Affective Disorder In First-degree Relatives Research Articles

Comparison of the effectiveness of duloxetine in depressed patients with and without a family history of affective disorders in first-degree relatives.

BackgroundIt remains unclear whether or not a positive family history of affective disorders predicts the effectiveness of antidepressant treatment of depression.AimsAssess the relationship of a family history of affective disorders to the efficacy of duloxetine in the treatment of depressive disorder.MethodsSeventy-seven patients with depressive disorder (as defined by the 10th edition of the International Classification of Diseases, ICD-10) were enrolled in the study and treated with standard doses of duloxetine for 12 weeks. Among these patients 37 had a family history of affective disorder in first-degree relatives and 40 did not. The Hamilton Depression rating scale (HAMD-17), Hamilton Anxiety rating scale (HAMA), Side Effects Rating Scale (SERS), Snaith-Hamilton Pleasure Scale (SHAPS), and Beck Depression Inventory (BDI) were assessed at baseline and at the end of the 2nd, 4th, 6th, 8th, and 12th week after enrollment. Repeated measures analysis of variance and logistic regression were used to analyze the association between a family history of affective disorders and the efficacy of duloxetine.ResultsPatients with a positive family history of affective disorders had an earlier age of onset, a longer duration of illness, a higher level of psychic anxiety, and more prominent anhedonia. Repeated measures analysis of variance showed a significant improvement in the severity of depression over the 12 weeks but no differences in the magnitude or speed of improvement between the two groups. Treatment was considered effective (i.e., drop in baseline HAMD-17 total score of ≥50%) in 75.7% of those with a family history of affective disorders and in 77.5% of those without a family history (X2=0.04, p=0.850). ConclusionsFamily history of affective disorders is not associated with the effectiveness of duloxetine in the acute treatment of depressive disorder.

Familial risk and childhood adversity interplay in the onset of psychosis.

BackgroundThe association between childhood adversity and psychosis in adulthood is well established. However, genetic factors might confound or moderate this association.AimsUsing a catchment-based case–control sample, we explored the main effects of, and interplay between, childhood adversity and family psychiatric history on the onset of psychosis.MethodChildhood adversity (parental separation and death, physical and sexual abuse) was assessed retrospectively in 224 individuals with a first presentation of psychosis and 256 community controls from South London, UK. Occurrence of psychotic and affective disorders in first-degree relatives was ascertained with the Family Interview for Genetic Studies (FIGS).ResultsParental history of psychosis did not confound the association between childhood adversity and psychotic disorder. There was no evidence that childhood adversity and familial liability combined synergistically to increase odds of psychosis beyond the effect of each individually.ConclusionsOur results do not support the hypothesis that family psychiatric history amplifies the effect of childhood adversity on odds of psychosis.Declaration of interestNone.Copyright and usage© The Royal College of Psychiatrists 2015. This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY) licence.

Religious involvement in major depression: Protective or risky behavior? The relevance of bipolar spectrum

BackgroundReligiosity has been reported to be inversely related to depression and to suicide as well, but there is a lack of studies on its impact on bipolar disorder and especially, on depressed patients belonging to the bipolar spectrum. MethodsAs part of the EPIDEP National Multisite French Study of 493 consecutive DSM-IV major depressive patients evaluated in at least two semi-structured interviews 1 month apart, 234 (55.2%) could be classified as with high religious involvement (HRI), and 190 (44.8%) as with low religious involvement (LRI), on the basis of their ratings on the Duke Religious Index (DRI). ResultsCompared to LRI, HRI patients did not differ with respect to their religious affiliation but had a later age at onset of their affective illness with more hospitalizations, suicide attempts, associated hypomanic features, switches under antidepressant treatment, prescription of tricyclics, comorbid obsessive compulsive disorder, and family history of affective disorder in first-degree relatives. The following independent variables were associated with religious involvement: age, depressive temperament, mixed polarity of first episode, and chronic depression. The clinical picture of depressive patients with HRI was evocative of chronic mixed depressive episodes described in bipolar III patients within the spectrum of bipolar disorders. LimitationsRetrospective design, recall bias, lack of sample homogeneity, no assessment of potential protective and risk factors, and not representative for all religious affiliations. ConclusionsIn depressive patients belonging to the bipolar spectrum, high religious involvement associated with mixed features may increase the risk of suicidal behavior, despite the existence of religious affiliation.

Clinical and psychosocial predictors of recurrence in recovered bipolar and unipolar depressives: a one-year controlled prospective study

Unipolar and bipolar patients with a chronic illness pattern were investigated to evaluate the relevance of clinical and psychosocial risk factors to predict subsequent recurrence. Self-esteem, social adjustment, social support and attributional style were assessed in 27 recovered bipolar patients, 24 recovered unipolar patients maintained on lithium or antidepressant prophylaxis and 26 healthy controls. They were further interviewed every 2 months in a 1-year period in order to diagnose affective episodes according to Research Diagnostic Criteria. Survival analyses and Cox's regressions demonstrated that being a unipolar patient and showing poor social adjustment were the strongest predictors of the occurrence of affective episodes. Self-esteem, social support, attributional style and clinical characteristics, such as age at illness onset, number of previous episodes or of previous hospitalizations and presence of affective disorder in first-degree relatives, were not found to be risk factors for further recurrence. This study stresses the importance of social adjustment in evaluating the outcome of affectively ill patients maintained on medication prophylaxis.

Affective Disorders in First-Degree Relatives of Adolescent Onset Bipolars, Unipolars, and Normal Controls

Two hundred and fifty-nine first-degree relatives of 23 adolescent bipolars (81 relatives); 26 unipolars (95 relatives); and 24 normal controls (83 relatives) were assessed for the presence of affective disorders, using the family history method. First-degree relatives of bipolar probands were significantly more likely to have a bipolar illness than those of unipolar probands (p = 0.03) and normal controls (p = 0.001). Rates of unipolar depression in first-degree relatives of bipolars and unipolars were not significantly different but differed significantly between bipolars and normals (p = 0.002) and unipolars and normals (p = 0.006). The implications of these findings for clinical work, diagnosis, and research in adolescents with affective disorders are discussed.

Double depression and episodic major depression: demographic, clinical, familial, personality, and socioenvironmental characteristics and short-term outcome.

The authors compared 31 outpatients with double depression to 50 outpatients with episodic major depression. Patients with double depression exhibited significantly greater impairment, more severe depressive symptoms, greater comorbidity, more personality disturbance, lower levels of social support, more chronic strains, and higher rates of bipolar II and nonbipolar affective disorders in first-degree relatives. In addition, in a 6-month follow-up, the patients with double depression were significantly less likely to recover, and a higher proportion experienced hypomanic episodes than did patients with episodic major depression. These data provide strong support for the clinical significance of double depression.

The early-late onset distinction in DSM-III-R dysthymia

DSM-III-R recently introduced early-late and primary-secondary subtypes of dysthymia. The present study explored the validity of the DSM-III-R early-late onset distinction by comparing early- and late-onset primary dysthymics on demographic, clinical and familial variables and short-term outcome. Compared to the late-onset dysthymics, the early-onset group had higher lifetime rates of superimposed major depressive episodes and anxiety disorders, had sought treatment significantly more frequently, had a higher rate of major affective disorders in first-degree relatives, and exhibited higher levels of depression throughout the course of a 6-month follow-up study. These data provide preliminary support for the validity of the DSM-III-R early-late onset distinction in dysthymia.

Mania and DSM-III schizophreniform disorder

The investigations applied DSM-III schizophreniform criteria to 111 patients satisfying Feighner criteria for mania. Thirteen manics (12%) who met the DSM-III criteria were compared to the remaining manics. Manics satisfying DSM-III schizophreniform criteria had more depressive symptoms, but the two groups did not differ significantly on a number of demographic, clinical, and laboratory variables previously found to discriminate schizophrenics from affectives. The morbid risk for affective disorder in first-degree relatives of manics satisfying DSM-III schizophreniform criteria, although not significantly different, was one-third that of the remaining manics. However, the morbid risk for alcoholism in the relatives of the schizophreniform sample was twice that of the other group. The relative groups did not differ in combined morbid risk for alcoholism and affective disorder. The validity for psychiatric research of the DSM-III schizophreniform category is discussed in light of these findings.

Lithium ion transport and affective disorders within families of bipolar patients. Identification of a major gene locus.

We have identified a genetic polymorphism in which one allele results in elevated RBC lithium ion ratios and also contributes to vulnerability to some forms of affective disorders. Interindividual variability in the lithium ion ratio (the ratio of the RBC to the plasma lithium ion concentration) is determined by variability in a lithium ion ratio (the ratio of the RBC to the plasma lithium ion concentration) is determined by variability in a lithium-sodium ion counterflow mechanism. Segregation analyses were conducted on lithium ion ratios in vitro in members of 120 normal families and on both the lithium ion ratio and the history of affective disorder in first-degree relatives of 31 bipolar patients. These analyses provided evidence for an autosomal major gene locus that influences the lithium ion ratio both in members of normal families and in relatives of bipolar patients. The allele at the major locus resulting in elevated lithium ion ratios was associated with an increased likelihood of psychiatric hospitalization among relatives of bipolar patients.

Affective disorder and alcoholism in families of agoraphobics.

We examined the family histories of 68 agoraphobic patients, 35 subjects with miscellaneous-specific phobias, and ten subjects with social phobias. Of the 68 agoraphobic subjects, 26 had a positive family history of affective disorder based on our criteria. Five of the subjects with miscellaneous-specific phobias and none of the social phobic subjects had positive family histories of affective disorder. The difference between these categories is statistically significant. Family history of alcoholism was found to occur significantly more frequently in the agoraphobic vs the miscellaneous-specific phobic group, but not when compared with the social phobic group. A subpopulation in each phobic category was examined for past or present personal depressive illness, but no statistical difference was found. The increased incidence of affective disorder in first-degree relatives distinguishes agoraphobia from other phobic disorders.

Early- and Late-Onset Bipolar Illness

We categorized a sample of 134 bipolar probands into early- and late-onset groups; age 30 years was the cutting point. Early-onset probands had three times the morbidity risk /MR) for affective disorder in first-degree relatives as late-onset probands and a greater proportion of relatives with the more severe, bipolar form. Early-onset patients also exhibited more neuropsychological dysfunction, less frequently had a unipolar manic course, and had a greater MR for alcoholism in first-degree relatives. The two groups did not differ in other clinical or historical characteristics or in the proportion of EEG abnormalities. Age at illness onset is useful in clarifying the genetic basis of affective disorder. The data are consistent with a polygenic or multifactorial model of illness in which the more severe genotype is expressed earlier in life and through the course of illness.

A comparison of unipolar and bipolar depressive illness.

In a study of 40 consecutively hospitalized patients with research diagnoses of endogenous depression, the authors found no difference between unipolar and bipolar depressive patients in the risk for affective disorder in first-degree relatives, proportion of EEG or neuropsychological abnormalities, clinical evidence of the depressive syndrome, or response to doctor's choice of treatment. Bipolar patients had an earlier age of onset and displayed more manic symptoms that did unipolar patients. The authors conclude that the two forms of depressive illness are clinically and genetically homogeneous, are without identifying EEG or cognitive differences, and have an equally good response to somatic treatments.