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Anne Duffy

Publications and source records attributed to Anne Duffy.

11 recordsLinked to original sources
PubMed2006

Temperament, life events, and psychopathology among the offspring of bipolar parents.

OBJECTIVES: The present study examines the relationship between temperament, recent and remote life events, and psychopathology among the offspring of parents with bipolar disorder and well comparisons. METHODS: Offspring of bipolar and well parents were clinically assessed using KSADS-PL format interviews. Lifetime psychiatric diagnoses were made on a blind consensus basis in accordance with DSM-IV criteria. Depending on offspring age, either the child or their parent on their behalf, completed a semi-structured interview quantifying the number and impact of recent life events and remote permanent losses, as well as a measure of temperament. RESULTS: In this study, there was an association between psychopathology and the number of recent negative life events, but no association between psychopathology and the number of early losses. Emotionality was positively correlated with recent life events. However, in stepwise regression analyses, only emotionality significantly contributed to lifetime psychopathology in general and emotionality and age contributed to the risk of mood disorder in particular. CONCLUSIONS: These findings, replicate in a sample of offspring at high risk for bipolar disorder, previously reported associations between high emotionality and unipolar depression. In this population, any effect of undesirable life events would appear to be mediated through the association with emotionality.

Adolescent↗
PubMed2006

Salivary cortisol secretion in remitted bipolar patients and offspring of bipolar parents.

OBJECTIVES: It is generally believed that cortisol secretion normalizes during clinical remission in mood disorders. However, this assumption has been challenged by preliminary reports of enhanced cortisol secretion in remitted bipolar patients and in the offspring of bipolar parents. The purpose of this study is to replicate findings of increased cortisol secretion during clinical remission in bipolar patients and in the offspring of bipolar parents, rigorously controlling for known confounders. METHODS: We conducted intensive cortisol sampling (six samples per day for three test days, on three consecutive weekends) on 15 bipolar type I and type II patients and 28 unrelated offspring of bipolar parents. Offspring had a history of unipolar depression. Participation was restricted to cases in complete sustained remission. Controls were matched as closely as possible for age, sex, and education. Mood and sleep measures were recorded on each sampling day. RESULTS: In total, 743 samples were collected from the patient group and 576 from controls. Correcting for repeat measures, there was no statistically significant difference in cortisol secretion at any sampling time between remitted bipolar patients, remitted offspring of bipolar parents, and normal controls. The cortisol waking response did not differ between patients and controls. Covariates, including sex, age, Beck depression score and hours of sleep, were not statistically significant. CONCLUSIONS: Our observations are consistent with the view that complete sustained clinical remission is associated with normal salivary cortisol levels throughout the day. A personal or family history of bipolar disorder per se does not appear to confer added risk for increased salivary cortisol secretion during sustained clinical remission.

Adolescent↗
PubMed2006

Introducing the Liverpool Care Pathway into nursing homes.

Around half a million older people aged 65 or over live in care homes across the UK and substantial numbers end their lives in these care settings. The Liverpool Care Pathway for the dying patient (LCP) was developed to transfer the hospice model of care into other care settings. This paper describes a pilot project to introduce the LCP into care homes local to the Queen Mary's Sidcup NHS Trust with a view to reducing the number of very ill elderly patients who are transferred to the acute trust from care homes and then die in A&E.

Aged↗
PubMed2004

MMPI as a measure of subthreshold and residual psychopathology among the offspring of lithium responsive and non-responsive bipolar parents.

OBJECTIVES: In bipolar adults, the Minnesota Multiphasic Personality Inventory (MMPI) can detect residual symptoms and confirm completeness of remission, thus helping to predict response to lithium prophylaxis. In the high-risk and early onset bipolar populations, the association of the MMPI with clinical course and treatment response has not yet been studied. The present study compares MMPI profiles completed by the well or remitted offspring of two groups of bipolar parents divided on the basis of parental response to long-term lithium. METHODS: As part of an ongoing prospective longitudinal high-risk study, offspring of bipolar parents determined to either respond or not respond to long-term lithium monotherapy completed the MMPI. At the time of MMPI completion, offspring were determined to be either well (unaffected) or clinically remitted (affected but euthymic) based on repeated prospective KSADS-PL format interviews conducted by a research psychiatrist and reviewed on a blind consensus basis. RESULTS: While there was no difference in the MMPI scores between subgroups of unaffected offspring, there was a significant difference in profiles between remitted offspring. Specifically, affected offspring of lithium non-responders showed significantly higher average scores on scales 6, 8 and 0 compared with affected offspring of lithium responders. These findings are consistent with the differences in MMPI profiles taken at optimum between the respective parent subgroups. CONCLUSIONS: The findings confirm the clinical observation that the affected offspring of lithium responders suffer from episodic fully remitting mood disorders, while the affected offspring of lithium non-responders suffer from mood disorders with incomplete remission. Further, the nature of the residual symptoms as indicated by the abnormal MMPIs support the view of heterogeneity of the bipolar diagnosis. The relevance to treatment response is discussed.

Adult↗
PubMed2004

A pilot study of visual backward masking performance among affected versus unaffected offspring of parents with bipolar disorder.

BACKGROUND: Cognitive dysfunction is evident in some euthymic patients with established bipolar disorder (BD), including deficits in visual backward masking (VBM) tasks which map to a specific neural pathway. A high-risk paradigm would clarify the temporal relation of cognitive dysfunction to clinical course. METHOD: We compared euthymic offspring (age range: 18-32 years) of lithium-responsive bipolar parents with and without a previous lifetime history of psychiatric illness to healthy comparison subjects with a negative family history, on a VBM task that requires target location. RESULTS: High-risk offspring with no lifetime psychiatric history performed the VBM task at levels of healthy controls. High-risk offspring with a previous history of a mood disorder, in complete remission, made significantly more errors at short target-mask intervals than control or never ill offspring. These higher error rates were not a consequence of faster response times. CONCLUSIONS: There is preliminary evidence of specific cognitive dysfunction early in the course of illness in affected offspring of parents with lithium responsive BD. VBM is ideal for future longitudinal studies addressing whether cognitive dysfunction in BD is a trait marker or a consequence of illness manifestation.

Adolescent↗
PubMed2003

Phenotypic spectra of bipolar disorder in responders to lithium versus lamotrigine.

OBJECTIVE: We conducted a study of clinical presentation and family history in patients responsive to either of two commonly used mood stabilizers, lithium and lamotrigine. METHODS: The sample included 164 subjects from 21 families of bipolar probands, 14 responders to lithium and seven to lamotrigine. Diagnostic information on first-degree relatives was obtained in a blind fashion through a combination of direct interviews (SADS-L) and family history assessments (FH-RDC). RESULTS: The probands differed with respect to clinical course (episodic in the lithium group, rapid cycling in the lamotrigine group), and comorbidity (panic attacks and substance abuse in the lamotrigine group). The relatives of lithium responders had significantly higher risk of bipolar disorder while relatives of lamotrigine responders had higher prevalence of schizoaffective disorder, major depression and panic attacks. CONCLUSIONS: These findings suggest that lithium- and lamotrigine-responsive patients differ with respect to course of illness, comorbidity and family history and may represent distinct subtypes of bipolar disorder.

Adolescent↗
PubMed2003

The cortisol awakening response in bipolar illness: a pilot study.

OBJECTIVE: A growing body of data suggests that a significantly enhanced salivary cortisol response to waking may indicate an enduring tendency to abnormal cortisol regulation. Our objective was to apply the response test to a population already known to have long-term hypothalamo-pituitary-adrenocortical (HPA) axis dysregulation. We hypothesized that the free cortisol response to waking, believed to be genetically influenced, would be elevated in a significant percentage of cases, regardless of the afternoon Dexamethasone Suppression Test (DST) value. METHOD: Using the free cortisol response to waking and the short daytime profile, we tested 18 clinically stable, lithium-responsive subjects from our long-term naturalistic follow-up of monthly DSTs. These tests include salivary testing every 15 minutes during the first hour of waking, followed by samples taken at 3:00 PM and 8:00 PM. RESULTS: While clinically stable on lithium prophylaxis, patients with bipolar disorder (BD) showed a significantly enhanced salivary cortisol response to waking, compared with control subjects (P < 0.03). Cortisol levels 30 minutes after waking significantly exceeded those in the large normative data provided in the literature (P < 0.001). CONCLUSIONS: Our observations support the hypothesis that the free cortisol response to waking can reflect relatively enduring HPA dysregulation, even when lithium-responsive BD patients are clinically well and their DSTs are normal. Because the test is easy to administer, the free cortisol response to waking may hold promise as a marker in studies of high-risk families predisposed to, or at risk for, mood disorders.

Adult↗
PubMed2002

Is response to prophylactic lithium a familial trait?

BACKGROUND: Selecting a drug according to the treatment response in a relative has been widely accepted advice in the management of mood disorders. However, this recommendation has not been adequately substantiated in the literature. We tested the hypothesis that response to long-term lithium treatment is a familial trait. METHOD: We compared response to long-term lithium treatment in bipolar relatives of bipolar lithium responders and bipolar controls. Twenty-four relatives with bipolar disorder (as determined using the Schedule for Affective Disorders and Schizophrenia-Lifetime version [SADS-L] and Research Diagnostic Criteria [RDC]) were identified in families of 106 patients with lithium-responsive bipolar disorder. A consecutive series of 40 lithium-treated patients in a bipolar clinic (meeting RDC and DSM-IV criteria for bipolar disorder) served as a comparison group. Lithium response was evaluated on a rating scale reflecting the quality and quantity of available data. RESULTS: The prevalence of unequivocal response among the relatives was 67%, as compared with the response rate of 35% in the comparison group (chi2 = 6.04, df = 1, p = .014). CONCLUSION: This highly significant difference in response between relatives and the control group supports the view that the response to lithium prophylaxis clusters in families.

Adult↗
PubMed2002

A prospective study of the offspring of bipolar parents responsive and nonresponsive to lithium treatment.

BACKGROUND: The descriptions of clinical course among bipolar youths vary significantly and differ markedly from the findings described in classical studies of bipolar adults. This difference may in part reflect genetic heterogeneity. Response to lithium monotherapy identifies a homogeneous subgroup of bipolar adults. The aim of this study was to prospectively characterize the clinical course, including antecedent and comorbid conditions, among the offspring of 2 groups of bipolar parents divided on the basis of response to lithium. METHOD: Parents were identified from families participating in ongoing molecular genetic studies and selected from specialty affective disorder clinics. For each child, 1 parent met Research Diagnostic Criteria/DSM-IV criteria for bipolar I disorder and either response or nonresponse to lithium prophylaxis. The other parent had no lifetime history of a major psychiatric illness. Blind to family affiliation and lithium response, all eligible offspring aged 10 to 25 years were interviewed using the Schedule for Affective Disorders and Schizophrenia for School-Aged Children-Present and Lifetime Version (K-SADS-PL), and best-estimate diagnoses were made by a panel of experts. Offspring were then reassessed over a 5-year period. RESULTS: Offspring of lithium responders (N = 34) had good premorbid functioning and manifested classical mood disorders with an episodic course. Comorbid conditions in this group remitted prior to the mood disorder. In contrast, offspring of lithium nonresponders (N = 21) had poorer premorbid functioning and manifested mood disorders with a chronic course. Comorbid conditions continued alongside the mood disorder. Clinical course among affected offspring was predicted by the disease course of the parent. CONCLUSION: The pattern of clinical course, remitting or nonremitting, appears to be inherited. Among the offspring of lithium-responsive bipolar parents, an early-onset subgroup with a classical episodic clinical course can be identified.

Adolescent↗
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