Ritanserin in the treatment of cocaine dependence

BACKGROUND: There have been numerous studies that have shown that offspring of depressed parents are at a high risk for major depressive disorder (MDD) and impairment. None have followed up the offspring into adulthood to obtain more precise estimates of risk. METHOD: One hundred eighty-two offspring from 91 families, in which 1 or more parents had MDD (high risk) or in which neither parent was depressed (low risk), were blindly reassessed in the third follow-up, using a structured diagnostic instrument 10 years after their initial identification. RESULTS: Compared with the offspring for whom neither parent was depressed, the offspring of depressed parents had increased rates of MDD, particularly before puberty, and phobias (both at approximately a 3-fold risk), panic disorder, alcohol dependence (at a 5-fold risk), and greater social impairment. The peak age at onset for MDD in both high- and low-risk offspring ranged from 15 to 20 years. The peak age at onset for anxiety disorder was considerably earlier, especially in female offspring in the high-risk group. The onset of alcohol dependence in the offspring in the high-risk group peaked in adolescence and then after the age of 25 years. The depressed offspring of depressed parents, compared with nondepressed parents, had more serious and impairing depressions during the follow-up period but were less likely to go for treatment. CONCLUSIONS: The offspring of depressed parents are a high-risk group for onset of anxiety disorder and MDD in childhood, MDD in adolescence, and alcohol dependence in adolescence and early adulthood. The findings support the potential value of early detection in the offspring of depressed parents.     

Offspring at high and low risk for depression and anxiety: mechanisms of psychiatric disorder

OBJECTIVES: To examine the effect of parental psychiatric diagnosis on the risk of psychiatric disorder in their offspring and to determine mediators and independent predictors of psychiatric disorder in offspring. METHOD: The sample consisted of 145 offspring (between the ages of 6 and 24 years, who were directly interviewed) of probands with early-onset (before age 30 years) major depressive disorder (MDD) without panic, panic disorder with and without major depression, and a normal, never psychiatrically ill control group who were part of a large study conducted to determine the relationship between panic disorder and major depression. RESULTS: The risk for offspring MDD was increased by proband recurrent early-onset MDD and coparent alcohol abuse. Chaotic family environment was the only independent predictor of dysthymia. The risk for offspring "any anxiety" disorder was increased by proband recurrent early-onset MDD and coparent impaired functioning. The association between MDD in proband and "panic spectrum" disorder in offspring was accounted for by chaotic family environment. CONCLUSION: Recurrent parental MDD has consistently been shown to be a strong risk factor for offspring MDD. Family environment plays an important role in low-level anxiety symptoms and dysthymia. Clinicians treating adults should be alert to risk factors for their offspring and to appropriate targets for early intervention.     

Is comorbidity with ADHD a marker for juvenile-onset mania?

OBJECTIVE: To compare the characteristics and correlates of mania in referred adolescents and to determine whether attention-deficit hyperactivity disorder (ADHD) is a marker of very early onset mania. METHOD: From 637 consecutive admissions, 68 children (< or = 12 years) and 42 adolescents (> 13 years) who satisfied criteria for mania were recruited. These were compared with the 527 nonmanic referrals and 100 normal controls. RESULTS: With the exception of comorbidity with ADHD, there were more similarities than differences between the children and adolescents with mania in course and correlates. There was an inverse relationship between the rates of comorbid ADHD and age of onset of mania: higher in manic children intermediate in adolescents with childhood-onset mania, and lower in adolescents with adolescent-onset mania. CONCLUSIONS: ADHD is more common in childhood-onset compared with adolescent-onset cases of bipolar disorder, suggesting that in some cases, ADHD may signal a very early onset of bipolar disorder. Clinical similarities between the child- and adolescent-onset cases provide evidence for the clinical validity of childhood-onset mania.     

Family risk factors, parental depression, and psychopathology in offspring.

Associations between parents' poor marital adjustment, parent–child discord, affectionless control, low family cohesion, and parental divorce and Diagnostic and Statistical Manual of Mental Disorders (DSM-III) diagnoses were explored in a study of 220 offspring of parents with and without major depression. Family risk factors were more prevalent among offspring of depressed parents. Risk factors were associated with major depression and any diagnosis for children of nondepressed parents; they were associated with conduct disorder for both groups. Parental depression was more important than family risk factors in models predicting major depression, anxiety disorders, and any diagnosis. Both parental depression and family risk factors were significant predictors of conduct disorder. Implications for the etiology of psychopathology and for analytic strategies are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Association of Parental Depression With Psychiatric Course From Adolescence to Young Adulthood Among Formerly Depressed Individuals.

The authors examined whether parental major depressive disorder (MDD) is associated with course of depression and other psychopathology among formerly depressed adolescents as they enter adulthood. The sample consisted of 244 individuals (age 24) in a longitudinal study who had experienced MDD by 19. Maternal MDD was associated with MDD recurrence, chronicity and severity, anxiety disorders, and (among sons only) lower psychosocial functioning in offspring between the ages of 19 and 24. Paternal MDD was associated with lower functioning. Sons of depressed fathers had elevated suicidal ideation and attempt rates in young adulthood. Recurrent paternal MDD was associated with depression recurrence in daughters but not sons. The impact of parental MDD on offspring could not be attributed to characteristics of the offspring's depression prior to age 19. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Childhood and adolescent depression: a review of the past 10 years. Part I

OBJECTIVE: To qualitatively review the literature of the past decade covering the epidemiology, clinical characteristics, natural course, biology, and other correlates of early-onset major depressive disorder (MDD) and dysthymic disorder (DD). METHOD: A computerized search for articles published during the past 10 years was made and selected studies are presented. RESULTS: Early-onset MDD and DD are frequent, recurrent, and familial disorders that tend to continue into adulthood, and they are frequently accompanied by other psychiatric disorders. These disorders are usually associated with poor psychosocial and academic outcome and increased risk for substance abuse, bipolar disorder, and suicide. In addition, DD increases the risk for MDD. There is a secular increase in the prevalence of MDD, and it appears that MDD is occurring at an earlier age in successive cohorts. Several genetic, familial, demographic, psychosocial, cognitive, and biological correlates of onset and course of early-onset depression have been identified. Few studies, however, have examined the combined effects of these correlates. CONCLUSIONS: Considerable advances have been made in our knowledge of early-onset depression. Nevertheless, further research is needed in understanding the pathogenesis of childhood mood disorders. Toward this end, studies aimed at elucidating mechanisms and interrelationships among the different domains of risk factors are needed.     

Evidence for genetic anticipation in nodal osteoarthritis

OBJECTIVE: Evidence was sought for genetic anticipation (disease occurring at an earlier age in subsequent generations, with increasing severity) in nodal osteoarthritis (NOA). METHODS: Age at symptom onset and disease severity was compared within 30 parent/offspring pairs with NOA. Correlation between the offspring age of disease onset and the parental age at conception was also assessed. RESULTS: The age at onset of nodal symptoms was earlier in the offspring (43 years (95% confidence intervals (CI) 38 to 47) v 61 (CI 58 to 65); mean difference 18 years (CI 13 to 22): p < 0.001) as was larger joint symptom onset (48 years (CI 41 to 55) v 67 (CI 61 to 73); mean difference 20 years (CI 13 to 27): p < 0.01). A negative correlation existed between age of offspring symptom onset and parental age at conception. Fifteen (50%) offspring had similar or more extensive disease than their parents. CONCLUSIONS: These results suggest genetic anticipation occurs in NOA and if confirmed a search for trinucleotide repeats is warranted.     

The Intergenerational Transmission of Externalizing Behaviors in Adult Participants: The Mediating Role of Childhood Abuse.

Childhood abuse was investigated as a potential mediator of the intergenerational transmission of externalizing behaviors (EXT) in adulthood among a large general population sample drawn from the National Comorbidity Survey. Community participants (N = 5,424) underwent diagnostic and psychosocial interviews and reported on their own adult symptoms of antisocial behavior and substance dependence, parental symptoms, and childhood abuse history. Multiple group structural equation modeling revealed that (a) EXT in parents was associated with childhood abuse in offspring, particularly among mother- daughter dyads, (b) abuse had a unique influence on adult EXT in offspring above parental EXT, and (c) abuse accounted for the relationship between parental EXT and offspring EXT in female but not male participants. This article emphasizes the importance of examining different environmental processes which may explain familial transmission of destructive behaviors in men and women and highlights the importance of family interventions that target parental symptoms to ameliorate risk to offspring. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dysthymia in the offspring of parents with primary unipolar affective disorder.

This study examined whether there is a familial relation between primary early-onset dysthymia and major affective disorder. In addition, it explored the prevalence of other forms of psychopathology and social impairment in the adolescent and young adult offspring of patients with primary unipolar affective disorder. Subjects included 47 offspring of patients with primary unipolar depression, 33 offspring of patients with chronic orthopedic and rheumatological conditions, and 38 offspring of randomly selected community controls with no personal or family history of psychiatric disorder. All offspring received structured diagnostic interviews. Diagnoses were derived blind to parental group by using multiple sets of diagnostic criteria. The offspring of unipolar patients exhibited significantly higher rates of affective disorder, major depression, and dysthymia than did the offspring of medical and normal controls. The groups did not differ on rates of nonaffective disorders. Parental characteristics associated with dysthymia in offspring included chronic depression, age of onset of major depression, number of hospitalizations, and multiple family members with major affective illness. These results support the view that at least some forms of early-onset dysthymia are variants of major affective illness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Test of the plausibility of adolescent substance use playing a causal role in developing adulthood antisocial behavior.

DSM-IV antisocial personality disorder diagnosis requires that conduct disorder be exhibited before age 15. However, recent studies have reported on men and women without conduct disorder before age 15 but qualified for the adulthood antisocial personality criterion (AAB). This general-population, retrospective study investigated the plausibility of causal relationships between adolescent drug and alcohol misuse (ADAM) and AAB among subgroups who reported childhood-onset conduct problems (CP), adolescent-onset CP, or no more than one conduct problem. Data from the Epidemiological Catchment Area Study (N=8,724) suggested that persons with childhood-onset CP are at much greater risk for AAB than persons with adolescent-onset CP. Nevertheless, large proportions of men and women with AAB had adolescent-onset CP or no CP. Regardless of CP history, being drunk by age 18 or having a drug use-related symptom before age 18 increased AAB risk, even after controlling for having a substance use-related disorder in adulthood. Mechanisms that potentially explain these associations are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family group cognitive–behavioral preventive intervention for families of depressed parents: 18- and 24-month outcomes.

Objective: In a long-term follow-up of a randomized controlled trial (Compas et al., 2009) to examine the effects at 18- and 24-month follow-ups of a family group cognitive–behavioral (FGCB) preventive intervention for mental health outcomes for children and parents from families (N = 111) of parents with a history of major depressive disorder (MDD). Method: Parents with a history of MDD and their 9- to 15-year-old children were randomly assigned to a FGCB intervention or a written information comparison condition. Children's internalizing, externalizing, anxiety/depression, and depressive symptoms; episodes of MDD and other psychiatric diagnoses; and parents' depressive symptoms and episodes of MDD were assessed at 18 and 24 months after randomization. Results: Children in the FGCB condition were significantly lower in self-reports of anxiety/depression and internalizing symptoms at 18 months and were significantly lower in self-reports of externalizing symptoms at 18 and 24 months. Rates of MDD were significantly lower for children in the FGCB intervention over the 24-month follow-up (odds ratio = 2.91). Marginal effects were found for parents' symptoms of depression at 18 and 24 months but not for episodes of MDD. Conclusions: Support was found for a FGCB preventive intervention for children of parents with a history of MDD significantly reducing children's episodes of MDD over a period of 2 years. Significant effects for the FGCB intervention were also found on internalizing and externalizing symptoms, with stronger effects at 18- than at 24-month follow-up. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Predicting time to recovery among depressed adolescents treated in two psychosocial group interventions.

Aims were to identify the demographic, psychopathology, and psychosocial factors predicting time to major depressive disorder (MDD) recovery and moderators of treatment among 114 depressed adolescents recruited from a juvenile justice center and randomized to a cognitive behavioral treatment (CBT) condition or a life skills-tutoring control condition. Nine variables predicted time to recovery over 1-year follow-up (e.g., earlier MDD onset, attention-deficit/hyperactivity disorder, functional impairment, hopelessness, negative thoughts, low family cohesion, coping skills); suicidal ideation and parental report of problem behaviors were the best predictors. CBT resulted in faster recovery time relative to control treatment, specifically among adolescents of White ethnicity, with recurrent MDD, and with good coping skills. Results suggest that psychopathology plays a more prominent role in maintaining adolescent depression than demographic or psychosocial factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comorbidity of unipolar depression: I. Major depression with dysthymia.

The degree of current and lifetime comorbidity between major depressive disorder (MDD) and dysthymia (DY) was examined in large community samples of older adolescents (n?=?1,710) and adults (n?=?2,060). DY was highly comorbid with MDD (lifetime odds ratio of 3.4 for adolescents and 1.6 for adults) and was more likely to precede than to follow MDD, especially in persons who became depressed early in life. MDD was by far the more frequent form of depression: Approximately 80% of the depressed persons experienced only MDD, 10% experienced only DY, and 10% experienced both MDD and DY. The large number of persons who had become depressed twice experienced MDD in the 2nd episode, regardless of the nature of the 1st depression. History of depression was associated with a greater probability for other mental disorders in both adolescents and adults; however, the rates of comorbidity for MDD did not differ from rates for DY or for both MDD and DY. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Binge drinking trajectories from adolescence to emerging adulthood in a high-risk sample: Predictors and substance abuse outcomes.

This study describes binge drinking trajectories from adolescence to emerging adulthood in 238 children of alcoholics and 208 controls. Mixture modeling identified three trajectory groups: early-heavy (early onset, high frequency), late moderate (later onset, moderate frequency), and infrequent (early onset, low frequency). Nonbingers were defined a priori. The early-heavy group was characterized by parental alcoholism and antisociality, peer drinking, drug use, and (for boys) high levels of externalizing behavior, but low depression. The infrequent group was elevated in parent alcoholism and (for girls) adolescent depression, whereas the nonbinger and late-moderate groups showed the most favorable adolescent psychosocial variables. All 3 drinking trajectory groups raised risk for later substance abuse or dependence compared with the nonbingers, with the early-heavy group at highest risk. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Children of affectively ill parents: a review of the past 10 years

OBJECTIVE: To review the literature investigating the effects of parental affective illness on children over the past decade. METHOD: A computerized search of articles published over the past 10 years was completed. Articles were reviewed and relevant studies are presented. RESULTS: Over the course of the past 10 years a number of longitudinal studies have confirmed that children of affectively ill parents are at a greater risk for psychiatric disorders than children from homes with non-ill parents. Life table estimates indicate that by the age of 20 a child with an affectively ill parent has a 40% chance of experiencing an episode of major depression. Children from homes with affectively ill parents are more likely to exhibit general difficulties in functioning, increased guilt, and interpersonal difficulties as well as problems with attachment. Marital difficulties, parenting problems, and chronicity and severity of parental affective illness have been associated with the increased rates of disorder observed in these children. CONCLUSION: The presence of depression in parents should alert clinicians to the fact that their children also may be depressed and therefore in need of services. J. Am. Acad. Child Adolesc.     

The structure of negative emotions in a clinical sample of children and adolescents.

The authors sought to define the latent factors associated with childhood anxiety and depression, using a structural equations/confirmatory factor-analytic approach involving multiple informants (i.e., parent and child report) of symptoms. A sample of 216 children and adolescents with diagnoses of an anxiety disorder or comorbid anxiety and mood disorders and their parents were administered measures of childhood fear, anxiety, and depression. Results of comparative modeling best supported 3-factor solutions (fear, anxiety, and depression) that were consistent with recent conceptual models of anxiety and depression (e.g., tripartite model). Results also suggested that 3 widely used measures of childhood negative emotion are conceptually heterogeneous (containing item sets that loaded on different latent factors) . Implications for the assessment of childhood negative emotions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Parental alcoholism and childhood psychopathology.

We reviewed studies about children of alcoholic parents published between 1975 and 1985 to clarify the relation between parental alcoholism and child psychopathology. We identified methodological problems in this body of literature and organized substantive findings around eight areas of outcome: (a) hyperactivity and conduct disorder; (b) substance abuse, delinquency, and truancy; (c) cognitive functioning; (d) social inadequacy; (e) somatic problems; (f) anxiety and depressive symptoms; (g) physical abuse; and (h) dysfunctional family interactions. The literature as a whole supported the contention that parental alcoholism is associated with a heightened incidence of child symptoms of psychopathology, in comparison with no increased incidence in offspring of nondisturbed parents. However, neither all nor a major portion of the population of children from alcoholic homes are inevitably doomed to childhood psychological disorder. Findings are discussed in terms of causality, child resiliency, and potential qualifying factors, such as variations in family disruption. Recommendations are presented regarding methodological improvements, possible mediating variables, and a multiple-risk conceptualization. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social phobia, avoidant personality disorder and atypical depression: co-occurrence and clinical implications

BACKGROUND: Increasing attention has been directed in recent years to the detection and treatment of psychiatric co-morbidity among depressed individuals. The overlap of social phobia (SP) and avoidant personality disorder (APD) has been well recognized and a relationship between these disorders and depression has been suggested. METHODS: The pattern and clinical implications of co-morbidity of SP and APD with major depressive disorder (MDD), diagnosed by DSM-III-R criteria, were studied among 243 out-patients presenting with depression. RESULTS: Overall, 26.7% of adults in our sample with MDD met criteria for SP and 28.4% for APD. Almost two-thirds of depressed adults meeting criteria for social phobia or avoidant personality disorder met criteria for both (SP+APD). Depressed adults who met criteria for both SP+APD exhibited a significantly higher proportion of atypical depression (54.8%) compared with those with neither SP nor APD (31.1%). Among depressed patients, the co-occurrence of SP with APD was also associated with an earlier age of onset of MDD, a greater number of comorbid Axis I diagnoses, and greater impairment of social adjustment and assertiveness. CONCLUSIONS: Results confirm the overlap of SP and APD in a depressed population and the high prevalence of these disorders in MDD. They suggest that depressed individuals with both SP and APD but not SP alone are at particularly high risk for atypical depression and for social dysfunction in excess of that caused by a current major depression.     

Predicting obesity in young adulthood from childhood and parental obesity

BACKGROUND: Childhood obesity increases the risk of obesity in adulthood, but how parental obesity affects the chances of a child's becoming an obese adult is unknown. We investigated the risk of obesity in young adulthood associated with both obesity in childhood and obesity in one or both parents. METHODS: Height and weight measurements were abstracted from the records of 854 subjects born at a health maintenance organization in Washington State between 1965 and 1971. Their parents' medical records were also reviewed. Childhood obesity was defined as a body-mass index at or above the 85th percentile for age and sex, and obesity in adulthood as a mean body-mass index at or above 27.8 for men and 27.3 for women. RESULTS: In young adulthood (defined as 21 to 29 years of age), 135 subjects (16 percent) were obese. Among those who were obese during childhood, the chance of obesity in adulthood ranged from 8 percent for 1- or 2-year-olds without obese parents to 79 percent for 10-to-14-year-olds with at least one obese parent. After adjustment for parental obesity, the odds ratios for obesity in adulthood associated with childhood obesity ranged from 1.3 (95 percent confidence interval, 0.6 to 3.0) for obesity at 1 or 2 years of age to 17.5 (7.7 to 39.5) for obesity at 15 to 17 years of age. After adjustment for the child's obesity status, the odds ratios for obesity in adulthood associated with having one obese parent ranged from 2.2 (95 percent confidence interval, 1.1 to 4.3) at 15 to 17 years of age to 3.2 (1.8 to 5.7) at 1 or 2 years of age. CONCLUSIONS: Obese children under three years of age without obese parents are at low risk for obesity in adulthood, but among older children, obesity is an increasingly important predictor of adult obesity, regardless of whether the parents are obese. Parental obesity more than doubles the risk of adult obesity among both obese and nonobese children under 10 years of age.     

Psychosocial predictors of the short-term course and outcome of major depression: A longitudinal study of a nonclinical sample with recent-onset episodes.

Three variables have been hypothesized to play important roles in prolonging the course of depressive episodes: a ruminative response style, significant interpersonal relationships, and childhood adversity. The authors examined whether these variables predicted the short-term course of major depressive disorder (MDD). Participants (n/&=/&84) were college students with a recent-onset major depressive episode. Assessments included several interview and self-report measures, and data on interpersonal relationships were obtained from close confidants. Follow-up interviews were conducted 6 mo later. After controlling for baseline severity, harsh discipline in childhood significantly predicted mean level of depression across the follow-up and level of depression at follow-up. Harsh discipline was also significantly associated with relapse but not with recovery. After controlling for baseline severity, rumination and the interpersonal variables did not predict the outcome of MDD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)