Biomedical subjects

J R DePaulo

Publications and source records attributed to J R DePaulo.

At least 19 recordsLinked to original sources

PubMed1995

Patterns of maternal transmission in bipolar affective disorder.

The mode of inheritance of bipolar affective disorder (BPAD) appears complex, and non-Mendelian models of inheritance have been postulated. Two non-Mendelian phenomena, genomic imprinting and mitochondrial inheritance, may contribute to the complex inheritance pattern seen in BPAD. Both imprinting and mitochondrial inheritance share the feature of differential expression of the phenotype, depending on the parent of origin. In this study we tested the hypothesis of a parent-of-origin effect on the transmission of BPAD. We examined the frequency and risk of affective disorder among relatives in a sample of 31 families ascertained through treated probands with BPAD and selected for the presence of affected phenotypes in only one parental lineage. Three specific comparisons were performed: (1) the observed frequency of transmitting mothers versus transmitting fathers; (2) the observed frequency and lifetime risk of BPAD among the maternal versus the paternal relatives of probands; and (3) the observed frequency and lifetime risk of BPAD for the offspring of affected mothers compared with the offspring of affected fathers. We observed a higher than expected frequency of affected mothers (P < .04), a 2.3-2.8-fold increased risk of illness for maternal relatives (P < .006), and a 1.3- 2.5-fold increased risk of illness for the offspring of affected mothers (P < .017). In seven enlarged pedigrees, fathers repeatedly failed to transmit the affected phenotype to daughters or sons. Taken together, these findings indicate a maternal effect in the transmission of BPAD susceptibility and suggest that molecular studies of mtDNA and imprinted DNA are warranted in patients with BPAD.

Bipolar Disorder↗

PubMed1993

Mood variability in normal subjects on lithium.

To investigate the effect of lithium carbonate on normal volunteers' moods, we randomly assigned 30 subjects to 5 weeks each of placebo and lithium treatment with crossover at midstudy. Lithium levels were maintained during the treatment period at a mean serum level of 0.54 mEq/L. All subjects completed visual analogue mood scales (VAMS) daily throughout the study period; segmented visual analogue scales (SVAS) measuring mood, anxiety, and energy and the Profile of Mood States (POMS) were completed weekly at testing sessions. Neither mean mood nor mood variability as assessed by the delta square (mean square successive difference) differed between placebo and lithium conditions. Segmented visual analogue scale mood ratings were highly correlated with the VAMS and similarly showed no difference between conditions. The self-rated mood variability, however, declined significantly in both experimental conditions as a function of time on study. None of the POMS factors differed between placebo and lithium conditions. These data suggest that lithium, in modest doses administered over 5 weeks, does not have a substantial mood-stabilizing effect in normal subjects.

Adult↗

PubMed1992

Bipolar II affective disorder in eating disorder inpatients.

We examined the association between affective disorders and eating disorders in 22 eating disorder inpatients who were interviewed using the Schedule for Affective Disorders and Schizophrenia-Lifetime Version. The first series of 11 were interviewed as part of an interrater reliability study; the second series, done as follow-up to the first, consisted of 11 consecutive admissions. Overall, there were 15 bulimics and seven anorexics. Nineteen patients had a major affective disorder, and 13 (59%) had bipolar II affective disorder. Bipolar II affective disorder appears to be a common finding in hospitalized patients with severe persistent eating disorders.

Adult↗

PubMed1992

Assessment of lineality in bipolar I linkage studies.

OBJECTIVE: To assess lineality in families of bipolar I probands, the authors used direct interviews of family members to reclassify families initially categorized as unilineal by family history. METHOD: The families of 1,800 treated bipolar I probands were screened by the family history method with multiple informants. If the proband had one or more affected sibs and one apparently unaffected parent, the parents (and then other available first- and second-degree relatives) were directly interviewed by psychiatrists. RESULTS: Of the 1,800 families screened, 56 were apparently suitable unilineal families with multiple affected members; 46 families were interviewed directly. After interviews with the parents, 12 families (26.1%) were found to be bilineal. Direct interviews of all available relatives in the 34 remaining families revealed that only 22 (47.8% of the 46 interviewed families) were unilineal or probably unilineal and 12 were probably bilineal. The probably bilineal families had a significantly higher proportion of siblings with unipolar disorder. In addition, the affected sibs from the probably bilineal families tended to have earlier onsets but had significantly fewer symptoms in the most severe depressive episode. CONCLUSIONS: Fewer than 50% of bipolar I families appearing unilineal according to family history were found to be unilineal by direct interviews. The phenotypic differences between the affected sibs from the probably bilineal families and those from the unilineal and probably unilineal families suggest differences in genetic mechanisms. These findings highlight the need to systematically assess lineality in all families considered for bipolar I linkage studies and support the preferential inclusion of unilineal families in linkage studies.

Adult↗

PubMed1992

Depression following myocardial infarction.

OBJECTIVE: Although many investigators have studied mood disorders following myocardial infarction, the prevalence, severity, and persistence of depression have been disputed, and standard rating scales and criteria for depressive disorders have infrequently been utilized. The authors' goal was to determine how frequently depressive disorders occur after myocardial infarction, and to investigate predisposing factors for such disorders. METHOD: Structured clinical interviews were administered to 129 inpatients within ten days of myocardial infarction. Patients were also evaluated using standardized rating scales for depression, social function, cognition, and physical impairment. DSM-III diagnoses were derived from the structured interview. RESULTS: Major depressive syndromes were present in 19 percent (n = 25) of the patients and were associated with prior history of mood disorder, female sex, large infarcts, and functional physical impairment. CONCLUSION: Major depression is common in the acute post-myocardial infarction period. Such disorders confer significant psychiatric morbidity and, if sustained, require psychiatric intervention.

Aged↗

PubMed1991

Fluoxetine treatment of bipolar II depression.

We have previously reported on the familial aggregation of bipolar II affective disorder and have speculated that new treatment approaches might be required for this difficult disorder. Based on Reimherr's report that fluoxetine responders were more likely to have poor prior responses to tricyclics and to have chronic depressions with "atypical" clinical features, we used fluoxetine to treat the chronic atypical depression in selected bipolar II outpatients. The 16 bipolar II patients in our series had been depressed for an average of 5.3 years prior to starting fluoxetine and had had poor responses to tricyclics, MAOIs, and lithium. All but one have had some response to fluoxetine. Ten of the 13 patients who have been taking fluoxetine for 10 or more months have had a good to very good response and the other 3 have had a fair response. Only one patient discontinued fluoxetine because of side effects. These findings should encourage further treatment research using fluoxetine and other serotonin reuptake blockers as well as research into the pathophysiologic identity of bipolar II as a possible distinct form of affective disorder.

Adult↗

PubMed1990

Bipolar II disorder in six sisters.

Several studies have suggested the utility of separating the type II (BPII) from type I bipolar affective disorder (BPI). The data supporting this suggestion include differences in the course of BPII illness, poorer response of BPII to medications, the higher frequency in BPII patients of non-affective co-morbidity and an increased risk of BPII disorder among relatives of BPII patients. This report of a family in which six sisters and several other family members share the disorder further supports the suggestion that BPII disorder 'breeds true', at least in some families. Since the diagnosis of the BPII disorder is relatively unstable, further study will be needed to establish BPII as distinct from BPI and unipolar disorders. Among others, molecular genetic methods will be useful in the resolution of this issue.

Adult↗

PubMed1990

Bipolar disorder and Crohn's disease.

Despite an extensive literature examining the relationship between Crohn's disease and psychiatric illness, there is only one published report of mania in a patient with Crohn's disease. The authors describe seven patients, six men and one woman, with both bipolar disorder and Crohn's disease. The age at onset of Crohn's disease was highly correlated with the age at onset of affective disorder (r = .89, p = .016) and mania (r = .79, p = .06). Four patients received prednisone therapy for Crohn's disease from 3 to 52 weeks before their first manic episode. The authors discuss the relationship of the two illnesses, including possible common provoking factors, the possible role of steroids, and the genetics of the disorders.

Adult↗

PubMed1990

Genetic linkage studies of bipolar affective disorder.

Underrecognition and undertreatment of affective disorders constitute a serious public health problem in this country. The recent availability of improved methods of genetic linkage analysis make the definition of the genetic basis of some types of bipolar affective disorders feasible within the foreseeable future.

Bipolar Disorder↗

PubMed1989

Relationship between psychiatric distress and alcohol use: findings from the Eastern Baltimore Mental Health Survey.

This study examined the nature and strength of relationships between levels of alcohol use and concurrent psychiatric distress among adults in the community aged 18-64 years. Data for this project were gathered by standardized interview methods during the 1981-1982 Eastern Baltimore Mental Health Survey. The 2558 survey respondents were initially selected by means of multistage probability sampling of adult household residents in eastern Baltimore, Maryland. This project's findings indicated gender differences in the relationships under study. There was a moderate degree of association between heavy alcohol use and psychiatric distress among women; at moderate levels of alcohol use, a modest association was also noted. In contrast, for males, the results suggested a small positive association between heavy alcohol use and concurrent psychiatric distress, although these findings were not conclusive.

Adaptation, Psychological↗

PubMed1989

The new genetics of bipolar affective disorder: clinical implications.

Underrecognition and undertreatment of affective disorders (i.e., major depressive disorder and bipolar affective disorder) constitute a serious public health problem in this country. The recent availability of sufficient mapped restriction fragment length polymorphism (RFLP) probes to cover the human genome and of improved methods of genetic linkage analysis make the definition of the genetic basis of bipolar affective disorders (and recurrent depressions) feasible within the foreseeable future. However, the degree of genetic heterogeneity involved might make the use of tightly linked RFLPs for diagnostic testing, as has been done for Huntington's disease or cystic fibrosis, impractical. Assuming multiple disease loci, then widely applicable and useful "molecular" diagnostic tests will await the cloning of the disease genes or identification of pathogenic gene products. In addition, the combination of genetic heterogeneity and a substantial degree of assortative mating (i.e., people with affective disorders marrying each other) in families with these disorders could make the search for linked loci a "bottleneck" in the path toward developing such diagnostic tests. Recently, three disease loci have been tentatively identified on chromosome 6, 11, and X.

Bipolar Disorder↗

PubMed1987

Therapeutic and genetic prospects of an atypical affective disorder.

The utility of bipolar type II affective disorder subgrouping is discussed. There is low diagnostic agreement among clinicians for this putative condition. However, the clustering of cases in families and the poor response to standard treatments suggest that it is a distinct subgroup. The clinical features of the depressive phase of this condition including chronicity, intermittency, hyperphagia, hypersomnia, and reactivity relate it to the constructs of "hysteroid dysphoria," atypical depression, and seasonal affective disorder. Its association to several abnormal motivated behaviors such as alcoholism and eating disorders allows the speculation that a distinct morbid mechanism involving serotonin may underlie it and that new serotonin reuptake blocking drugs may be useful in treating it. Finally, the genetic identity of this subgroup in all likelihood will be established or rejected by genetic linkage studies utilizing the restriction fragment length polymorphism map of the genome.

Genetic Markers↗

PubMed1986

Renal function and lithium: a longitudinal study.

Forty lithium-treated manic-depressive patients underwent two renal function assessments 6 to 18 months apart to assess the course of renal function changes associated with lithium therapy. No change in glomerular filtration rate was noted. Although the average 24-hour urine volume increased significantly, large increases occurred in few patients. Most patients had no substantial urine volume change, and a few had decreases. The changes were correlated with serum lithium levels. The results suggest that the majority of patients develop little renal concentrating impairment, while a small proportion of patients become more polyuric with further lithium treatment.

Adult↗

PubMed1985

Symptomatic, familial, perinatal, and social correlates of computerized axial tomography (CAT) changes in schizophrenics and bipolars.

Computerized axial tomography (CAT) scans were blindly examined, and lateral ventricular-to-brain ratios calculated in 19 schizophrenic and 27 bipolar patients, and in an equal number of individually matched normal controls. Family history, early development, past psychiatric history, and current functioning and symptomatology were analyzed for all patients. Lateral ventricular enlargement on CAT was found in a significant proportion of both patient groups. Patients with such enlargement tended to have greater numbers of negative symptoms and poorer premorbid adjustment, but did not differ regarding family history of psychiatric illness. A subgroup of schizophrenics with presumed early brain damage was identified. This group had more marked ventricular enlargement, a greater number of negative symptoms, and an earlier onset of illness.

Achievement↗

PubMed1985

RBC choline and renal disorders during lithium treatment.

The authors measured RBC choline level, plasma choline level, and renal concentrating ability in 26 lithium-treated patients, seven psychiatric control subjects, and seven normal control subjects. An analysis of variance revealed no significant relationship between renal concentrating ability and either RBC choline level or RBC/plasma choline ratio.

Adult↗

PubMed1984

Lateral ventricular enlargement associated with persistent unemployment and negative symptoms in both schizophrenia and bipolar disorder.

Forty-six patients with schizophrenia or bipolar disorder and 46 individually matched normal volunteers underwent computed tomographic (CT) scans of the head. The ventricular-to-brain ratio was strongly associated with persistent unemployment and negative symptoms in both patient groups. Previous findings of relative lateral ventricular enlargement in a proportion of schizophrenic and bipolar patients were also replicated. Implications of the relationship between CT changes and chronic unemployment among the patients are discussed.

Adolescent↗

PubMed1984

Clinical correlates of lateral ventricular enlargement in bipolar affective disorder.

The presence of lateral ventricular enlargement in some manic-depressive subjects, as assessed by ventricular-brain ratios (VBRs), has been reported. A study of 27 bipolar patients and 27 individually matched normal controls confirmed that finding. Bipolar patients had significantly larger VBRs than did controls. Clinical measures associated with the presence of ventricular enlargement in the bipolar patients included more frequent hospitalizations and histories of persistent unemployment. Other measures of illness severity or social deterioration were not significantly associated with large VBR.

Adult↗

PubMed1984

Lithium.

Lithium carbonate is the single most important long-term treatment for recurrent affective disorders. The side effects of long-term treatment involve mainly the renal system, and therefore it is essential that patients be medically monitored closely. Lithium intoxication is a serious but largely preventable complication. Because its mechanisms of action are unknown, the effective use of lithium remains an empirical but essential part of modern psychiatric practice.

Aggression↗