Disorders In First-degree Relatives Research Articles

Personality and Depression: A Commentary

Can J Psychiatry 2008;53(1):3-5 Research on the relation between personality and depression seems to have generated at least as much heat as light as these reviews neatly summarize. Authors of the first article, Dr Jane Foster and Dr Glenda MacQueen,1 point out that it is unclear whether neuroscience has advanced to the point where useful comments on the biological underpinnings of complex traits such as personality can be made, let alone the relation of these traits to depression. In the second article, Dr R Michael Bagby and coauthors2 remind us of the limitations of personality disorder as categories, question their stability over time, and adroitly discuss the many confounders around the relation of personality to depression. The question becomes: Why bother? The answer lies in the potential of the relation to assist us with understanding the etiology of depression and in helping to optimize treatment of depression2 fundamental issues doctors would like to know about any illness. Background Interest in the relation between personality and depression is not new. Ancient classifications focused on temperament with depression largely considered an epiphenomenon. Melancholic temperament was associated with individuals who were moody, pessimistic, and vulnerable to episodic depression. A neurobiological explanation was even offered: an excess of black bile. The idea that personality is intimately tied up with psychopathology has persisted. Kraepelin postulated that a cyclothymic disposition inclined patients to manic-depressive insanity, while Kretschmer considered that cycloids were a forme fruste of manic-depressive psychosis. Psychoanalysts believed that patients with depression had undue interpersonal dependency, obsessionality, and labile self-esteem.3 More recent attempts to classify depression have frequently incorporated personality variables and often attempted to link them to treatment response. Eysenck claimed that psychotic and neurotic depression were related to the underlying personality dimensions of psychoticism and neuroticism.4 Paykel produced a depressive typology with 4 categories: anxious depressives, hostile depressives, young depressives with personality disorder, and psychotic depressives. He reported that the subtypes had a differential response to amitriptlyline.5 Winokur et al6 introduced the concept of depressive spectrum disease defined by the presence of alcoholism or antisocial personality disorder in first-degree relatives. Such patients were deemed less amenable to traditional treatments for depression. Akiskal's typology is outlined by Bagby et al,2 but again links personality, depression, and treatment response. Personality Disorders and Personality Traits In 1980, the separation of personality disorder and depression in DSM-III largely stopped the incorporation of personality variables in the classification of depression. Personality pathology was now seen as a comorbid disorder with its own axis. The view appeared to be that simply diagnosing each disorder was the best conceptualization. This separation, while stimulating research, has also led to stagnation and apparent endless speculation on how common personality disorders are in depressed patients (generally conceded to be very common) and what types of personality disorder are most frequent (this varies depending on the sample studied). In my view, personality disorder categories are so flawed and overlapping that the argument is barely worth pursuing. Similarly, studying the neurobiology and genetics of such flawed phenotypes are unlikely to yield useful results. Interest has therefore increasingly turned to personality traits associated with depression, particularly neuroticism or harm avoidance and negative emotionality. Here the evidence is more consistent. Bagby et al2 conclude that empirical work consistently demonstrates that depressed individuals exhibit elevated scores on neuroticism and have higher negative emotionality. …

Increased Risk of Depressive and Anxiety Disorders in Relatives of Patients With Parkinson Disease

Relatives of patients with Parkinson disease (PD) have an increased risk of PD and other neurologic disorders; however, their risk of psychiatric disorders remains uncertain. To study the risk of depressive disorders and anxiety disorders among first-degree relatives of patients with PD compared with first-degree relatives of controls. In a population-based, historical cohort study, we included 1000 first-degree relatives of 162 patients with PD and 850 first-degree relatives of 147 controls. Both patients with PD and controls were representative of the population of Olmsted County, Minnesota. Documentation of psychiatric disorders was obtained for each relative separately through a combination of telephone interviews with the relatives (or their proxies) and review of their medical records from a records-linkage system (family study method). Psychiatric disorders were defined using clinical criteria from the DSM-IV or routine diagnoses. We found an increased risk of several psychiatric disorders in first-degree relatives of patients with PD compared with first-degree relatives of controls (hazard ratio [HR], 1.54; 95% confidence interval [CI], 1.21-1.95; P <.001). In particular, we found an increased risk of depressive disorders (HR, 1.45; 95% CI, 1.11-1.89; P = .006) and anxiety disorders (HR, 1.55; 95% CI, 1.05-2.28; P = .03). The results were consistent in analyses that adjusted for type of interview, excluded relatives who developed parkinsonism, or excluded relatives who developed both a depressive disorder and an anxiety disorder. These findings suggest that depressive disorders and anxiety disorders may share familial susceptibility factors with PD.

The Familial Risk and HLA Susceptibility among Narcolepsy Patients in Hong Kong Chinese

To explore the familial aggregation and HLA susceptibility of narcolepsy in Hong Kong Chinese by objective sleep measurements and HLA typing. Case control design Twelve narcoleptic probands, 34 first-degree relatives, and 30 healthy controls. N/A. Each subject underwent a standardized nocturnal polysomnogram (PSG), followed by a daytime multiple sleep latency test (MSLT). HLA typing was performed for all subjects. One relative (2.9%) was diagnosed as suffering from narcolepsy with cataplexy. Nearly 30% of the relatives fulfilled the criteria of narcolepsy spectrum disorder (shortened mean sleep latency [MSL] and/or the presence of sleep onset REM periods [SOREMPs]). When using the population data for comparison, the relative risk of narcolepsy in first-degree relatives was 85.3. The odds ratio of narcolepsy spectrum disorder in first-degree relatives was 5.8 (95% CI: 1.2 - 29.3) when compared to healthy controls. There existed 6 multiplex families, in which all 10 relatives with narcolepsy spectrum disorders, including all 3 relatives with multiple SOREMPs, were positive for HLA DQB1*0602. Our study demonstrated a definitive familial aggregation of narcolepsy, narcolepsy spectrum disorders, and possibly cataplexy in Hong Kong Chinese. This familial aggregation supported an inherited basis for narcolepsy spectrum. The tight co-segregation of HLA DQB1*0602 and narcolepsy spectrum disorders might suggest that HLA typing, especially DQB1*0602, at least partly confer the familial risk of narcolepsy. In addition, our study suggested that the subjective questionnaire measurements including Ullanlinna Narcolepsy Scale and Epworth Sleepiness Scale were unable to detect the presence of narcolepsy spectrum disorders among the relatives. A stringent objective measurement-based design for family studies is suggested for future study. Further studies are indicated for the determination of the mode and molecular level of narcolepsy transmission.

Clinical characteristics and treatment response in obsessive-compulsive disorder (OCD) with poor insight: A 3-year prospective follow-up study

The aim of this study was to evaluate the clinical characteristics of OCD patients with poor insight, and the predictive value of poor insight with respect to response to treatment with serotonin reuptake inhibitors (SRIs). One hundred ten patients fulfilling DSM-IV criteria for OCD were included in the study and assessed by standardized instruments. Seventy-nine patients were treated with SRIs and followed prospectively for 3 years. During the follow-up period, the clinical status of each patients was evaluated monthly during the first year and bimonthly thereafter by means of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Hamilton Rating Scale for Depression (HDRS). Twenty-one percent of the patients did not recognize obsessive-compulsive symptoms as unreasonable or senseless. Patients with poor insight had a earlier age at onset, a greater severity of obsessive-compulsive symptoms at intake, a higher rate of schizophrenia spectrum disorders in first-degree relatives and a higher comorbidity rate of schizotypal or obsessive-compulsive personality disorders. At the end of the study, 62% percent of the patients with normal insight responded to SRIs, whereas none of the patients with poor insight was found to be responder. The study provides evidence that poor insight is associated with specific clinical characteristics and treatment failure in OCD. Further studies should aim at identifying additional treatment strategies that are effective in OCD patients with poor insight.

Clinical variables related to antidepressant-induced mania in bipolar disorder

Background The development of mania or hypomania during antidepressant treatment is a serious complication of the clinical management of bipolar disorder (BP). The primary aim of this study was to evaluate the clinical variables related to antidepressant-induced mania or hypomania (AIM) in patients with BP. Methods DSM-IV BP-I or BP-II patients who had had at least one depressive episode treated with antidepressants were considered. Patients were subdivided into two groups according to the presence ( n = 30) or absence ( n = 106) of manic or hypomanic episodes occurring during antidepressant treatment. Possible predictive clinical variables of AIM were considered: gender, diagnostic subtype, age at onset, duration of illness, duration of untreated illness, type of antidepressant administered, number of previous spontaneous hypomanic or manic episodes, number of previous depressive episodes, presence of lifetime suicide attempts, presence of mood stabilizer treatments, presence of psychotic symptoms during spontaneous episodes, family history for psychiatric disorders in first degree relatives. Data were compared between the two groups, with (AIM+) and without (AIM−) antidepressant-induced mania, using Student's t tests and chi-square tests. Results The lack of mood stabilizer treatments during antidepressant therapy (chi-square = 37.602, df = 1, p < 0.001) and the exposure to tricyclic antidepressants (chi-square = 4.901, df = 1, p < 0.05) resulted significantly associated to the development of AIM. Limitations This study was not done under controlled conditions and the relatively small sample studied warrants further replications. Conclusions These results point out the risk of mania induction associated to the use of tricyclic antidepressants in BP patients, mainly in absence of adequate mood stabilizers.

Substance use and other psychiatric disorders in first‐degree relatives of opioid‐dependent males: a case–controlled study from India

To assess the prevalence of substance use and other psychiatric disorders in first-degree relatives of males with opioid dependence compared to normal controls. Observational, case-control study using family history method. A drug addiction treatment centre in northern India. First-degree relatives of 100 male probands with opioid dependence and no comorbidity (n=493) and those of 50 matched probands from normal population (n=254). Measurement Family interview of probands and family members, using the Family Interview for Genetic Studies. The main outcome measure was relative risk (expressed as odds ratio after controlling for confounding variables using logistic regression) of familial aggregation of psychiatric and substance use disorders. First-degree relatives of opioid-dependent males were more likely to have a psychiatric disorder than those of normal controls [adjusted odds ratio (OR) 4.47; 95% confidence interval (CI) 1.97-10.11; P<0.001], especially for opioid use disorders in the brothers (adjusted OR 6.55; 95% CI 1.44-29.88; P=0.015) and for alcohol use disorders in the fathers of the probands (adjusted OR 5.64; 95% CI 2.39-13.24; P<0.001). Other disorders (major depression, chronic psychosis and obsessive compulsive disorder) did not have significant aggregation in the first-degree relatives of opioid-dependent subjects. This study provides further evidence for the higher rates of alcohol and opioid dependence in first-degree relatives of opioid-dependent patients. The exact pattern of this familial aggregation may be influenced by the gender of the relatives and their relation to the proband.

Familial characteristics of autoimmune and hematologic disorders in 8,406 multiple myeloma patients: A population‐based case‐control study

A population-based case-control study was conducted to evaluate risk of developing multiple myeloma (MM) associated with personal history of autoimmune diseases and occurrence of autoimmune and selected hematologic disorders in first-degree relatives. Data were obtained for all (n = 8,406) MM cases diagnosed in Sweden (1958-1998), with linkable relatives, 16,543 matched controls and first-degree relatives of cases (n = 22,490) and controls (n = 44,436). Odds ratios (ORs) were calculated to quantify the risk of MM in relation to personal/family history of 32 autoimmune disorders. Familial aggregation of malignancies was evaluated in a marginal survival model using relatives as the cohort. The risk for MM was significantly elevated among subjects with a personal history of pernicious anemia (OR = 3.27; 2.22-4.83) and individuals with a family history of systemic lupus erythematosus (OR = 2.66; 1.12-6.32). Compared with controls, relative risk (RR) of MM was significantly increased (RR = 1.67; 1.02-2.73) in relatives of cases, particularly relatives of probands aged > or =65 at diagnosis (RR = 2.50; 1.19-5.27). Risks were nearly 4-fold elevated among female relatives (RR = 3.97; 1.54-10.2) and among relatives of female probands (RR = 3.74; 1.58-8.83). MM cases had more cases of monoclonal gammopathy of undetermined significance (MGUS) among their relatives than controls, but the numbers were too small to be conclusive. There was generally no increase in risk of MM in probands whose relatives had hematologic malignancies other than MM. These findings do not support a strong association between personal/familial autoimmune diseases and MM. However, MM itself shows significant familial aggregation, implicating the etiologic importance of this type of hematological neoplasm and perhaps MGUS in germ line genes.

The relationship of neuroticism and extraversion to symptoms of anxiety and depression in the general population

Few studies have investigated the relationship of the personality dimensions of neuroticism and extraversion to the symptoms of depression and anxiety in the general population. A random general population sample (ages 20-70 years), from two Finnish cities was surveyed with the Eysenck Personality Inventory (EPI), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). In addition, questions regarding diagnosed lifetime mental disorders, health care use for psychiatric reasons in the past 12 months, and history of mental disorders in first-degree relatives were posed. Among the 441 subjects who participated, neuroticism correlated strongly with symptoms of depression (r(s)=.71, P<.001) and anxiety (r(s)=.69, P<.001), and somewhat with self-reported lifetime mental disorder (r(s)=.30, P<.001) and health care use for psychiatric reasons in the past 12 months (r(s)=.24, P<.001). Extraversion correlated negatively with symptoms of depression (r(s)=-.47, P<.001), anxiety (r(s)=-.36, P<.001), self-reported lifetime mental disorder (r(s)=-.17, P<.001), and health care use for psychiatric reasons in the past 12 months (r(s)=-.14, P=.004). In multiple regression models, even after adjusting for gender, age, and education, BDI scores were significantly associated with neuroticism, extraversion, and age, whereas BAI scores were associated only with neuroticism. Neuroticism is strongly associated with depressive and anxiety symptoms, and intraversion is moderately associated with depressive symptoms in the urban general population. The relationship of these personality dimensions to both self-reported lifetime mental disorders and use of health services for psychiatric reasons strengthens the clinical validity of these personality dimensions.

Temperament, character and symptoms of anxiety and depression in the general population

Few studies have investigated the relationship of temperament and character, as conceptualized in the Temperament and Character Inventory–Revised (TCI-R), to symptoms of depression and anxiety in the general population. In this study a random sample of subjects (20 to 70 years), in two Finnish cities, were surveyed with the TCI-R, Beck Depression and Anxiety Inventories, plus questions related to diagnosed lifetime mental disorders, health care use for psychiatric reasons during the past 12 months, and history of mental disorders in first-degree relatives. Altogether 347 subjects (38.6%) responded. Of the TCI-R dimensions, Harm Avoidance correlated with symptoms of depression (r s = 0.555, p < 0.001), anxiety (r s= 0.560, p < 0.001), self-reported lifetime mental disorder (r s = 0.272, p< 0.001), health care use for psychiatric reason during the past 12 months (r s = 0.241, p< 0.001) and family history of mental disorder (r s = 0.202, p<0.001). Self-directedness correlated negatively with symptoms of depression (r s = -0.495, p< 0.001), anxiety (r s = -0.458, p < 0.001), lifetime mental disorder (r s = 0.225, p< 0.001) and health care use (r s = -0.135, p = 0.013). Overall, Harm Avoidance and Self-directedness seem to associate moderately with depressive and anxiety symptoms, and somewhat predict self-reported use of health services for psychiatric reasons, and lifetime mental disorder. High harm avoidance may associate with a family history of mental disorder.

Family History of Suicidal Behavior and Mood Disorders in Probands With Mood Disorders

First-degree relatives of persons with mood disorder who attempt suicide are at greater risk for mood disorders and attempted or completed suicide. This study examined the shared and distinctive factors associated with familial mood disorders and familial suicidal behavior. First-degree relatives' history of DSM-IV-defined mood disorder and suicidal behavior was recorded for 457 mood disorder probands, of whom 81% were inpatients and 62% were female. Probands' lifetime severity of aggression and impulsivity were rated, and probands' reports of childhood physical or sexual abuse, suicide attempts, and age at onset of mood disorder were recorded. Univariate and multivariate analyses were carried out to identify predictors of suicidal acts in first-degree relatives. A total of 23.2% of the probands with mood disorder who had attempted suicide had a first-degree relative with a history of suicidal behavior, compared with 13.2% of the probands with mood disorder who had not attempted suicide (odds ratio=1.99, 95% CI=1.21-3.26). Thirty percent (30.8%) of the first-degree relatives with a diagnosis of mood disorder also manifested suicidal behavior, compared with 6.6% of the first-degree relatives with no mood disorder diagnosis (odds ratio=6.25, 95% CI=3.44-11.35). Probands with and without a history of suicide attempts did not differ in the incidence of mood disorder in first-degree relatives (50.6% versus 48.1%). Rates of reported childhood abuse and severity of lifetime aggression were higher in probands with a family history of suicidal behavior. Earlier age at onset of mood disorder in probands was associated with greater lifetime severity of aggression and higher rates of reported childhood abuse, mood disorder in first-degree relatives, and suicidal behavior in first-degree relatives. Risk for suicidal behavior in families of probands with mood disorders appears related to early onset of mood disorders, aggressive/impulsive traits, and reported childhood abuse in probands. Studies of such clinical features in at-risk relatives are under way to determine the relative transmission of these clinical features.

Increased Prevalence of Functional Bowel Disorders in First Degree Relatives of IBD Patients

Increased Prevalence of Functional Bowel Disorders in First Degree Relatives of IBD Patients

Family History of Psychiatric Illness as a Risk Factor for Schizoaffective Disorder

Schizoaffective disorder may be related to both schizophrenia and bipolar disorders, but no population-based studies, to our knowledge, have investigated this association in families. To determine whether a psychiatric history of schizoaffective disorder, bipolar disorder, or schizophrenia among parents and siblings is a risk factor for developing a schizoaffective disorder, and whether a specific pattern of family history of psychiatric illness exists in persons with schizoaffective disorder compared with persons with bipolar disorder or schizophrenia. Register-based cohort study. Denmark. The 2.4 million persons born in Denmark after 1952. Relative risks of the 3 illnesses estimated by Poisson regression. In total, 1925 persons had a schizoaffective disorder, 3721 had a bipolar disorder, and 12 501 had schizophrenia. The relative risk of schizoaffective disorder was 2.76 (95% confidence interval, 2.49-3.06) if a first-degree relative had a history of mental illness compared with a person with no first-degree relatives with such a history. There was an additional risk (95% confidence interval) of 2.57 (2.11-3.13), 3.23 (2.63-3.95), or 1.92 (1.43-2.57) if the first-degree relative had schizophrenia, bipolar disorder, or schizoaffective disorder, respectively, compared with other psychiatric admissions. When bipolar disorder was the outcome, bipolar disorder in first-degree relatives was by far the significantly strongest risk factor. When schizophrenia was the outcome, the significantly strongest risk factor was schizophrenia among first-degree relatives. Schizoaffective disorder is not simply a subgroup of either bipolar disorder or schizophrenia but may be genetically linked to both, with schizoaffective disorder being a subtype of each or a genetic intermediate form.

Prevalence of respiratory disorders in first-degree relatives of panic disorder patients

Background Panic Disorder (PD) patients often report a history of respiratory pathology, such as asthma. It is known that both PD and respiratory disorders, like asthma, run in families. A common diathesis for PD and some respiratory disorders may be present both in PD patients and their first-degree relatives. We examined whether the lifetime prevalence of respiratory disorders is higher in first-degree relatives of PD patients than in first-degree relatives of patients with other anxiety disorders. Methods The lifetime history of respiratory pathology was assessed in 379 first-degree relatives of patients with an anxiety disorder by means of a questionnaire. Results We found the first-degree relatives of PD patients to report more chronic obstructive pulmonary diseases (COPD) in general (24.8%) and asthma (10.5%) in particular than the comparison group (13.2% and 3.3%, respectively). Limitations Our data rely on retrospective self-reports. Conclusions Our findings are consistent with and extend previous studies suggesting a specific association between COPD, asthma in particular, and PD.

Major Depression in Patients with Borderline Personality Disorder: A Clinical Investigation

Borderline personality disorder (BPD) is characterized by a high frequency of comorbidity with major depressive disorder (MDD). This study aimed to compare the clinical characteristics of 2 groups of patients with MDD: those with concomitant BPD and those with other concomitant personality disorders. We assessed 119 outpatients, using a semistructured interview for demographic and clinical features, the Structured Clinical Interview for DSM-IV, Hamilton anxiety and depression scales, the Zung Self-Rating Depression Scale (ZSDS), the Social and Occupational Functioning Assessment Scale (SOFAS), the Sheehan Disability Scale, and the Revised Childhood Experiences Questionnaire. We performed a regression analysis, using the number of criteria for BPD as the dependent variable. Severity of BPD was positively related to the ZSDS score, to self-mutilating behaviours, and to the occurrence of mood disorders in first-degree relatives; it was negatively related to the SOFAS score and age at onset of MDD. Patients with comorbid MDD and BPD present differential characteristics that indicate a more serious and impairing condition with a stronger familial link with mood disorders than is shown by depression patients with other Axis II codiagnoses.

Familial aggregation of schizophrenia‐spectrum disorders and obsessive‐compulsive associated disorders in schizophrenia probands with and without OCD

A substantial proportion of schizophrenia patients also has obsessive-compulsive disorder (OCD). To further validate the clinical validity of a schizo-obsessive diagnostic entity, we assessed morbid risks for schizophrenia-spectrum disorders and OC-associated disorders in first-degree relatives of schizophrenia probands with and without OCD. Two groups of schizophrenia probands [with OCD (n = 57) and without OCD (n = 60)] and community-based controls (n = 50) were recruited. One hundred eighty two first-degree relatives of probands with OCD-schizophrenia, 210 relatives of non-OCD schizophrenia probands, and 165 relatives of community subjects were interviewed directly [59.3% (108/182), 51.9% (109/210), and 54.5% (90/165), respectively], using the Structured Clinical Interview for Axis-I DSM-IV Disorders and Axis II DSM-III-R Personality Disorders and the remaining relatives were interviewed indirectly, using the Family History Research Diagnostic Criteria. Relatives of OCD-schizophrenia probands had significantly higher morbid risks for OCD-schizophrenia (2.2% vs. 0%; P = 0.033) and OCPD (7.14% vs. 1.90%; P = 0.014), and a trend towards higher morbid risk for OCD (4.41% vs. 1.43%; P = 0.08) compared to relatives of non-OCD schizophrenia probands. When morbid risks for OCD, OCPD, and OCD-schizophrenia were pooled together, the significant between-group difference became robust (13.74% vs. 3.33%; P = 0.0002). In contrast, relatives of the two schizophrenia groups did not differ significantly in morbid risks for schizophrenia-spectrum disorders, mood disorders, or substance abuse disorders. A differential aggregation of OC-associated disorders in relatives of OCD-schizophrenia versus non-OCD schizophrenia probands, provides further support for the validity of a putative OCD-schizophrenia ("schizo-obsessive") diagnostic entity.

Morbid risk for psychiatric disorder among the relatives of methamphetamine users with and without psychosis

It is not clear why some methamphetamine (MAMP) abusers develop psychotic symptoms, while others use MAMP regularly over long periods and remain unscathed. We tested the hypotheses that those users who develop MAMP-induced psychosis (MIP) have greater familial loading for psychotic disorders than users with no psychosis. Four hundred forty-five MAMP users were recruited from a psychiatric hospital and a detention center in Taipei, and were assessed with the Diagnostic Interview for genetic studies (DIGS-C) and the Family Interview for genetic study (FIGS-C). Morbid risk (MR) for psychiatric disorders in first-degree relatives was compared between those MAMP users with a lifetime diagnosis of MAMP psychosis and those without. The relatives of MAMP users with a lifetime diagnosis of MAMP psychosis had a significantly higher MR for schizophrenia (OR = 5.4, 95% CI: 2.0-14.7, P < 0.001) than the relatives of those probands who never became psychotic. Furthermore, the MR for schizophrenia in the relatives of the subjects with a prolonged MAMP psychosis (MIP-P) was higher than in the relatives of those users with a brief MAMP psychosis (MIP-B) (OR = 2.8, 95% CI: 1.0-8.0, P = 0.042). The greater his or her familial loading for schizophrenia, the more likely a MAMP user is to develop psychosis, and the longer that psychosis is likely to last.

FAMILIAL AGGREGATION OF IBS IS SPECIFIC TO IBS

Purpose: IBS has been observed to aggregate in families-17% in IBS-relatives versus 7% of spouse control relatives (Gut 2003; 52:1703-7). Whether other functional and non-functional gastrointestinal disorders cluster in families is unknown. Because of the overlap between IBS and other disorders, we hypothesized that there would be an increased frequency of other functional gastrointestinal disorders in first-degree relatives of IBS patients compared with relatives of controls (the patient's spouse). Methods: Patients attending an IBS educational program and residents of Olmsted County, Minnesota who had been coded as IBS on a database and their spouses were mailed a validated self-report Bowel Disease Questionnaire (BDQ) including a somatic symptom checklist and a family information form (FIF). A BDQ was mailed to all first-degree relatives of subjects identified from the FIF. The prevalence of Gastroesophageal Reflux Disease (GERD), Functional Dyspepsia (FD), Functional Constipation (FC), Functional Diarrhea (Fdi), and Functional Bloating (FB), based on standard criteria, were calculated in patient-relatives and spouse control-relatives. Results: The BDQ was sent to a total of 355 eligible relatives, of which 71% responded. Relatives were comparable in mean age, sex distribution, and somatization score. The prevalence of the above disorders in IBS-relatives and spouse-control relatives are shown in the table. Except for FB and FC, the prevalence of GERD, FD, FDi were similar between the two relative groups.TableConclusions: Familial aggregation of IBS had previously been shown in this dataset. Except for bloating, aggregation of other gastrointestinal disorders was not observed suggesting that aggregation of IBS symptoms is specific for IBS cases compared with controls. This suggests that IBS (and FB) may be a distinct entity separate from other functional disorders.

The clinical characteristics of unipolar vs. bipolar major depression in ADHD youth

ObjectiveTo investigate the characteristics of unipolar vs. bipolar depression in youth using a sample of children referred for a study on attention deficit hyperactivity disorder (ADHD). MethodsWe compared children with unipolar depression (N=109) to those with bipolar depression (N=43) using boys and girls (N=280) referred for a study on ADHD. Comparisons were made in characteristics of depression, comorbidity and family history. All diagnoses were made using the KSADS-E. ResultsIn comparison to children with unipolar depression, children with bipolar depression were more likely to have met criteria for depression due to both “sad” and “mad” mood states as stated in the KSADS-E, have severe depression with suicidality, anhedonia and hopelessness. Children with bipolar depression were more likely to have comorbid conduct disorder, severe oppositional defiant disorder, agoraphobia, obsessive compulsive disorder and alcohol abuse, compared to children with unipolar depression. Bipolar depressed children had lower GAF scores and higher rates of hospitalization. Bipolar depression is associated with higher levels of psychiatric disorders in first-degree relatives. ConclusionsIn youth, bipolar depression is distinct from unipolar depression in quality and severity of symptoms, comorbidity and family history. This presentation can aid clinicians in identifying children and adolescents with bipolar disorder.

Family history and psychiatric comorbidity in persons with kleptomania

The current study was constructed to examine the family history and psychiatric comorbidity of a group of persons with kleptomania. Thirty-one subjects with DSM-IV kleptomania were administered the Structured Clinical Interview for DSM-IV (SCID) and the Minnesota Impulse Disorders Inventory (MIDI). The Family History Research Diagnostic Criteria (FH-RDC) were used to collect information about psychiatric disorders in first-degree relatives. Subjects with kleptomania were more likely than comparison subjects to have any lifetime impulse-control disorder (χ 2 = 12.569; df = 1; P < .001) and to have a first-degree relative with an alcohol use disorder (χ 2 = 6.994; df = 1; P = .008) or any psychiatric disorder (χ 2 = 12.056; df = 1; P = .001). Persons with kleptomania appear to have a higher lifetime prevalence of impulse-control disorders and are more likely to have first-degree relatives with alcohol problems than are comparison subjects.

Occult mood disorders in 104 consecutively presenting children referred for the treatment of attention-deficit/hyperactivity disorder in a community mental health clinic.

To ascertain the prevalence of mood disorders among consecutively evaluated prepubertal children presenting for the treatment of attention-deficit/hyperactivity disorder (ADHD) in a community mental health clinic. 104 children received systematic assessments designed to identify individuals meeting the DSM-IV criteria for major depressive disorder (MDD), mania, and ADHD. "Standard" and "modified" criteria for mania were employed. Modified criteria, in an effort to minimize false-positive diagnoses of mania, required the presence of euphoria and/or flight of ideas. A child meeting the criteria for MDD or either set of criteria for mania was categorized as having a mood disorder. Mood disorders in first-degree relatives were assessed using a systematic interview. Data were gathered from 2000 to 2002. Sixty-two children (59.6%) had a mood disorder. Compared with those who did not have a mood disorder, they were 3.3 times more likely (54.8% vs. 16.7%) to have a family history of any affective disorder (p <.0001) and 18.3 times more likely (43.5% vs. 2.4%) to have a family history of bipolar disorder (p <.0001). Twenty (32.3%) of the children with and none without a mood disorder had psychotic features (p <.0001). Compared with those meeting only the standard criteria for mania, those meeting the modified criteria were 9.1 times more likely (69.8% vs. 7.7%) to have a family history of an affective disorder (p <.0001) and 7.3 times more likely (55.8% vs. 7.7%) to have a family history of bipolar disorder (p =.002). Children who presumably have ADHD often have unrecognized affective illness. Our findings support the view that children meeting the modified criteria for mania have veritable bipolar disorder. These findings, which were derived in the course of delivering routine clinical services in a community mental health clinic, are consistent with those obtained in research settings suggesting that children presenting with ADHD often have occult mood disorders, especially unrecognized bipolarity. We suggest that clinicians encountering children with prominent features of ADHD inquire about the presence of euphoria and flight of ideas. We submit that the presence of these "classic" manifestations of mania strongly suggests the presence of occult bipolarity, even if course of illness otherwise markedly deviates from "classic" descriptions.