The Iowa 500: familial and clinical findings favor two kinds of depressive illness

Gender differences in symptomatic profiles of depression: results from the São Paulo Megacity Mental Health Survey

BACKGROUND

Few studies have investigated symptomatic subtypes of depression and their correlates by gender.

METHODS

Data are from the São Paulo Megacity Mental Health Survey. Symptom profiles of 1207 subjects (864 women; 343 men) based upon symptoms of the worst depressive episode in lifetime were examined through latent class analysis. Correlates of gender-specific latent classes were analyzed by logistic regression.

RESULTS

For both men and women, a 3-class model was the best solution. A mild class was found in both genders (41.1% in women; 40.1% in men). Gender differences appeared in the most symptomatic classes. In women, they were labeled melancholic (39.3%) and atypical (19.5%), differing among each other in somatic/vegetative symptoms. The melancholic class presented inhibition and eating/sleeping symptoms in the direction of decreasing, whereas the atypical class had increased appetite/weight, and hypersomnia. For men, symptoms that differentiate the two most symptomatic classes were related to psychomotor activity: a melancholic/psychomotor retarded (40.4%) and agitated depression (19.6%). The highest between-class proportion of agitation and racing thoughts was found among men in the agitated class, with similarity to bipolar mixed state.

LIMITATIONS

Analyses were restricted to those who endorsed questions about their worst lifetime depressive episode; the standardized assessment by lay interviewers; the small male sample size.

CONCLUSIONS

The construct of depression of current classifications is heterogeneous at the symptom level, where gender different subtypes can be identified. These symptom profiles have potential implications for the nosology and the therapeutics of depression.

Predictive value of thought disorder in new-onset psychosis

OBJECTIVE

This research addresses the relationship of formal thought disorder in the early stages of psychotic illness to the long-term outcome of mental health many years later. The specific topic of concern was to evaluate the prognostic significance of thought disorder on the severity of psychosis over time.

METHODS

Subjects with new-onset psychosis were evaluated on a variety of measures including education, physical health, Brief Psychiatric Rating Scale scores. They were also given the Thought, Language, and Communication Scale to evaluate thought disorder. Subjects were interviewed again at 10 and 20 years to evaluate variations in outcome. Appropriate statistical methods were used to evaluate changes in the level of functioning over time.

RESULTS

Thought disorder was not unique to schizophrenia. Bipolar patients presented with significant positive thought disorder at the onset of psychosis. Overtime positive thought disorder gradually improved in most patients. Negative thought disorder was more persistent, especially in subjects with schizophrenia. Initial psychosis with thought disorder characterized by poverty of content seemed to be associated with poor long-term outcome.

CONCLUSION

Formal thought disorder can predict outcome in some cases of psychosis. Not all types of thought disorder have the same prognostic implication. Positive forms of thought disorder (pressured speech, tangentiality) had no significant predictive value. Negative thought disorder (particularly poverty of speech and poverty of content) tend to predict a chronic, more unrelenting course of illness.

Association of a D2S2944 allele with depression specifically among those with substance abuse or antisocial personality

Associations have previously been reported between a 124-bp allele at D2S2944 and recurrent, early-onset depression in women. These earlier reports also noted but did not emphasize a possible association between this allele and alcohol-specific depression. We have analyzed the Iowa Adoption Study data to test this association. D2S2944 allele typing was available for 247 subjects from the Iowa Adoption Studies. Information on lifetime affective, alcohol, drug, and antisocial personality (ASPD) disorders was available from a structured interview. We used logistic regression to analyze adjusted and interactive D2S2944 associations with depression. Controlling other risk factors, the 124-bp allele had a strong association with DSM-IV major depression specific to those with histories of alcohol abuse/dependence and/or ASPD. (Overlap between the two prevented further specification of the interaction.) The association was not gender-specific and was not limited to alcohol-related depressive episodes. This relationship appears stronger than the D2S2944 association previously reported for early-onset depression in women. We note that, in combination with additional liabilities towards depression in women and alcoholism/sociopathy in men, the 124-bp allele may provide a basis for the phenomenon of depressive spectrum illness proposed by Winokur.

Psychomotor agitation: poorly defined and badly measured

BACKGROUND

Psychomotor agitation is commonly associated with various psychiatric disorders. This article reviews the definition and measurement of agitation over the past 100 years.

METHODS

Definitions and descriptions of agitation were taken from dictionaries of etymology, medicine and psychiatry, and from psychiatric textbooks. A systematic MEDLINE (1966-1996) search of 'psychomotor', 'agitation', and 'restlessness' was conducted. This was augmented by a search for other relevant references cited in the articles identified by MEDLINE.

RESULTS

The definition of psychomotor agitation has varied in ambiguous and contradictory ways, both over time and in contemporary writings. Tools developed to measure agitation are either too unreliable, or else reflect this conflict of definition and are not comparable.

CONCLUSIONS

A preferred definition of agitation is proposed which takes into account both theoretical and empirical data. This has implications for further research into psychomotor agitation in classification of and treatment response in affective disorders, old age psychiatry and the evaluation of putative anti-agitation drugs.

A novel arylsulfatase A protein variant and genotype in two patients with major depression

A new, 'diffuse, multiple banding', electrophoretic variant of arylsulfatase A protein was found in two patients with major depression. Protein analyses showed that this variant and the normal enzyme differed in amino acid sequence and/or post-translational modifications unrelated to phosphate groups and oligomannose glycans. Analysis of the arylsulfatase A genes from a subject with the new variant identified three mutations; one gene had the two mutations associated with arylsulfatase A pseudodeficiency, and the other had a G to T transversion which changes a tryptophan to cysteine in the protein. These mutations result in an arylsulfatase A protein heteromer with diffuse electrophoretic banding. The possible association of these mutations with major depression is discussed.

Personality disorders: conceptual issues and responsibility

The historical roots of the concepts of abnormal personality, social deviance, delinquency and penal responsibility are described, demonstrating that former concepts of psychopathic personality often included negative social evaluations. Modern classification systems such as DSM-III-R and ICD-10 prefer a behavior-oriented definition of personality disorders, which increases reliability but may lead to a reductionistic and purely criteriological assessment of personality. A checklist for the assessment of personality disorders (AMPS) according to ICD-10 and DSM-III-R is presented, including four subaffective forms derived from the typology of personality disorders described by Kurt Schneider and Kretschmer. To justify statements of diminished legal responsibility or irresponsibility under the German Penal Code, a differentiation between psychopathological phenomena in personality disorders and pure social deviance is needed. The three notions of psychopathy, sociopathy and dissocial behavior are suggested to guide necessary decisions concerning prognosis and therapy chances.

Relevance of early age-of-onset in genetic studies of bipolar affective disorder

Early age-of-onset appears to predict higher familial loading in bipolar affective disorder. This finding, coupled with ongoing attention to the importance of genomic heterogeneity for segregation and linkage analyses, underscores the value of research on juvenile samples. This research is reviewed, and implications for future research on genetic classification of bipolar illness are noted.

Depression before and after age 65. A re-examination

Systematic and detailed psychopathological examination of 400 consecutive primary major depressives failed to confirm common clinical stereotypes which ascribe greater somatisation, hypochondriasis, agitation, psychotic tendencies, and chronicity to old age. Those above 65 were more likely to suffer from single episodes of depression that were often precipitated, whereas subjects whose illness began earlier were more likely to express depression as part of a recurrent unipolar or bipolar disorder, with higher rates of affective temperamental pathology and familial affective illness. The acute clinical picture was relatively uniform in older and younger depressives and, taken together with the other findings, tends to favour a spectrum model of primary mood disorders.

A video analysis of the non-verbal behaviour of depressed patients before and after treatment

Using videotaped interviews of depressive in-patients, which were recorded on day 0 and day 21 of antidepressive pharmacotherapy, the behavioural structure of the syndromal main aspects, retardation and agitation, was analysed. This analysis was done on the basis of non-verbal behaviour only. A factor analysis was carried out on the observational data. Three independent factors, constituting together the clinical picture of endogenous depression, could be defined: one factor of retardation and two different factors of agitation. The importance of such non-verbal analyses for a more differentiated diagnostic evaluation, on the one hand, and to provide more insight into the diagnostic process as such, on the other, is pointed out. Additionally it was found that syndromal complexity decreases in a characteristic manner along with clinical improvement.

Psychomotor retardation and agitation in depression. Relationship to age, sex, and response to treatment

Patients with primary affective disorder who had either psychomotor agitation alone or psychomotor retardation alone were studied. Compared to psychomotor retardation, psychomotor agitation appears to be seen more frequently in women, older patients, and individuals who have a late onset to their illness. In addition, those with agitation alone appeared to have a better and faster response to electroconvulsive therapy.

Mania and DSM-III schizophreniform disorder

The investigations applied DSM-III schizophreniform criteria to 111 patients satisfying Feighner criteria for mania. Thirteen manics (12%) who met the DSM-III criteria were compared to the remaining manics. Manics satisfying DSM-III schizophreniform criteria had more depressive symptoms, but the two groups did not differ significantly on a number of demographic, clinical, and laboratory variables previously found to discriminate schizophrenics from affectives. The morbid risk for affective disorder in first-degree relatives of manics satisfying DSM-III schizophreniform criteria, although not significantly different, was one-third that of the remaining manics. However, the morbid risk for alcoholism in the relatives of the schizophreniform sample was twice that of the other group. The relative groups did not differ in combined morbid risk for alcoholism and affective disorder. The validity for psychiatric research of the DSM-III schizophreniform category is discussed in light of these findings.

Common genetic mechanisms in alcoholism and psychiatric disorders: negative evidence from a study of ethnic group patients

Alcoholism in the male relatives of patients with various (nonalcoholic) psychiatric disorders is consistently elevated above population risk. Over the years, this finding has given rise to theories which propose that some forms of alcoholism are attributable to the pleiotropic expression of genes underlying these disorders. This mechanism was tested in the fathers of patients from ethnic groups associated with culturally suppressed alcohol abuse where it was predicted that decreased alcoholism would be substituted for by increased psychiatric disorder. Results, however, failed to support such a mechanism. Other explanations of this elevated alcoholism were considered.

The Iowa 500: field work in a 35-year follow-up of depression, mania, and schizophrenia

This paper reports a follow-up and family study being carried out at the University of Iowa College of Medicine on primary affective disorders and schizophrenia in patients hospitalized thirty-five years ago. The purpose of this project is to obtain objective data to shed light on our understanding of these two major functional psychoses -- their diagnostic validity, clinical features, course and outcome, heterogeneity, life histories, related illnesses and characteristics of familial association. This research started with 525 patients selected from inpatients consecutively admitted to the Iowa Psychopathic Hospital between 1934 and 1944, and with a stratified random sample of 160 surgical patients admitted to the University General Hospital during the same period. A specially designed structured interview form -- the Iowa Structured Psychiatric Interview (ISPI) -- is used to follow up all living index patients, and as many of their living first-degree relatives as possible. At this time, over one-third of the estimated total study population of three thousand patients and relatives have been personally interviewed, and the preliminary findings are reported here.

The Iowa 500: follow-up of 225 depressives

In previous studies we have suggested that there are two types of depressive illness (4, 5). The first of these is depressive spectrum disease which has as its prototype the early-onset female depressive; the second type is pure depressive disease, the prototype of which is the late-onset male depressive. Other family studies support the differences between these two prototypes (1, 8). The early-onset females have a considerable amount of alcoholism and probably sociopathy in their male first-degree relatives. The late-onset males have an ordinary amount of these illnesses in their male relatives. In the families of early-onset females, female relatives outnumber male relatives for the presence of depressive illness; this is not seen in late-onset males, where male and female relatives have equal amounts of depressive illness.