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Objective: This 5-year follow-up study was designed to explore the factors that might lead to alcoholism in patients with bipolar disorder. Method: The authors studied patients with bipolar illness (70 with alcoholism and 161 without], their relatives, and a comparison group composed of relatives' acquaintances. All were evaluated with versions of the Schedule for Affective Disorders and Schizophrenia, and diagnoses were made according to the Research Diagnostic Criteria. Thirty of the bipolar alcoholic patients whose affective disorder was primary were also compared with 34 whose alcoholism was primary. Results: Alcoholism was more frequent in the bipolar patients than in the comparison subjects. There were no significant differences between the alcoholic and nonalcoholic bipolar patients in family history of alcoholism or affective disorders, suggesting that bipolar illness with alcoholism is not explicable by a family history of alcoholism and that the alcoholism seen in bipolar illness is dissimilar to alcoholism as a primary disorder. Alcoholism associated with bipolar illness was more likely to remit than primary alcoholism. There was no significant difference in family history between the patients with primary alcoholism and those with primary bipolar disorder. The patients with primary alcoholism had significantly fewer episodes of affective disorder during followup, suggesting that their type of bipolar illness was less severe and may have needed the added insult of alcoholism to make it manifest. Conclusions: The study supports the idea that not all alcoholism is primary with a corresponding familial diathesis. Rather, alcoholism associated with bipolar disorder is often a secondary complication

OBJECTIVE Family studies have demonstrated a higher rate of schizoid personality in the families of probands with schizophrenia and a higher rate of paranoid personality in the families of probands with delusional disorder. The authors sought to investigate the familial characteristics of probands with schizoid and paranoid personality disorders and to delineate the clinical characteristics of the two groups. METHOD Records of 351 inpatients with discharge diagnoses that included the term "schizoid personality" or "paranoid personality" were examined to identify patients who met DSM-III-R criteria for schizoid personality disorder (N = 34) or paranoid personality disorder (N = 19). Comparisons were made between the two groups with respect to clinical symptoms, familial characteristics, and longitudinal course. RESULTS The authors found that probands with schizoid personality disorder were hospitalized at an earlier age than probands with paranoid personality disorder, had more intervention before the index admission, and had greater morbidity following the index admission. They also found that descriptors of the two syndromes tended to congregate in the respective family material, but the differences were not statistically significant. Differences in the familial prevalence of schizophrenia were also not statistically significant. CONCLUSIONS These familial data do not support the hypothesis that schizophrenia congregates in the families of probands with schizoid personality disorder. Possible explanations for this finding are discussed.

Of 72 alcoholics who had abstained for a mean of 64 months, 15% had serious, debilitating depressive symptoms, which had begun after a mean of 35 months of sobriety.

The authors identified 259 alcoholic probands and 507 first-degree relatives. Alcoholic relatives of probands with psychotic symptoms were significantly more likely to have psychotic symptoms than those related to probands without psychotic symptoms. This finding suggests separate genetic transmission.