The purpose of this study was to demonstrate the approach of using the degree of familial aggregation to validate a subtype of affective illness. In order to determine whether clinical response to pharmacological therapy in the proband treated for non-bipolar major depression constitutes a distinct subtype of depression, rates of affective illness were examined among relatives of probands who were categorized according to the speed and magnitude of their response to somatic treatment in controlled clinical trials. First-degree relatives of probands who experienced rapid improvement during the first week and poor response on termination of treatment, were found to have the highest rates of major depression. These results require replication.

Antidepressive Agents↗

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Validation of criteria for major depression through controlled family study.

As compared with depressed relatives of normals, depressed relatives of affective patients are more likely to have severe impairment or incapacitation in their major life role when depressed, and more likely to suffer multiple episodes. These findings suggest that among major depressions, these clinical criteria may usefully identify cases with a familial, possibly genetic, vulnerability.

Age Factors↗

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The relationship of patient difficulty to therapist performance in interpersonal psychotherapy of depression.

The efficacy of Interpersonal Psychotherapy (IPT) in the treatment of ambulatory major depression was demonstrated in the recently completed NIMH Treatment of Depression Collaborative Research Program (Elkin et al. 1986). Factors which enhance or impede the administration of the treatment delimit effective patient care and should therefore be understood. This report examines the relationship of pretreatment patient attitudes and in-treatment patient difficulty to the ability of therapists to competently conduct IPT, using data from a training program in IPT. The hypothesis was that the patient's ability and willingness to establish a relationship and undertake the task demands of therapy would influence the therapist's ability to administer treatment. Patient difficulty was found to be strongly related to both therapists' and supervisors' judgements of therapist performance during IPT sessions: when patients were more difficult, therapists were judged to have performed more poorly. Patients' preexisting negative expectations about the potential outcome of treatment were associated with patient difficulty and poorer therapist performance, while the level of presenting symptomatology was not. Thus, it appears that the patient's ability to engage in a productive therapeutic relationship rather than the severity of his presenting problems influenced the therapist's ability to competently perform IPT. The findings regarding the relationship of patient difficulty to ratings of therapist performance suggest that patient difficulty should be taken into account in assessing therapist competence, whether for studies of therapeutic efficacy or for clinical supervision and training in general.

Adult↗

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Early-onset major depression in parents and their children.

In a study of 6-23-year-old offspring of depressed and of normal parents, an inverse relationship between the rates of major depression among the children and the age of onset of major depression in their proband parents was found. The children of parents who had an onset of major depression that was younger than age 20 years overall had the highest risk of major depression. There was specificity in the findings in that these higher rates were nearly all accounted for by prepubertal onsets of major depression in their children. There was a 14-fold increased risk of onset of depression before age 13 in the children of probands who had onset less than age 20. These results were not confounded by the current age of the proband or the children, by interview status (children were interviewed), by comorbidity in the parents or by assortative mating. Future family genetic studies should examine the rates and patterns of illness of the biological relatives of probands with prepubertal-onset major depression.

Adolescent↗

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Parental concordance for affective disorders: psychopathology in offspring.

This paper examines the effects of parental concordance for affective disorders and psychopathology among the 219 offspring of probands with major depression and normal controls. The lifetime prevalence of psychiatric disorders was significantly higher among the spouses of depressed probands as compared to those of normal controls. The spouses of 37% of the normals and 69% of the depressed probands met criteria for a diagnosis of major depression, an anxiety disorder, or alcoholism. Parental concordance for diagnoses, particularly for anxiety disorders, substantially increased the risk of major depression and anxiety disorders in their children. Moreover, the marital relationship, some aspects of family adjustment and severity of current symptoms were significantly worse among the couples who exhibited diagnostic concordance for anxiety, alcoholism and/or depression. The major implication of these findings is that the diagnostic status of both parents should be considered in the design and analysis of studies of children. The findings of the present study also underscore the importance of assessment of comorbid disorders in parents and offspring. Although the original study design focused on the risk of depression in children of parents in treatment for major depression, stronger transmissibility was found for anxiety disorders plus depression than for major depression alone. However, the exclusion criteria of a lifetime history of mania or hypomania led to an extremely low proportion of probands with pure major depression without concomitant anxiety disorders. These findings confirm the results of previous studies which have demonstrated a strong degree of overlap between affective and anxiety syndromes. The increased risk of anxiety disorders in the offspring of parents who had sought treatment for non-bipolar major depression suggests that anxiety may constitute an early form of expression of affective disorders. Confirmation of the finding of age-dependent expression of anxiety and depression in prospective longitudinal studies of children is indicated.

Adolescent↗