Biomedical subjects

K R Merikangas

Publications and source records attributed to K R Merikangas.

119 records · Page 7Linked to original sources

PubMedDate not supplied

Vulnerability to drug abuse among opioid addicts' siblings: individual, familial, and peer influences.

Vulnerability to drug abuse was explored among 132 siblings of opioid-addicted probands. Multiple risk factors at the levels of the individual, family, and peer group were examined, including sensation-seeking, teenage experimentation with drugs, ordinal position in the family relative to the addicted proband, birth order, and the extent to which peers used drugs and offered drugs to the individual during adolescence. Risk factors were assessed via questionnaire and interview data, while diagnoses of adult drug abuse were derived from structured interviews. Early experimentation with drugs was found to be a powerful risk variable: siblings who had tried drugs as teenagers were almost five times as likely as others to be drug abusers as adults. Other significant correlates of adult drug abuse included sensation-seeking and drug use among the adolescent peer group. Results of the study are discussed in terms of implications for preventive intervention in the field of substance abuse.

Adult↗

PubMedDate not supplied

Headache and personality: results of a community sample of young adults.

The present study investigated the association between personality, symptoms and headache subtypes in a prospective longitudinal epidemiologic study of a cohort of 19- and 20-year-olds in Zurich, Switzerland. Personality was assessed by the Freiburg Personality Inventory (FPI), a standardized self-report personality instrument, which yields nine primary factors and three secondary factors. The Symptom Checklist 90 (SCL-90) was employed to examine somatic and psychological symptoms. Subjects with migraine exhibited elevated rates of neuroticism compared to non-migraine subjects on FPI. Somatization was the only primary symptom factor on the SCL-90 which discriminated between subjects with migraine and those without migraine. Persons with migraine with aura exhibited greater impairment than any of the other headache subtypes or controls on both the FPI and SCL-90. Subjects with tension-type headache did not differ from controls on any of the personality or symptom factors.

Adult↗

PubMedDate not supplied

Headache syndromes and psychiatric disorders: association and familial transmission.

This paper examines the association between psychiatric disorders and headache syndromes in a longitudinal epidemiologic sample of young adults who were selected from the general population of Zurich, Switzerland. Headache syndromes were defined according to the newly introduced diagnostic criteria of the International Headache Society in 1988. The prevalence rates of psychiatric disorders, according to specific headache subtypes, were examined both cross-sectionally and longitudinally. In the cross-sectional data, migraine with aura was associated with hypomania, recurrent brief depression, and all of the anxiety disorders, whereas only the phobic disorders and panic were elevated among subjects with migraine without aura. Similar findings emerged for the longitudinal data, with the exception that major depression was associated with both subtypes of migraine. Subjects with tension-type headaches did not differ from controls with respect to any of the effective or anxiety disorders in both the cross-sectional and longitudinal data. Prospective study data indicated that the age of onset of anxiety disorders generally preceded that of migraine and that the onset of affective disorders in the majority of comorbid subjects followed that of the onset of migraine. In order to investigate the mechanism for the associations between anxiety/depression syndromes and migraine, patterns of co-transmission of migraine and anxiety/depression were examined in data from a controlled family history study of migraine. The results were consistent with a syndromic relationship between migraine and anxiety/depression, rather than their representing discrete manifestations of shared underlying etiology. The implications of these data for research and clinical work are discussed.

Adult↗

PubMedDate not supplied

Drug response as a predictor of transmission of non-bipolar major depression within families.

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↗

PubMedDate not supplied

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↗

PubMedDate not supplied

Depressive spectrum diagnoses.

There has been widespread debate about the validity of the contemporary diagnostic classification system of depression. The major goal of this study is to examine the prognostic significance of each of the major subtypes of depression using data from 5 interviews of a 15-year prospective community-based cohort study. The stability of the following diagnostic subtypes across the duration of the study was examined: major depressive disorder (MDD), dysthymia, recurrent brief depression (RBD), and minor depression. The results show that there was little stability for the specific subtypes of depression among those who continued to manifest depression during the follow-up period; 51% of those with MDD and 44% of those with RBD met criteria for another subtype of depression. When stability was observed, the same subtype often occurred in combination with the development of another subtype. Among individuals with a single subtype, severity was greatest among those with dysthymia, whereas individuals with combined subtypes had greater severity than those with a single subtype. The lack of longitudinal stability of the diagnostic subtypes of depression suggests that depression is better expressed as a spectrum rather than a set of discrete subtypes.

Adult↗

PubMedDate not supplied

Substance abuse, comorbidity, and sensation seeking: gender differences.

Two hundred sixty-two probands and 261 of their relatives with DSM-III-R diagnoses of drug and alcohol abuse and/or anxiety disorders completed the Zuckerman Sensation Seeking Scale. It was hypothesised that subjects with both substance abuse disorders and comorbid anxiety disorders would have lower sensation-seeking profiles than subjects with substance abuse alone. This was confirmed in women, with thrill- and adventure-seeking scores showing significant differences between pure substance abusers and those with a comorbid anxiety disorder, lending support to theories that substance abusers are a heterogeneous group. In men, there were fewer significant differences between diagnostic groups. If substance abusers are indeed a heterogeneous group, with some motivated by high sensation-seeking needs, a better understanding of these motivations can lead to more effective strategies of prevention and treatment, according to etiology.

Adult↗

PubMedDate not supplied

The comorbidity of alcoholism with anxiety and depressive disorders in four geographic communities.

The comorbidity of alcoholism with anxiety and depressive disorders was examined in four epidemiologic investigations from diverse geographic sites. Despite variability in lifetime prevalence rates for these disorders, there was strong cross-site consistency in the magnitude and specific patterns of comorbidity. Individuals with alcohol abuse or dependence generally experienced a twofold to threefold increased risk of anxiety and depressive disorders. Phobic conditions typically preceded the onset of alcoholism, but no systematic pattern was observed for panic or depressive disorders. Considerable heterogeneity was also observed concerning the impact of comorbid conditions on symptoms of the index disorder. While the presence of comorbid anxiety or depressive disorders was consistently associated with moderate increases in the symptoms of alcohol abuse or dependence, alcoholism was associated with large increases in the number of depressive symptoms and little or no increase in phobic symptoms. The findings are discussed in terms of the self-medication hypothesis and the etiologic heterogeneity of these forms of comorbidity in the general population.

Adolescent↗

PubMedDate not supplied

Implications of genetic epidemiology for the prevention of substance use disorders.

Despite advances in characterizing human genotypes, the complex process through which genes exert their influence limits the application of molecular genetics to human diseases. Substance use disorders are necessarily complicated by gene-environment interaction because exposure to an exogenous substance is required for their development. The methods of genetic epidemiology are specifically designed to identify sources of complexity that impede etiologic findings and prevention efforts. The goal of this paper is to illustrate the application of family study methods to identify risk factors for substance abuse and their implications for prevention. The Yale Family Study is a controlled family study of the comorbidity of substance and psychiatric disorders. The sample consists of 223 probands with substance use and/or an anxiety disorders and community controls, 1218 adult first degree relatives and spouses, and 203 offspring (ages 7-17) followed for 8 years. Results indicated familial aggregation of substance disorders in adults and children, independence of familial aggregation of alcoholism and drug dependence, and specificity of familial clustering of some drugs of abuse. Familial factors are more strongly associated with substance dependence than abuse, with an attributable risk of 55%. Premorbid psychiatric disorders--social phobia and bipolar affective disorder in adults, and depression, anxiety, conduct, and oppositional defiant disorders in children--were strongly associated with the subsequent development of substance dependence (attributable risks ranging from 44 to 86%). A family history of substance abuse and premorbid psychopathology are strongly associated with the development of substance use disorders. Implications for primary and secondary prevention are discussed. As specific genetic vulnerability markers for substance use disorders become identified, application of the tools of genetic epidemiology may be employed to identify specific environmental risk factors that may serve as targets for prevention.

Adolescent↗

PubMedDate not supplied

Comorbidity of substance use disorders with mood and anxiety disorders: results of the International Consortium in Psychiatric Epidemiology.

This article reports the results of a cross-national investigation of patterns of comorbidity between substance use and psychiatric disorders in six studies participating in the International Consortium in Psychiatric Epidemiology. In general, there was a strong association between mood and anxiety disorders as well as conduct and antisocial personality disorder with substance disorders at all sites. The results also suggest that there is a continuum in the magnitude of comorbidity as a function of the spectrum of substance use category (use, problems, dependence), as well as a direct relationship between the number of comorbid disorders and increasing levels of severity of substance use disorders (which was particularly pronounced for drugs). Finally, whereas there was no specific temporal pattern of onset for mood disorders in relation to substance disorders, the onset of anxiety disorders was more likely to precede that of substance disorders in all countries. These results illustrate the contribution of cross-national data to understanding the patterns and risk factors for psychopathology and substance use disorders.

Adolescent↗

PubMedDate not supplied

Familial relationship between mood disorders and alcoholism.

Clinical and epidemiological studies have consistently revealed an association between alcohol use disorders and both bipolar and nonbipolar mood disorders. However, the evidence regarding the nature of these associations is unclear. The familial patterns of alcohol and affective disorders were examined using data from a controlled family study of probands with alcohol and anxiety disorders who were sampled from treatment settings and the community. The substantial degree of comorbidity between mood and anxiety disorders among probands allowed for the examination of comorbidity and familial aggregation of alcohol and mood disorders. The major findings are that (1) alcoholism was associated with bipolar and nonbipolar mood disorders in the relatives; (2) there was a strong degree of familial aggregation of alcohol dependence and both types of mood disorders were observed; and (3) there was no evidence of cross-aggregation (i.e., increase in mood disorders among probands with alcohol dependence, and vice versa) between alcoholism and mood disorders. The independent familial aggregation of bipolar disorder and alcoholism and the finding that the onset of bipolar disorder tended to precede that of alcoholism are compatible with a self-medication hypothesis as the explanation for the frequent co-occurrence of these disorders. In contrast, the independent familial aggregation and the tendency of an earlier onset of alcoholism than that of nonbipolar depression suggest that unipolar mood disorders are frequently secondary to alcoholism.

Adult↗