Unipolar Affective Disorder Research Articles

Anticipation in unipolar affective disorder

Anticipation in unipolar affective disorder

A linkage study of affective disorder with DNA markers for the ABO-AK1-ORM linkage group near the dopamine beta hydroxylase gene

Combining data from a number of studies has provided evidence for a susceptibility allele for affective disorder near to the ABO-AK1-ORM region on chromosome 9q34. The dopamine beta hydroxylase gene locus is also at 9q34. Five multigenerational families with bipolar and unipolar affective disorder were analyzed for linkage with highly polymorphic microsatellite markers from the candidate region. The segregation of the illness in these families was compatible with an autosomal dominant susceptibility allele. Linkage analyses using conservative parameters seemed to provide strong evidence against a major susceptibility allele in this region including the candidate gene dopamine beta hydroxylase in these families.

Resistance to lithium: What alternatives exist?

AbstractLithium is highly valued for the treatment of mania and depression. Resistance may occur to one of its two main indications: firstly for the treatment of acute episodes of mania, and secondly for the prevention of relapse either of bipolar affective disorder (manic depression) or of unipolar affective disorder (recurrent depression).For the management of manic episodes, alternative possibilities include neuroleptics, carbamazepine, electroconvulsive therapy (ECT) and sodium valproate. Neuroleptics are effective, but may precipitate depression. Carbamazepine is effective either alone or as a supplement to the lithium. ECT is an impressively powerful treatment for mania. Valproate appears to be effective but more studies are desirable.Alternatives to lithium in the prevention of relapse of recurrent affective disorders include antidepressants, carbamazepine and ECT. For the prevention of relapses of bipolar affective disorder antidepressants have the disadvantage of increasing the frequency of manic episodes. In unipolar disorder they are a valid alternative to lithium but with some disadvantages. Carbamazepine is effective in the prophylaxis of bipolar affective disorder and should be considered especially in patients with rapid cycling or those with psychotic features.Only open studies are available on ECT and valproate as prophylactic agents. Preliminary work has been carried out on verapamil, flupenthixol, clonazepam, methylene blue, clorgyline, clonidine, tryptophan and 5‐hydroxy tryptamine.

Diagnostic reliability of the history of hypomania in bipolar II patients and patients with major depression

Records of patients who had been systematically evaluated at the Center for Anxiety and Depression were reviewed. Included in this report are records of patients who had a diagnosis of bipolar II or unipolar affective disorder as determined by one of the authors and who also underwent a Structured Clinical Interview for DSM-III (SCID). A second study was undertaken with L.K.T. observing the clinical interview of D.L.D. and both clinicians making a diagnosis for the patient. There was reasonable diagnostic agreement between D.L.D. and SCID for diagnosis of bipolar II disorder. Twelve of 34 patients clinically diagnosed as bipolar II were diagnosed by the SCID as unipolar. These 12 patients failed to demonstrate clinical factors, which could help explain the diagnostic difference between SCID and the clinical diagnosis. There was excellent agreement on 34 patients as to the presence or absence of hypomania, comparing two clinicians. The SCID interview underestimates the diagnosis of hypomania, a condition that can be diagnosed reliably by clinicians trained to make this diagnosis. This finding has some implications for DSM-IV, where there is a proposal for inclusion of bipolar II disorder as a parallel entity with bipolar disorder.

Suicidal behavior in bipolar and unipolar affective disorders: a meta-analysis

A meta-analysis of studies of suicidal behavior in patients with bipolar and unipolar affective disorders found two possible trends: an excess of subsequent completed suicide in unipolar patients and an excess of subsequent attempted suicide in bipolar patients. Suggestions were made for future research

Schizoaffective disorder and affective disorders with mood-incongruent psychotic features: keep separate or combine? Evidence from a family study.

This study investigated whether the distinction between schizoaffective disorder and affective disorders with mood-incongruent psychotic features as described in DSM-III-R is reflected by aggregation of schizophrenia in the families of probands with the former disorder and aggregation of affective disorders mainly among the relatives of probands with the latter type of disorders. The probands were 118 inpatients with definite lifetime diagnoses of DSM-III-R schizoaffective disorder or a major mood disorder with incongruent psychotic features according to structured clinical interviews. Diagnostic information on 475 of the probands' first-degree relatives was gathered through direct interviews (with 80% of the living first-degree relatives) or the family history approach. The rates of affective and psychotic disorders among these relatives were then compared with those among the relatives of a comparison group of 109 interviewed individuals from the general population who were matched on sociodemographic factors to the inpatient probands. With regard to the familial aggregation of schizophrenia, the DSM-III-R distinction emerged as valid. However, the risk of unipolar affective disorders was enhanced in the families of all of the subgroups of patients studied. The unipolar/bipolar distinction in both DSM-III-R diagnostic groups was reflected by distinct patterns of bipolar disorders in the relatives. The results partly support the DSM-III-R dichotomy of schizoaffective disorder and affective disorders with mood-incongruent psychotic features. Although the differences between these two diagnostic groups were significant, the magnitude of the differences remained relatively modest.

Unipolar depression: Diagnostic inconsistency and its implications

Major depressive disorder using Feighner et al. (Arch. Gen. Psychiatry 26, 57-63, 1972) and DSM-III or DSM-III-R criteria has proven to be a heterogeneous diagnosis. It apparently includes a wide variety of clinical conditions. This report, based upon the results of a multi-year blind follow-up of 500 randomly selected psychiatric outpatients focuses on certain problems associated with the diagnosis of primary unipolar affective disorders. At index, 141 patients received diagnoses of primary unipolar depression. At follow-up, only 62 (44%) of these received the same diagnosis, with an additional 14 (10%) receiving a diagnosis of undiagnosed: questionable primary unipolar depression, and 5 (4%) a diagnosis of bipolar disorder. Thus, about 43% received other diagnoses at follow-up: 35 (25%) diagnoses of secondary depression and 25 (18%) other diagnoses without indication of an affective component. Bipolar patients' stability was significantly better for those who were manic at intake.

Personality Traits in Offspring of Parents with Unipolar Affective Disorder: An Exploratory Study

The adolescent offspring of parents with unipolar affective disorder (n = 46) were compared to the offspring of parents with chronic medical conditions (n = 33) and to offspring of normal controls (n = 38) on a questionnaire battery assessing a wide range of personality traits. Offspring of unipolars did not differ from offspring of parents with chronic medical conditions or offspring of normal parents on self-report measures of dependency, self-criticism, neuroticism, introversion, obsessionality, constraint, emotional expressiveness, affective intensity, and attributional style. Overall, these findings fail to support the role of personality as vulnerability markers for mood disorders in at-risk adolescents and young adults. However, some differences on self-report were found between subgroups of offspring.

Onset age independently distinguishes bipolar I and II from recurrent unipolar affective disorder : F.J. McMahon, G.A. Chase, S.G. Simpson, D.A. Myers, O.C. Stine, S.E. Folstein, J.R. DePaulo Johns Hopkins University School of Medicine, Baltimore, MD 21205

Onset age independently distinguishes bipolar I and II from recurrent unipolar affective disorder : F.J. McMahon, G.A. Chase, S.G. Simpson, D.A. Myers, O.C. Stine, S.E. Folstein, J.R. DePaulo Johns Hopkins University School of Medicine, Baltimore, MD 21205

Everyday creativity and bipolar and unipolar affective disorder: preliminary study of personal and family history

SummaryPreliminary new data support the enhancement of ‘everyday’ creativity among those persons with bipolar disorders who manifest milder rather than more severe mood elevations, and among certain individuals who are likely to carry bipolar liability but themselves show no clinical mood elevations – in this case, unipolar depressives with a family history of bipolar disorder, when compared with depressives lacking this history. Creativity was assessed using the lifetime creativity scales (Richards el al, 1988). Underlying mechanisms may be multifactorial and complex. Results suggest that both personal and family history should be considered when making predictions concerning creativity and affective disorders.

Long-latency auditory event-related potentials in schizophrenia and in bipolar and unipolar affective disorder

Long-latency auditory event-related potentials were examined in 96 subjects with schizophrenia, 99 with bipolar affective disorder and 48 with major depressive (unipolar) disorder, and compared with 32 in-patient and 213 normal controls. The latency of the P3 component was significantly greater in the schizophrenic and bipolar subjects compared to other groups. The difference was stable with respect to clinical state at the time of testing and was not due to age differences or the effect of psychotropic medications. The results support the clinical distinction between bipolar and unipolar affective disorders, but also show that P3 change is not specific to schizophrenia and found in bipolar but not unipolar affective disorder.

Using a dummy quantitative variable to deal with multiple affection categories in genetic linkage analysis

Some diseases which have a genetic contribution to aetiology do not demonstrate a clear correspondence between genotype and phenotype. A variety of different clinical syndromes may be thought to reflect the action of a gene, but the probability of affection conditional on genotype may vary between these different diagnostic categories. The normal approach of repeating linkage analyses several times using different diagnoses to define individuals as affected loses power in two ways: multiple testing must be allowed for, and the distinction between more and less extreme forms of affection is lost. It is shown that for fully dominant or recessive autosomal diseases it is straightforward to assign a quantitative value to each diagnostic category to obtain the desired ratio of the likelihoods of affection conditional on the three possible genotypes. The increased power provided by using this quantitative value in linkage analysis is demonstrated by application to simulated pedigrees containing cases of bipolar and unipolar affective disorder.

Valproate for Rapid-Cycling Unipolar Affective Disorder

Valproate for Rapid-Cycling Unipolar Affective Disorder

Diagnosing personality disorders in psychiatric inpatients

This study investigated assumptions made by DSM-III and DSM-III-R regarding Axis I-Axis II associations and sex differences for the 11 personality disorders (PD). A total of 112 patients formed 4 Axis I diagnostic groups: recent-onset schizophrenia (n = 35); recent-onset mania (n = 26); unipolar affective disorder (n = 30); and a mixed diagnostic group (n = 21). The prevalence of PD was determined using the Structured Interview for DSM-III Personality Disorders (SIDP). Schizophrenia was associated with antisocial PD and schizotypal PD; manic disorder was associated with histrionic PD; and unipolar affective disorder was associated with borderline, dependent and avoidant PD. Some of these results were consistent with DSM-III/DSM-III-R postulates. However, there was little support for the DSM-III/DSM-III-R statements on sex differences in the prevalence of PD, except for antisocial PD. The implications of the results for DSM-III/DSM-III-R assumptions are discussed.

Cognitive specificity for marital discord and depression: What types of cognition influence discord?

Three cognitive variables; cognitions related to depression, dysfunctional beliefs about marriage, and attributions of blame for spouses' behavior, were examined as correlates of marital discord or depression among fifty white women who met DSM-III criteria for unipolar affective disorder or dysthymia and were maritally discordant. Marital adjustment correlated with attributions of blame and dysfunctional marital beliefs whereas depression correlated with depressogenic cognitions only. Regression analyses indicated that attribution of blame was most consequential for marital discord while depressogenic cognition was most consequential for depression. Attribution of blame was found to be a plausible mediator of the association between spouses' communication and their marital adjustment. The results suggest that to enhance the impact of individual therapy on marital satisfaction it may be necessary to incorporate a direct focus on the types of cognition most strongly related to marital satisfaction.

Evidence against close linkage of unipolar affective illness to human chromosome 11p markers HRAS1 and INS and chromosome Xq marker DXS52

The genetic basis of various subtypes of the affective disorders has been investigated by family, twin, and adoption studies, as well as by segregation and linkage analysis. Linkage analyses of bipolar disorder with the chromosome 11p15 DNA markers HRAS1 and INS, and the chromosome Xq28 markers for color blindness and G6PD have been reported. We have used restriction fragment length polymorphisms as markers to examine linkage in three extended families with unipolar affective illness, ascertained through probands with either recurrent unipolar or bipolar II illness. Using an inclusive definition of the affected phenotype, linkage could be excluded up to 28cM around the HRAS1-INS linkage group on chromosome 11p15, and up to 5cM around the DNA marker DXS52 on Xq28. Negative linkage results were also obtained for two more restrictive definitions of affective illness. Thus, we find no evidence for the involvement of the chromosomal regions 11p15 and Xq28 with unipolar affective disorder in these three families.

Outcome in unipolar affective disorder after stereotactic tractotomy

Outcome in unipolar affective disorder after stereotactic tractotomy

The comparative cognitive side‐effects of lithium, carbamazepine and combined lithium‐‐carbamazepine in patients treated for affective disorders

AbstractThe cognitive side‐effects of lithium, carbamazepine (CBZ) and combination CBZ and lithium were compared in a crossover double‐blind study. The CBZ range was 17–26 Mmol/1 and the lithium range 0·41–1·10 mmol/1. Twelve subjects (seven females, five males), five with bipolar and seven with unipolar affective disorders, were randomly distributed to one of three group; the order of the conditions was different for each group, whereby each condition was tested in each of the three time phases of the study. The group varied according to the order of the three drug conditions. From measures of memory, attention and perceptuomotor functioning two measures showed significant differences between drug conditions. A tracking task showed impairment in the combined CBZ‐‐lithium condition compared to the single administration of either drug. A memory task testing cued recall for prose was performed better in the CBZ group; results were not confounded by correlations with self‐ratings of mood.

Assortative Mating in Affective and Anxiety Disorders

We studied 1090 subjects who were consecutively interviewed by one of the authors in an outpatient setting. Data regarding marital status and psychiatric illness in spouses had been systematically obtained during the interview. Our data suggest that patients with bipolar illness are less likely to marry than patients with unipolar affective disorder and that women patients with anxiety disorders are less likely to marry than women patients with unipolar affective disorders. Data regarding assortative mating suggest that men with bipolar illness are more likely to have affectively ill wives than controls. No increase in assortative mating was demonstrated for men or women patients with anxiety disorders. The implications of these findings are discussed, and the replication of these findings by a blind family method would be of interest.

Gender Differences in Affective, Schizoaffective, and Schizophrenic Disorders

This study examines gender differences in the clinical profiles and long-term outcomes of chronic DSM-III Axis I psychotic inpatients from the Chestnut Lodge followup study. Diagnostic groups include schizophrenia, schizoaffective psychosis, and unipolar affective disorder. Sex differences were frequent, especially in schizophrenia. Females with schizophrenia, for example, had superior premorbid social, sexual, and marital adjustments. They presented at index hospitalization with more depression, self-destructive behaviors, and troubled interpersonal relationships. Their long-term outcomes were better than males in terms of social activity, work competence, time symptomatic, substance abuse, and marital and parental status. Baseline gender differences were comparatively sparse for the schizoaffective and unipolar cohorts. Outcome differences were virtually nonexistent among the schizoaffective patients but unipolar females received better ratings than males in work competence and substance abuse. Females had a later onset of illness and males presented with more antisocial behaviors across all three diagnostic groups. Results highlight the importance of analyzing data by gender in studies of the psychotic disorders.