁₂. All the mice receiving the vitamins outlived the control group. At the termination of the experiment, 30 days later, 50% of the treated mice appeared normal and healthy, whereas the remainder showed signs of tumor distention.

Ascertainment bias for non-twin relatives in twin proband studies

When families are ascertained through affected twins, as for example when twin probands are selected from a registry and their non-twin relatives studied, a correction for ascertainment bias is needed. It is shown that probandwise counting (where relatives of doubly ascertained twin pairs are counted twice) is the appropriate method. The bias resulting from pairwise counting is given and depends on the genetic model and on the probability of selecting an affected twin as a proband. For the multifactorial and generalized single major locus models the bias is small, and the problems associated with nonindependent ascertainment are negligible in practice.

Inhibiting effect of dehydroascorbic acid on cell division in ascites tumors in mice

The transplantable murine ascites tumors, P388 leukemia and Ehrlich carcinoma, demonstrated complete inhibition of mitotic activity after treatment with dehydroascorbic acid in mice. Citric acid at the same pH value (2.4), however, showed no diminution of mitoses. Microscopic examination of the stained ascites exudate taken from the mice treated with 10 mg dehydroascorbic acid revealed few tumor cells and a pronounced increase in white blood cells, whereas the ascites tumor exposed to citric acid appeared normal.

Computed tomography in oral and maxillofacial surgery

The use of computed tomography (CT) in oral and maxillofacial surgery is discussed. The CT scan delineates lesions in the oral and maxillofacial complex to aid in planning of surgical treatment. Case examples are presented, and the indications for the use of CT scanning are discussed.

General causal models for sex differences in the familial transmission of multifactorial traits: an application to human spatial visualizing ability

A general multifactorial model is given for the inheritance of traits that exhibit a sexual dimorphism. The model allows for polygenic inheritance, cultural transmission, phenotypic assortative mating, and a common environment of rearing. Several cultural mechanisms are described for which transmission from parent to offspring is sex-dependent and for which many different patterns of sex-specific correlations can result. A special case of the general model is described in which phenotypic differences between males and females are due only to differences in nontransmissible environmental factors and/or genetic factors that do not contribute to variability within a sex. Application of these models to human spatial visualizing ability, using data reported by others, gives an estimate of 45 per cent for the proportion of the variance that is accounted for by transmissible factors. Neither an X-linked hypothesis nor a sex-specific cultural mechanism is required to explain the transmission of spatial ability.

Analysis of behavioral traits in the presence of cultural transmission and assortative mating: Applications to IQ and SES

General linear models of familial resemblance are described which allow for polygenic inheritance, cultural transmission from parent to offspring, phenotypic assortative mating, common environment, and maternal and parental effects. These models use observed phenotypic correlations between multiple classes of relatives and/or correlations between individuals reared in separated and extended family structures to yield maximum likelihood parameter estimates. The models are first applied to American kinship data for IQ, with the variance of IQ partitioned as 30% additive genetic, 29% due to cultural inheritance, 9% due to gene--culture covariance, and 32% due to nontransmissible environment. Under the assumption that the correlations between (nontransmissible) environments of DZ and MZ twins are the same, an approximate treatment of dominance yields an estimate of 23% dominance variation.

Posttraumatic acalculous cholecystitis

Acalculous cholecystitis occurred in six patients after trauma and burns. The majority developed signs and symptoms similar to acute calculous cholecystitis. All were treated by cholecystectomy after traditional conservative treatment failed. All had either gangrenous changes or focal necrosis of the gallbladder. Postoperative recovery was uniform. Acalculous cholecystitis occurs in 0.5% of large series of injured or burned patients. Delayed recognition led to a high mortality, reported as 24% overall with 10% related to gallbladder disease. Although cholecystostomy has been advocated, it appears that cholecystectomy, when feasible, affords the best overall results.