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Biomedical subjects

G Winokur

Publications and source records attributed to G Winokur.

At least 19 recordsLinked to original sources
PubMed1992

Familial subtypes of unipolar depression: a prospective study of familial pure depressive disease compared to depression spectrum disease.

In a large multicenter effort, major depressives were systematically studied at index admission and prospectively followed up for 5 years. Primary unipolar depressives with a family history of alcoholism (depression spectrum disease) differ from depressives with a family history of depression only (familial pure depressive disease) in having more familial anxiety and somatization disorder, more divorce, more suicide attempts, more negative life events, and needed more time to recover from the index episode. In the 5-year follow-up they are more likely to develop alcoholism and drug abuse. Depressive spectrum disease patients are more likely to meet systematic criteria for neurotic depression. The data suggest that major depression is a syndrome that is heterogeneous, and may be a final common pathway of more than one familial illnesses.

Adult↗
PubMed1992

Failed and short seizures associated with prior electroconvulsive therapy.

Electroconvulsive therapy (ECT) has not been associated with many long-lasting effects that are associated with the treatments itself. The impact of having prior ECT to determine if the increased seizure threshold that is noticed during the treatment course is long-lasting was studied. If so, more failed and short seizures should occur among those patients who have had prior electroconvulsive treatments. A review of the treatments of 114 males and 220 females indicated a strong association of prior ECT with failed as well as short seizures for men but not for women.

Adult↗
PubMed1992

Alpha 2 adrenergic receptor subtypes in depression: a candidate gene study.

Alpha 2 adrenergic receptors play an important role in regulating the neuronal release of norepinephrine through presynaptic feedback inhibition in the locus ceruleus. Therefore, alpha 2 adrenergic autoreceptors may underlie some aspects of the pathogenesis and symptomatic expression of depressive illness. We studied two brain-expressed alpha 2 adrenergic receptor genes as genetic markers in linkage analyses in 17 multiplex pedigrees of unipolar depression. Neither of the genes was supportive of linkage to depression. Lod scores of less than -2 were found in both familial pure depressive disease pedigrees and in depression spectrum disease pedigrees. Therefore, we conclude that depression in our pedigrees is not related to mutations in the two alpha 2 adrenergic receptor genes tested.

Adult↗
PubMed1992

Alcoholism and primary major depression: a family study approach to co-existing disorders.

Alcoholism and major depression appear together at much higher than chance rates, but reasons for this are obscure. We used the direct diagnostic assessment of 177 probands with primary, unipolar depression and 619 of their first degree relatives to explore the significance of concomitant alcoholism. The male relatives of alcoholic probands of both sexes had substantially higher rates of alcoholism than did the male relatives of non-alcoholic probands. Among female probands, but not among male probands, alcoholism was associated with markedly higher familial rates of primary depression, particularly among female relatives. These data contained no evidence that comorbidity itself was familial. The appearance of alcoholism in depressed women may indicate depression spectrum disease, a disorder which manifests as depression in women and alcoholism in men. In contrast, men with both primary depression and alcoholism may be exhibiting two distinct illnesses.

Adolescent↗
PubMed1992

Testing the validity of the neurotic depression concept.

We applied an operational definition of neurotic depression to 185 hospitalized patients who met Feighner and DSM-III-R criteria for unipolar depression. Based on a systematic chart review, 37 patients met the criteria for neurotic depression. As a group, these patients differed from nonneurotics in symptoms, clinical course, outcome, and family history. The neurotic depressives were younger and more likely to identify precipitating factors. They were less likely to meet criteria for melancholia and to have delusions. They were more likely to be ill 3 years later and more likely to have familial alcoholism. These differences help to confirm the validity of the neurotic depression concept.

Adult↗
PubMed1992

Psychotic symptoms and age of onset in affective disorders.

Prevalence of hallucinations and delusions was studied in 1,763 patients with unipolar major depression, bipolar affective disorder, and schizoaffective disorder. The authors found that the presence of psychotic features was negatively associated with age of onset for the group as a whole, and bipolar affective disorder (manic or mixed type) specifically. The clinical implications of the findings are discussed.

Adult↗
PubMed1992

Anxiety syndromes as epiphenomena of primary major depression: outcome and familial psychopathology.

OBJECTIVE: Anxiety symptoms often appear within depressive 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.

Adolescent↗
PubMed1991

The prediction of suicide. Sensitivity, specificity, and predictive value of a multivariate model applied to suicide among 1906 patients with affective disorders.

Stepwise multiple logistic regression was utilized in an attempt to develop a statistical model that would predict suicide in a group of 1906 Iowans with affective disorders admitted to a tertiary care hospital. The risk factors identified by this approach included the number of prior suicide attempts, suicidal ideation on admission, bipolar affective disorder (manic or mixed type), gender, outcome at discharge, and unipolar depressive disorder in individuals with a family history of mania. However, the model failed to identify any of the patients who committed suicide. The results appear to support the contention that, based on present knowledge, it is not possible to predict suicide, even among a high-risk group of inpatients.

Adult↗
PubMed1991

The prediction of recovery using a multivariate model in 1471 depressed inpatients.

Stepwise multiple logistic regression was used in an attempt to develop a statistical model which would predict "recovery" in a group of 1471 depressives admitted to a tertiary care hospital. Six variables identified by this approach included: Electroconvulsive therapy, personality disorder, chronicity, anxiety disorder, organic mental disorder, and dysthymia. The meaning and significance of the findings are discussed.

Adult↗
PubMed1991

Familial alcoholism in primary unipolar major depressive disorder.

OBJECTIVE: Some studies have suggested relationships between depression in probands and alcoholism in relatives. Other studies have not, but some of these have used inappropriate control groups or failed to divide probands by sex. METHOD: The present study controlled for sex of probands and used several comparison groups to further explore the familial relationship between depression and alcoholism. Diagnoses for 723 directly interviewed relatives of 326 probands with primary unipolar depression were compared to diagnoses in 469 control subjects chosen by an acquaintanceship method to demographically resemble the relatives of affective disorder probands. Diagnoses in the uninterviewed relatives of both control and depressed subjects were used for comparisons as well. RESULTS: Results indicated higher rates of alcoholism in the families of depressed women but not in the families of depressed men. CONCLUSIONS: This familial association between alcoholism and depression may be the result of either genetic or environmental factors or an interaction between the two.

Alcoholism↗
PubMed1991

Depression and previous alcoholism in the elderly.

A prospective study of male in-patients over 55 years old who met Feighner criteria for non-bipolar depression was performed to determine if a previous history of alcoholism significantly influenced treatment or response to treatment. Among 58 subjects with complete follow-up information, the 16 who had a history of alcoholism had a presentation at index which differed from that of the non-alcoholics, and on follow-up they clearly had more chronic illness. This elderly sample with alcoholism resembles 'neurotic-reactive' depressives described in younger samples, and supports a past history of alcoholism as being a risk factor for chronicity of depression on follow-up in the elderly population.

Aged↗
PubMed1991

Close linkage of esterase-D to unipolar depression and alcoholism is ruled out in eight pedigrees.

Unipolar depression and alcoholism were tested for genetic linkage to esterase-D at 13q14.1. Tight linkage to esterase-D was ruled out for three phenotypes using three models of penetrance: (1) unipolar depression and alcoholism taken together as affected, (2) unipolar depression alone as affected with alcoholism considered unaffected and (3) alcoholism alone as affected with unipolar depression considered unaffected. This study does not support an earlier finding of possible linkage between the esterase-D locus at 13q14.1 and alcoholism.

Adolescent↗
PubMed1990

Linkage of c-Harvey-ras-1 and INS DNA markers to unipolar depression and alcoholism is ruled out in 18 families.

Eighteen families informative for c-Harvey-ras-1 and INS DNA markers were tested for linkage to unipolar depression and alcoholism. No evidence of linkage was found between these DNA markers and the disorders observed in the families. This study fails to replicate the Old Order Amish Study and suggests that a significant degree of genetic heterogeneity may be present among psychiatric disorders.

Adolescent↗
PubMed1990

Relationship of electroconvulsive therapy to course in affective illness: a collaborative study.

Bipolars treated with electroconvulsive therapy (ECT) during the index episode were matched on the variables of age, sex, previous admissions and previous hospitalizations with 23 bipolars who did not receive ECT. A similar match was made for 42 unipolars who were under the age of 40 at time of admission. All patients were followed for 5 years. Those patients treated with ECT, both bipolars and unipolars, had the same numbers of episodes in follow-up as their matched groups. However, in both bipolar and unipolar ECT-treated patients, there were more follow-up rehospitalizations. The reason for this is not known but three possibilities exist. Successful treatment with ECT may make the family and patient more prone to consider rehospitalization. Secondly, the originally treated ECT patients may have had more aggressive doctors who were more likely to rehospitalize. Finally, ECT may change the course of an individual's illness in such a way that more severe episodes occur and rehospitalizations are necessary. The findings suggest the need for long-term studies following ECT on clinical and biological variables.

Adult↗
PubMed1990

Perspectives on bipolar illness.

Based on evidence available at present, it appears that heterogeneity does exist within bipolar disorder. Persons with mania differ in family history of affective illness, their age at the onset of illness, sex, and organic cause and course of the illness. The question of how these variables influence an individual's response to treatment has never been systematically studied. Multicenter trials of the various antimanic agents need to be conducted to determine whether the various subgroups of manic patients have different pharmacological response profiles. At present, the clinical management of mania is best approached using lithium carbonate in a dosage adequate to achieve a 12-hour serum lithium level to 1.0 to 1.2 mEq/L. The time to response is usually 2 to 3 weeks, and during this period an antipsychotic or benzodiazepine agent may be added to help control symptoms such as agitation or sleeplessness. Prophylactic maintenance with 12-hour serum lithium levels between 0.8 and 1.0 mEq/L should be used for at least 6 to 12 months after resolution of the manic episode. In patients with more than one episode, lithium maintenance therapy may need to be continued indefinitely. In patients who are not responsive to lithium, the most prominent alternative therapies include anticonvulsants and calcium-channel blocking agents. Anticonvulsants (e.g., carbamazepine, valproic acid, clonazepam) are generally first used as alternative therapy (either alone, or in combination with lithium), followed by a calcium-channel blocker (e.g., verapamil). Clinical practice would generally suggest first using the alternative agent alone, then adding lithium if response is inadequate.(ABSTRACT TRUNCATED AT 250 WORDS)

Anticonvulsants↗