Family History Of Psychiatric Disorders Research Articles

DSM-IV intermittent explosive disorder: a report of 27 cases.

The authors' objective was to provide data regarding the demographic, phenomenological, course of illness, associated psychiatric and medical comorbidity, family history, and psychiatric treatment response characteristics of rigorously diagnosed subjects who met DSM-IV criteria for intermittent explosive disorder. Twenty-seven subjects meeting DSM-IV criteria for a current or past history of intermittent explosive disorder were given structured diagnostic interviews. The subjects' medical histories, family histories of psychiatric disorders, and responses to psychiatric treatments were also assessed. Most subjects described their intermittent explosive disorder symptoms as very distressing and/or highly problematic. All 27 subjects described aggressive impulses prior to their aggressive acts. Of 24 subjects who were systematically queried, 21 (88%) experienced tension with the impulses; 18 (75%), relief with the aggressive acts; and 11 (48%), pleasure with the acts. Most subjects stated that their aggressive impulses and acts were also associated with affective symptoms, particularly changes in mood and energy level. Twenty-five (93%) subjects had lifetime DSM-IV diagnoses of mood disorders; 13 (48%), substance use disorders; 13 (48%), anxiety disorders; 6 (22%), eating disorders; and 12 (44%), an impulse-control disorder other than intermittent explosive disorder. Subjects also displayed high rates of comorbid migraine headaches. First-degree relatives displayed high rates of mood, substance use, and impulse-control disorders. Twelve (60%) of 20 subjects receiving monotherapy with an antidepressant or a mood stabilizer reported moderate or marked reduction of their aggressive impulses and/or episodes. Intermittent explosive disorder appears to be a bona fide impulse-control disorder that may be related to mood disorder and may represent another form of affective spectrum disorder.

Obstetric complications and familial morbid risk of psychiatric disorders.

Obstetric complications (OCs) have been found to occur in higher frequency in patients with schizophrenia. One explanation for this finding is that the genes that contribute to the schizophrenia phenotype also influence the likelihood to experience OCs. If this were true, morbid risk of psychiatric illness should be higher in the first-degree relatives of both schizophrenic and control probands exposed to OCs, compared to probands not exposed to OCs. We set out to test this hypothesis. Information on OCs, blind to family history of psychiatric disorder, was collected retrospectively through maternal interview in 151 psychotic patients and 100 controls. Family history (FH) in relatives of cases (n = 600) and controls (n = 461) was assessed with the FH-RDC and through personal interviews. Tests for associations between family history and OCs were conducted using Cox proportional hazard regression. In the cases, familial morbid risk of affective disorder was greater in those with a history of OCs (hazard ratio (HR) = 1.9, P = 0.007). Analyses examining individual complications revealed associations between FH of affective disorder and pre-eclampsia (HR = 2.9, P = 0.003) and FH of affective disorder and breech presentation (HR = 2.8, P = 0.02), especially when family history in the relatives was confined to affective illness in the mother (HR pre-eclampsia = 4.4, P = 0.009; HR breech-presentation = 4.2, P = 0.008). In controls, affective illness in the mother was not only associated with breech presentation (HR = 7.0, P = 0.01) and pre-eclampsia (HR = 4.4, P = 0.03) but also with other complications. Familial morbid risk of schizophrenia and related psychoses was not associated with OCs. The positive associations between OCs and familial morbid risk of affective disorder suggest that the factors that contribute to familial aggregation of affective symptoms in psychotic patients also influence the likelihood to experience OCs. Although the proportion of OCs that could be attributed to these factors was very small, part of the relationship between family history of affective disorder and psychosis may be mediated by OCs.

P.1.064 Antidepressant theraphy response and age, number of episodes, duration of episodes, and family history of psychiatric disorder

P.1.064 Antidepressant theraphy response and age, number of episodes, duration of episodes, and family history of psychiatric disorder

Neuropsychiatric Manifestations of Right Hemisphere Lesions

A wide variety of neuropsychiatric syndromes are associated with right brain dysfunction, including mania, depression, psychosis, hallucinations, personality changes, anxiety, dissociative states, and altered sexual behavior. This review summarizes the anatomic relationships reported between specific neuropsychiatric syndromes and localized right brain lesions. Information is derived from individual case studies and case series. Most neuropsychiatric syndromes are found to be associated with damage to the limbic system. Disruption of body schema and interpersonal functions mediated primarily by the right hemisphere contributes to the neuropsychiatric disability associated with right hemisphere injury. Nonlesion biologic and sociocultural influences including a family history of psychiatric disorder, personal psychiatric history, and the presence of cerebral atrophy increase the vulnerability to neuropsychiatric morbidity following right brain damage. Investigation of the secondary neuropsychiatric disorders occurring with right brain dysfunction contributes to understanding the pathophysiology of idiopathic psychiatric syndromes.

Pre-morbid psychometric profile of subjects at high familial risk for affective disorder.

Recent observations indicate that a certain pre-morbid personality profile ('autonomic lability', i.e. elevated neuroticism, frequent somatic complaints and increased interpersonal sensitivity) appears to be a valid antecedent of major depression. However, most of these prospective studies used samples drawn from the general population, which limits the power of any observed differences between subjects who developed a depressive disorder during the follow-up period and those who did not. We investigated the psychometric profile of 54 high-risk probands (aged between 18 years and 45 years) without a current or lifetime diagnosis of any psychiatric disorder, but who had first-degree relatives with an affective disorder according to DSM-III-R criteria. Twenty-two control probands, matched for age and gender and without any personal or family history of psychiatric disorders, served as the reference group. As a group, the high-risk probands scored higher than the controls on scales that assessed neuroticism, rigidity, depressive cognitions, vegetative lability and stress. With an individual-orientated approach (cluster analysis), 30 high-risk probands were identified as conspicuous, characterized by elevated rigidity and increased 'autonomic lability'. The remaining 24 high-risk probands showed a psychometric profile very similar to that of the controls. The present findings in 54 probands at high risk for affective disorders not only strongly underline the assumption that the personality trait 'autonomic lability' is a valid antecedent of at least major depression, but also add the personality trait 'rigidity' as a further and potential candidate for a true vulnerability marker for affective disorders.

Trihexyphenidyl (Artane) Dependence: A Controlled Investigation between Users and Abusers

This controlled study aims to identify the socioclinical factors predisposing psychiatric patients to abuse trihexyphenidyl (artane) and to document the extrapyramidal symptoms in artane abusers and users. Thirty patients (n=30), with mainly two major functional psychoses and who were abusing trihexyphenidyl, were compared with 90 artane user patients (n=90), who were matched for both the diagnosis and treatment. Besides a detailed clinical interview, each patient was assessed by using DSM-IIIR criteria, Brief Psychiatric Rating Scale, Simpson and Angus Scale, and Abnormal Involuntary Movement Scale. The analysis of data showed that, compared with users, trihexyphenidyl abusers were significantly characterized by being unmarried, unemployed, smokers and having past and concurrent history of multiple drug abuse, and genetic loading of mental disorders. Both groups of patients were prescribed antipsychotic drugs and trihexyphenidyl on a longer basis. Besides other socioclinical parameters, premorbid personalities, stressful life events and extrapyramidals, including tardive dyskinesias, we did not differentiate between the two groups. Artane abusers, when compared with users, were significantly characterized by less negative psychopathology. However, other psychopathological domains, in particular, the positive symptoms and depression, did not differentiate between abusers and users. In conclusion, patients having these socioclinical profiles tend to develop trihexyphenidyl abuse. The mental health professionals should not prescribe trihexyphenidyl indiscriminately or for a long time to such patients, who indeed require long-term antipsychotic maintenance medications.

Effect of acute tryptophan depletion on behavioral, cardiovascular, and hormonal sensitivity to cholecystokinin-tetrapeptide challenge in healthy volunteers

Recent data suggest that serotonergic (5-HT) mechanisms may mediate the anxiogenic effects of cholecystokinin (CCK)-related peptides. Accordingly, we investigated the effect of lowering plasma tryptophan to the elicitation of behavioral, cardiovascular, and hormonal changes in healthy volunteers challenged with the tetrapeptide CCK agonist, CCK-4. Forty men without personal or family history of psychiatric disorders were randomly assigned to either a tryptophan-free amino acid mixture, which decreases central 5-HT concentrations, or a control mixture. Five hours after administration of the amino acid mixture, all subjects received a single intravenous injection of CCK-4. The main finding of the study was that acute depletion of tryptophan failed to modify the panicogenic and cardiovascular effects of CCK-4, although it did enhance CCK-4-mediated increases in ACTH/cortisol and prolactin secretion. While these findings suggest that at least part of the neuroendocrine action of CCK-4 is mediated through the 5-HT system, the locus of the 5-HT-CCK interaction and the specific 5-HT receptor subtype involved remains to be determined.

Amphetamine use: return of an old scourge in a consultation psychiatry setting

Recreational use of amphetamine and its analogues has increased considerably during the last decade. The aim of this study was to determine possible demographic characteristics of amphetamine users and nonusers who were seen in psychiatric consultations on inpatient medical and surgery wards. The authors examined data from 2,983 patients admitted to the University of California, San Diego, Medical Center and seen by consultation-liaison psychiatrists from January 1989 to June 1995. Amphetamine use was identified by the results of toxicological screening or patients' self-reports. Throughout the interval covered by the analysis, 8.7% of the patients with consultations were current amphetamine users. The percentage of users decreased from 9.1% in 1989 to 4.5% in 1992 but increased after that to reach 15.6% in the first half of 1995. The users were generally younger than the nonusers; they were typically male, white, single, uninsured, and unemployed. In comparison with nonusers, the users were more likely to have a past psychiatric history (outpatient treatment or inpatient admission) and a family history of psychiatric disorder. The users were more often admitted because of suicide attempts, had a higher probability of being HIV-positive, and were overrepresented in the psychiatric consultations requested by the departments of infectious diseases, obstetrics/gynecology, and trauma surgery. The high prevalence of amphetamine-using patients referred for psychiatric consultation is striking. Although young white men were especially likely to be users, there were users in all age groups, in nearly all hospital wards, and with a variety of psychiatric symptoms.

Season of birth and schizophrenia: Sex difference

1. 1. A statistically significant increased risk of schizophrenia for individuals born in winter has been reported. The increase risk is of the order of 5–15%. The seasonal effect is more marked among females. This winter birth effect suggests some environmental agents, probably a neuropathogen one, acting on the foetus. 2. 2. The present study sought to test the environmental damage hypothesis by application of the family history of psychiatric disorder distinction to season of birth data divided according to sex and using a control population. 3. 3. From computer records, all patients admitted to the psychiatric department of Marseilles Timone hospital between January 1984 and December 1989 who satisfied DSM III, DSM III R criteria for schizophrenia were identified. Patients were then classified into two groups : family history of psychiatric disorder versus no family history. Division according to the sex was carried on after two groups were formed. 4. 4. The data show ( 1 ) a significant excess of births in the early months of the year (p < 0.05) for all patients with no family history of psychiatric disorder, (2) a significant excess of births for females (p < 0.05) with no family history. 5. 5. These results provide indirect support for the neurodevelopmental theory of schizophrenia.

Treatment Orientation and Associated Characteristics of North American Academic Psychiatrists

We present data showing the degree to which a "biological-psychotherapeutic" division persists in American psychiatry, and how psychiatrists' treatment orientation is associated with personal and professional characteristics. Almost two thirds of academic psychiatrists who responded to our survey (N = 435) could be classified as either biological (27%) or psychotherapeutic (37%) in orientation, according to the proportion of their caseload to which they provided psychotherapy (< or = 25% vs. > 75%). There appears to have been an increase over the last 35 years in the proportion of psychiatrists who can be classified as biologically oriented and a decrease in the proportion who can be classified as psychotherapeutically oriented, as well as the emergence of a large class of intermediate or "eclectic" practitioners (36%). Several personal and professional attributes were distributed differentially according to treatment orientation. Psychotherapeutically oriented respondents more frequently reported personal histories of psychiatric disorders than did biologically oriented respondents (64% vs. 39%) as well as greater satisfaction with clinical work (81% vs. 53% "very satisfied"). Differences were also found in age, gender, history of personal psychotherapy, family history of psychiatric disorder, history of marijuana use, degrees of involvement in research, teaching and clinical care of patients, and overall work satisfaction, as well as other characteristics.

Epidemiology of Suicide

This article presents the epidemiology of suicide with a special focus on suicides among the elderly, and discusses the known risk factors for suicide within a framework designed to encourage a systematic approach to theory testing and prevention. Throughout the world, suicide rates are highest among the elderly. The risk factors for suicide can be classified as distal or proximal, and, within these broad categories, as sociodemographic, psychiatric, biological, familial, and situational. Mental and addictive disorders are the major risk factors for suicide in all age groups. Other risk factors include male gender, disrupted marital status, prior suicide attempt, reduced brain stem serotonergic activity, family history of psychiatric disorder or suicide, a firearm in the home, and a recent, severely stressful life event. Since risk factors for suicide rarely occur in isolation, prevention efforts are more likely to succeed if multiple risk factors are targeted.

In Quest of Identifying Vulnerability Markers for Psychiatric Disorders by All-Night Polysomnography

The persistence of a depressionlike sleep pattern in fully remitted depressed patients suggests that the pattern is a trait characteristic of sleep measurements. However, in the past, subjects have undergone investigation only after the onset of the disorder, and, therefore, the altered sleep pattern may merely represent a biological scar. We polysomnographically investigated 54 healthy subjects who had no lifetime or current diagnosis of a psychiatric disorder but had at least one first-degree relative with major depression or a bipolar disorder and at least one further close relative with major depression, a bipolar disorder, or a schizophrenic disorder. Twenty unrelated control probands without a personal and family history of psychiatric disorders and 18 unrelated inpatients with major depression served as reference groups. Prior to investigation, all healthy subjects had been free of any prescription and nonprescription drug for at least 3 months. The depressed patients were free of drugs for at least 1 week. All subjects slept for 2 nights in the sleep research unit. The sleep of the second night was recorded and visually scored. Analysis of the individual sleep cycles in these subjects revealed both a reduced amount of slow wave sleep and increased rapid eye movement density in the first sleep cycle. Discriminant analysis showed that 10 subjects (18%) had sleep patterns similar to those of depressed patients. According to our observations, one fifth of the healthy subjects with a high genetic load for psychiatric disorders showed a conspicuous (depression-like) sleep pattern. The follow-up will determine whether this sleep pattern indeed represents a trait marker indicating vulnerability.

Irritable bowel syndrome and family history of psychiatric disorder: A preliminary study

A series of 70 consecutive patients with irritable bowel syndrome (IBS) were interviewed concerning their family history of psychiatric disorders. A series of 60 consecutive patients with major depression (MDE) were also interviewed, as were a control group of 46 relatives of patients with organic brain disease. The results showed that both IBS and MDE groups had a similar, higher prevalence of relatives with psychiatric illness than controls, and that this was due to a higher prevalence of anxiety and depressive disorder in the relatives. The implications of these findings are discussed.

Steroid induced rare bipolar mood disorder

A patient with multiple psychosomatic disorder developed a steroid induced rare bipolar mood disorder (both mania and depression). The "unmasking effect" of steroids and a positive family history of psychiatric disorder as a possible risk factor, hitherto undocumented, is suggested in steroid induced psychosis.

Medical history in women with premenstrual syndrome.

This study was designed to identify significant factors in the medical history of women with premenstrual syndrome (PMS). Medical history variables of 190 women with PMS were compared with those of a group of 182 women without premenstrual symptoms who sought gynecological care (control group). All the participants were carefully selected by interview and designated questionnaires. Women with a past or present psychiatric history were excluded. The results showed that age, number of children, age of menarche, smoking history and family history of psychiatric disorders of the women with PMS and the controls were similar. Women with PMS exhibited a significantly greater frequency of postpartum depression (43% versus 12%), past birth control pill use (91.6% versus 45.9%), alcohol use (39.5% versus 14.8%) and drug use (48.4% versus 14.1%) than did the controls respectively; all p values were < 0.05). Our data suggest an association between these factors and PMS. They should be identified in women with premenstrual complaints during the initial visit, and the roles of these factors in the pathophysiology of PMS need to be further investigated.

Phenylpropanolamine-induced psychosis: Potential predisposing factors

Phenylpropanolamine (PPA) is a sympathomimetic drug contained in numerous over-the-counter and prescription decongestants and appetite suppressants. A range of adverse effects have been reported, including neuropsychiatric reactions in patients known to be taking recommended doses. Given that psychiatric symptoms are not included in the manufacturer's lists of adverse drug reactions, the incidence may be significantly higher. We report a case of paranoid psychosis following use of a decongestant containing PPA and summarize the case report literature of psychiatric adverse effects to PPA in which doses were known and stated to be within recommended guidelines. A pattern of possible risk factors emerges from these reports. These may include 1) symptoms or history of mood spectrum disorder, 2) history of psychosis, 3) female sex, 4) family history of psychiatric disorder. The possibility that a higher incidence of adverse events occurs in a vulnerable population has not been systematically addressed, and seems called for. We recommend that physicians specifically inquire about patients' use of decongestants and diet aids. In half of the above cases, symptoms resolved without the use of antipsychotics.

Obtaining a family psychiatric history: is it worth the effort?

The purpose of this study was to determine whether, for first-degree relatives of patients presenting to a mood disorders clinic, family history information on psychiatric conditions collected by a psychiatrist and incorporated into the patient's medical records is as informative as that gathered during an interview specifically designed to collect family history data. The study group consisted of 472 first-degree relatives of 78 randomly selected index cases from a large mood disorders genetic database. Family history of psychiatric disorders recorded in regular psychiatric medical records ("clinician history"), and data obtained by a genetic counsellor administering specific family psychiatric history questionnaires to patients and multiple family informants ("family history") were compared using a kappa statistic. Good agreement between the two methods on the presence or absence of a psychiatric disorder was found among first-degree relatives of index cases, but poor agreement was found with respect to the presence or absence of a specific mood disorder diagnosis(es) in a relative. The results suggest that a clinician-generated family psychiatric history is sensitive to the presence or absence of a psychiatric disorder when compared to a more structured detailed genetic interview. However, for research purposes, a clinician-generated family psychiatric history of a specific mood disorder diagnosis, without supporting collateral information, may not be reliable for use in supporting a mood disorder diagnosis in a patient and/or his relatives.

Psychiatric Disorders Among American Indian vs. Other Patients With Psychoactive Substance Use Disorders

In this study 100 American Indian (AI) patients and 200 non-AI patients with a psychoactive substance use disorder (PSUD) were studied with special reference to associated psychiatric disorders. Current Axis I diagnoses, previous psychiatric treatment, and family history of psychiatric disorder were compared among these two groups. AI patients from a university hospital clinical population had excess numbers of organic mental disorder (OMD), including both acute OMD (i.e., delirium tremens and alcoholic hallucinosis) and chronic OMD (i.e., alcohol amnestic disorder, alcohol dementia, and trauma-induced OMD). Overall, “dual diagnosis” was more frequent among the AI patients, due primarily to the excess incidence of OMD. The rate of other psychiatric diagnoses was comparable between the two groups. Within the non-OMD psychiatric diagnoses, a few differences did occur. AI patients manifested increased anxiety disorders, whereas non-AI patients had increased eating disorders. Previous psychiatric treatment and family history of psychiatric disorder did not differ between AI and non-AI patients. Treatment implications are based on these data combined with reports from the literature.

Cellular immunity, HLA-class I antigens, and family history of psychiatric disorder in endogenous psychoses

We found an increased lymphocyte proliferation after stimulation with an antigen “cocktail” in 49 schizophrenic patients and 37 patients suffering from affective psychosis, compared with 45 healthy control subjects. On the basis of this and other findings such as increased numbers of CD3 + and CD4 + cells, an increased ration of CD4 +/CD8 + cells, and a reduced level of suppressor cell activity in schizophrenia and endogenous depression, we investigated the influence of the human leukocyte antigen-Class I (HLA-A, HLA-B, HLA-C) system on the altered immune function and evaluated the relationship to immune function of a family history of psychiatric disorders. A cluster analysis of cases with regard to the HLA-Class I antigens was first performed in a group of 133 healthy control subjects, and two immunogenetically different clusters were found; then 86 patients (49 schizophrenics, 37 affective psychoses) for whom immune functional data were available were assigned to the two HLA-I clusters that had been determined in the control subjects. Analyses of variance (ANOVAs) showed no differences in immune function between the two clusters. With respect to the cluster assignment and the family history of psychiatric diseases, a two-way ANOVA revealed significant differences in the lymphocyte response to the antigen cocktail, in the number of CD8 + cells, and in one suppressor cell assay. When patients were compared by ANOVA on the basis of family history of psychiatric disorder, patients with a positive family history showed a significantly higher number of CD4 + cells and a higher CD4 +/CD8 + ratio. Moreover, certain HLA genes, especially HLA-A1, HLA-B8, HLA-B16, and HLA-C2 seemed to be related to the immune function and/or to the immune function and the family history.

Psychopathology in human immunodeficiency virus infection: Lifetime and current assessment

The present study determined lifetime and current psychiatric functioning in a sample of homosexual or bisexual men at various stages of human immunodeficiency virus (HIV) infection in order to address several questions regarding the relationship between psychopathology and HIV infection. HIV + asymptomatic or symptomatic and HIV − homosexual or bisexual men completed self-report measures of psychological and health functioning and participated in structured diagnostic interviews. Additional information regarding HIV-related life events and their potential relationship to onset of disorder and family history of psychiatric disorder were obtained. A high lifetime prevalence of affective and substance use disorder was found, with almost one half of the sample meeting criteria for both disorders. Lifetime affective disorder diagnosis was associated with a positive family history of affective disorder. HIV-related events were most closely associated with onset or recurrence of affective disorder compared with other disorders. Low current rates of psychiatric disorder and levels of emotional distress were found, with no differences in degree of psychiatric adjustment across stage of infection. We conclude that the lifetime prevalence of certain categories of psychiatric disorder is high in both HIV + and HIV − homosexual samples. Increased rates of psychiatric disorders do not appear to be a consequence of HIV infection. However, episodes of illness, particularly affective disorder, may develop following an HIV-related event such as confirmation of infection. Although symptomatic subjects have more somatic difficulties, there appears to be no relationship between stage of illness and level of emotional distress.