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Objective: This study used an adoption study design to separate genetic from environmental factors in the etiology of depression spectrum disease, a type of major depression characterized by families in which male relatives are alcoholic and females are depressed. The genetic etiology hypothesis of depression spectrum disease proposes that an alcoholic genetic diathesis predisposes to depression in females but alcoholism, not depression, in males. Method: The study examined 197 adult offspring (95 male and 102 female) of alcoholic biological parents and used logistic regression models to determine the contribution to major depression in male and female adoptees that could be explained by the genetic alcoholic diathesis combined with an environmental factor that was characterized by psychiatrically or behaviorally disturbed adoptive parents. Results: Major depression in females was predicted by an alcoholic diathesis only when combined with the disturbed adoptive parent variable. The same regression model failed to predict depression in males. Other possible environmental confounding factors contributing to an increased chance of depression were found in females: fetal alcohol exposure, age at the time of adoption, and a family with an adopted sibling who had a psychiatric problem. These variables did not diminish the significance of the prediction of depression with the alcohol genetic diathesis and disturbed parent model. Conclusions: The results show that a genetic factor is present for which alcoholism is at least a marker, and which exerts its effect in women as a gene-environment interaction leading to major depression. This finding suggests that an important etiologic factor in depression spectrum disease is gene-environment interaction.

Objective: This study used the concept of diagnostic stability to examine the validity of three subtypes of major depression. Method: Patients with major depressive disorder (N = 424) were assigned baseline diagnoses according to structured interviews and the Research Diagnostic Criteria. Follow-up evaluations took place at 6-month intervals over the next 5 years and annually for an additional 3 years. During this period 424, 246, 163, and 96 of the patients who had recovered from the index episode had one, two, three, and four recurrences, respectively, of major depressive disorder. The kappa statistic was used to quantify the likelihood that patients with the psychotic, agitated/retarded, or endogenous subtype of depression in a given episode would again manifest that subtype in subsequent episodes. Results: The psychotic subtype showed the most enduring diagnostic stability across multiple subsequent episodes. Even after three intervening episodes, patients with baseline psychotic major depression were five times more likely to develop a psychotic depression than were other depressed patients. For all three subtypes, diagnostic stability was greater for contiguous episodes than for noncontiguous episodes. Psychotic, agitated/retarded, and endogenous subtypes showed significant stability after control for the bipolar/unipolar and primary/secondary distinctions. The endogenous subtype was stable among patients with primary depression but not among those with secondary depression. Conclusions: The psychotic subtype was the most valid of the subtypes tested from the perspective of diagnostic stability. The fact that stability across adjacent episodes exceeded stability across more distantly spaced episodes may reflect state-dependent determinants, and these are likely to vary by subtype.

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, familiar 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.

Objective: Patients with bipolar disorder differ from patients with unipolar depression by having family histories of mania with an earlier onset and by having more episodes over a lifetime. This study was designed to determine whether additional aspects of course of illness, the presence of medical diseases, childhood traits, and other familial illnesses separate the two groups. Method: In a large collaborative study, consecutively admitted bipolar and unipolar patients were systematically given clinical interviews. Data were collected on medical diseases and childhood behavioral traits. Systematic family history and family study data were also obtained. The patients were studied every 6 months for 5 years. Results: The group of bipolar patients had an earlier onset, a more acute onset, more total episodes, and more familial mania and were more likely to be male. These differences were relatively independent of each other. The bipolar patients were also more likely to have shown traits of hyperactivity as children. The unipolar patients had a significantly greater number of lifetime medical/surgical interventions than the bipolar patients, even when age was controlled. Alcoholism was more frequently found in the families of the bipolar patients, even when alcoholism in the probands was controlled; however, this difference was not significant. Conclusions: This study supports the usefulness of distinguishing between bipolar and unipolar patients in treatment and research studies.

Objective: Anxiety symptoms often appear within episodes, but their significance is uncertain. This study sought to determine whether they indicate the coexistence of a separate disease process and whether they have prognostic significance. Method: A series of patients with primary depression who entered a follow-up and family study included 37 who also had obsessions or compulsions, 93 who had panic attacks, 101 who had phobias, and 196 who had none of these anxiety syndromes. Each of the overlapping groups defined by the presence of a specific anxiety syndrome was compared to the group that had none of these syndromes with respect to baseline demographic, phenomenological, and historical features, illness rates among directly interviewed relatives, and diagnostic stability and clinical outcome at semiannual follow-ups over a period of 5 years. Results: Depressive symptoms at intake were more longstanding and severe among patients with specific anxiety symptoms, and these patients went on to experience more depressive morbidity during the ensuing 5 years. The development of autonomous anxiety disorders was rare, however, and specific anxiety syndromes in the probands did not increase risks for the corresponding disorders among relatives. Conclusions: When restricted to episodes of major depression, anxiety syndromes appear to be prognostically significant epiphenomena rather than indicators of an additional disorder.

Results of studies examining relationships between depression and familial alcoholism have been inconsistent. However, many studies do demonstrate that females diagnosed with depressive disorder who come from alcoholic families tend to have more marital and sexual problems and more generally unstable lifestyles than other depressed patients. To further explore the relationships between major depression and familial alcoholism, 723 primary relatives of 326 nonalcoholic patients diagnosed with major depression were interviewed, and their diagnoses were compared with those of 469 relatives of nondepressed comparison subjects who served as a control group. Subjective personal information relayed by the depressed patients and controls, as well as information gathered from relatives, was assessed. Analysis of the data revealed significantly more alcoholism in families of depressed women than in families of control subjects. Families of depressed men did not demonstrate any more alcoholism than those of control subjects. It is not yet known whether associations between familial alcoholism and depression in women are genetic in nature. It is considered likely that interactive effects of genetic and environmental factors, such as difficulties inherent in living with an alcoholic, contribute to this association. (Consumer Summary produced by Reliance Medical Information, Inc.)

There has been little research into depression in individuals with a past history of alcoholism. The majority of studies that have looked at rates of depression in alcoholics suggest a co-occurrence of 30 to 60 percent, but the subjects of such studies have been active alcoholics, who have responded poorly to tricyclic antidepressant drugs. To assess the relevance of a history of alcoholism (no current use) in elderly persons who are depressed, a study was conducted using 58 males hospitalized for depression. Mean age of those with a history of alcoholism (16 patients) was 57.7 years, while that of those without a history (42 patients) was 62.5 years. Subjects were interviewed and their clinical records were reviewed; three to five years later the subjects were interviewed regarding their incidence of illness during the period since discharge. The results suggest that males with a history of alcoholism tend to suffer from depression that is exogenous in nature (i.e., a reaction to a stressor as opposed to strictly a biochemical change). Treatment of such depression is less aggressive. However, the pattern of recurrence tends to be more chronic among these individuals than among those with more severe depressions but without an alcoholic background. Despite the tendency toward chronic depressive symptoms, there was only a small reversion back to drinking behavior during the study period. Several possible interpretations of the data are suggested, but it is important to note that this is an isolated sample with many variables unaccounted for. (Consumer Summary produced by Reliance Medical Information, Inc.)