Life events and relapse in bipolar affective disorder.

In a 2 year study of life events and relapse in a cohort of 62 patients with bipolar affective disorder, an excess of events was found during the month immediately preceding relapse. Of 52 relapses 19% were preceded by a severe event in the previous month, compared to a background rate of 5% of patients experiencing a severe event each month at other times. The rate of life events prior to relapse was not apparently different between manic and depressive relapse, though the number of depressive episodes was small.     

Life events preceding the onset of panic disorder

The life events experienced in the 12 months prior to the first panic attack were studied in 23 patients with a DSM-III diagnosis of panic disorder as well as in 23 healthy subjects matched for age, sex, social and educational level. Patients showed significant excess of life events compared to controls, however life events were assessed. Panic patients in fact scored higher on the number of events, the weighted scores (according to Paykel's scale) and the number of subjects who underwent a major life event (death or severe illness, either personal or of a cohabiting relative) in the two months preceding the onset of symptoms.     

Life events and illness onset: A review

Investigations attempting to show a correlation between life events and the onset of any illness are reviewed. A brief discussion of the main methodologic problems in this area of research is also presented. Investigations of the sick role and the effect of stress upon illness behavior indicate that greater control of these variables is desirable. To gain this, it is suggested that in future studies, illness be more adequately documented than it has been to date. In the studies reviewed here, the data are not sufficiently sound to warrant any firm conclusions conceming the relationship between life events and illness onset.     

Life events and the dexamethasone suppression test in affective illness

Forty patients with primary endogenous major depression were followed up during a 12-month period after recovery, on maintenance therapy. Neither the results of the DST, nor the life events reported could predict the occurrence of affective relapses although bereavement life events tended to be observed more frequently in patients relapsing, regardless of the type of antidepressant treatment.     

Stability of the diagnosis of primary affective disorder. A four-year follow-up study

Most modern studies on depression use standardized diagnostic approaches, such as the St. Louis Criteria or the RDC. The main aim of these methods is to select reliable samples for research purposes. However, doubts have been raised as to whether the groups derived through these criteria are homogeneous. In order to investigate the stability of the diagnosis of Primary Affective Disorder (PAD), a group of 78 patients meeting the criteria for this disorder were followed for 4 years. During this period 19.2% of patients showed important psychopathological symptoms other than affective. No particular factor, apart from bipolar illness, was found to be significantly predictive of a stable diagnosis. However, the rate of diagnoses would have been greater by taking into account family history and premorbid personality of the patients. The authors conclude that other sources of information, beyond present symptoms, ought to be taken into account in order to reach more homogeneous groupings.     

Childhood sexual abuse and affective symptoms in women: a general population study

BACKGROUND: Child sexual abuse (CSA) is associated, after controlling for other adversities, with a range of non-psychotic disorders in adult life. There is a need to clarify whether CSA contributes to risk of disorder in the absence of such adversities, and given that associations may be accounted for by genetic mechanisms, whether they are seen where the perpetrator of CSA is not a biological relative, and where there has been only one incident. METHODS: A questionnaire-based study of a socio-economically representative sample of women age 25-36 (N = 862) was carried out. Parental care and control were assessed using the Parental Bonding Instrument, and CSA using a previously validated questionnaire. Current affective symptoms were assessed from the depression scale of the GHQ-28. RESULTS: Low maternal and paternal care were associated with risk of abuse by a biologically unrelated perpetrator before the age of 11, but not during early adolescence. Low maternal care and CSA each made independent contributions to the prediction of affective symptoms. CSA by a non-relative was strongly associated with GHQ depression, as was CSA by a non-relative that had occurred only once. CONCLUSIONS: Quality of parental care probably influences risk of CSA by unrelated abusers in younger children, while there may be a combination of genetic and parental influences on the risk of abuse by a relative. The strong association of affective symptoms in adult life with CSA by a non-relative suggests an environmental effect. Studies, utilizing genetic designs, of the role of childhood trauma in relation to adult affective symptoms are needed.     

A population study of adult onset limb-girdle muscular dystrophy.

Complete ascertainment of adult onset limb-girdle muscular dystrophy in the Lothian Region of Scotland was attempted. Ten index cases were identified giving a prevalence of 1.3 per 100 000 (0.9 per 100 000 for cases where the diagnosis of muscular dystrophy was supported by both electromyographic and muscle biopsy findings). In these 10 sibships there had been 11 affected subjects, significantly less than the 16.5 cases expected for autosomal recessive inheritance. Excluding cases suspected of being Becker muscular dystrophy, the prevalence was 0.7 per 100 000 (0.3 per 100 000 for proven cases of muscular dystrophy) and there remained a significant difference between the number of cases observed (5) and the number expected (9.1) for autosomal recessive inheritance. The prevalence of limb-girdle muscular dystrophy with onset in adult life has apparently declined over the past 30 years, as would be expected with the recognition of other conditions which cause the same pattern of weakness, making this a relatively rare disorder which should only be considered when other diagnoses have been excluded. The possibility that some cases diagnosed as limb-girdle muscular dystrophy may have had Becker muscular dystrophy emphasises the urgent need for a greater understanding of the biochemical basis of these conditions so that such diagnostic and genetic counselling dilemmas can be resolved.     

Somatoform pain disorder in the general population

BACKGROUND: Chronic pain disorder is assumed to represent a frequent and disabling condition. However, data on the prevalence of somatoform pain symptoms and somatoform pain disorder in the community are limited to date. METHODS: German versions of the Composite International Diagnostic Interview were administered to a representative national sample of 4,075 people. Somatoform pain disorder was diagnosed by standardized diagnostic algorithm based on the DSM-III-R criteria (absence of adequate physical findings). One subgroup was identified as also meeting the DSM-IV criterion B for 'significant distress or psychosocial impairment due to the somatoform pain'. RESULTS: A lifetime prevalence rate of somatoform pain disorder according to DSM-III-R of 33.7% and a 6-month rate of 17.3% was found. When applying the DSM-IV B criterion, the prevalence rate dropped to 12.3 and 5.4%, respectively. In both groups more than 95% of the probands had contacted their doctor because of the pain. In 25% of the probands the pain was positively assigned to psychological factors. A female:male ratio of 2:1 was found. CONCLUSIONS: Somatoform pain disorder (DSM-III-R) is a frequent condition. However, only about one third of these subjects is severely distressed or impaired by the pain. A clear operationalized concept of the DSM-IV criterion C 'psychological factors are judged to have an important role in the onset, severity, exacerbation or maintenance of the pain' should be provided in the further development of the diagnosis 'pain disorder' in order to make this diagnosis suitable for general population surveys.     

Specific somatoform disorder in the general population

The authors assessed the validity of the recently proposed diagnosis for specific somatoform disorder in the general population. German versions of the DSM-IV adapted Composite International Diagnostic Interview were administered to a representative sample of 4075 individuals. Multivariate analyses were used to compare impairment, life satisfaction, and use of health care. A total of 803 of 4075 subjects (19.7%) with undifferentiated somatization disorder were identified, which included 51 subjects (1.3%) who met criteria for specific somatoform disorder. Subjects with specific somatoform disorder were more impaired, had lower life satisfaction, and had higher use of health care than subjects with undifferentiated somatization disorder only. The proposed diagnosis of specific somatoform disorder demonstrated a high validity independent of comorbid depressive and anxiety disorders.     

Life events, difficulties and onset of depressive episodes in later life.

BACKGROUND: The importance of stressful life events and long-term difficulties in the onset of episodes of unipolar depression is well established for young and middle-aged persons, but less so for older people. METHOD: A prospective case-control study was nested in a large community survey of older people. We recruited 83 onset cases during a 2-year period starting 2 1/2 years after the survey, via screening (N = 59) and GP monitoring (N = 24), and 83 controls, a random sample from the same survey population. We assessed depression with the PSE-10 and life stress exposure with the LEDS. RESULTS: Risk of onset was increased 22-fold by severe events and three-fold by ongoing difficulties of at least moderate severity. Severe events accounted for 21% of all episodes but ongoing difficulties for 45%. The association of onset with life stress, often health-related such as death, major disability and hospitalization of subject or someone close, was most pronounced in the cases identified by screening. While a clear risk threshold for events was found between threat 2 and 3 (on a scale of 1-4), the risk associated with difficulties increased more gradually with severity of difficulty. Compared with controls, severe events involved a larger risk for cases without a prior history of depression (OR = 39.48) than for cases with (OR = 8.86). The opposite was found for mild events (OR = 2.94 in recurrent episodes; OR = 1.09 in first episodes). The impact of ongoing difficulties was independent of severity of episode and history of depression. CONCLUSION: Although the nature of life stress in later life, in particular health-related disability and loss of (close) social contacts, is rather different from that in younger persons, it is a potent risk factor for onset of a depressive episode in old age. Severe events show the largest relative risk, but ongoing difficulties account for most episodes. The association of severe events with onset tends to be stronger in first than in recurrent episodes. Mild events can trigger a recurrent episode but not a first one.     

A comparative study on dual patients with affective disorder

BACKGROUND: The main purpose of the study was to investigate whether there are differences between dual patients with affective disorders regarding the different kinds of substances abused - a topic which has hardly been dealt with in the literature. METHODS: Clinical charts of 94 dual and 94 non-dual patients, matched for sex, age, and diagnosis, were scrutinized and the data of both groups compared with each other, with regard to the substance of abuse. RESULTS: A total of 17.4% of all patients with affective disorders were found to be dual patients and the proportion of dual patients was equal among patients with unipolar disorder, bipolar disorder, and dysthymia. Only a few significant differences were found between dual and non-dual patients; more differences were identified when the dual group was divided into patients abusing alcohol (59%), opioids/cocaine (22%), and sedatives/hypnotics (19%). In particular, the group of patients abusing illegal drugs was found to be younger and to show more behavioral pathology. All three groups of dual patients differed regarding the onset of their affective illness. LIMITATIONS: Retrospective study of clinical records. CONCLUSIONS: There are differences between dual patients with affective disorders abusing different substances. The choice of a particular substance of abuse appears to be the function of the age of onset of the disorder.     

Reliability and relationship of various ages of onset criteria for major affective disorder

This paper presents data on six different clinical definitions (indices) of age of onset for major affective disorders. The inter-rater reliability for each index and the relationships among these indices are discussed. Age of onset for impairment with affective symptoms was found to be a reliable and useful index of early onset. It discriminated between unipolar depressed subjects and both bipolar I and bipolar II subjects.     

情感性精神障碍患病前后所生子女易患效应的研究

目的 探讨情感性障碍患者病前病后所生子女的易患效应。方法 对符合国际疾病分类第１０版和中国精神分类方案的诊断标准第２版修订本中情感性精神障碍诊断的１０２年先证者家系登门调查,收集子女发病与父母患病前后所生子女的有关资料。     

Life events, difficulties and dilemmas in the onset of chronic fatigue syndrome: a case-control study

BACKGROUND: The role of stress in the onset of chronic fatigue syndrome is unclear. Our objectives in this study were first, to determine the relation between the onset of chronic fatigue syndrome and stressful life events and difficulties. Secondly, we examined the role of a particular type of problem, dilemmas, in the onset of chronic fatigue syndrome. METHOD: We used a case-control design with 64 consecutive referrals from an Infectious Diseases/ Liaison Psychiatry Fatigue clinic and 64 age- and sex-matched controls from a general practice population control group in Leeds. We had two main outcome measures; the odds ratios of the risk of developing chronic fatigue syndrome after experiencing a severe life event, severe difficulties or both in the year and 3 months preceding onset; and the proportion of subjects in each group who experienced a dilemma prior to onset. RESULTS: Patients with chronic fatigue syndrome were more likely to experience severe events and difficulties in the 3 months (OR = 9, 95% CI 3.2 to 25.1) and year (OR = 4.3, 95% CI 1.8 to 10.2) prior to onset of their illness than population controls. In the 3 months prior to onset 19 of the 64 patients (30%) experienced a dilemma compared to none of the controls. CONCLUSIONS: Chronic fatigue syndrome is associated with stressful events and difficulties prior to onset. Those events and difficulties characterized as being dilemmas seem to be particularly important.     

Findings before diagnoses of asthma among the elderly in a longitudinal study of a general population sample.

Forty elderly subjects who denied ever having asthma or emphysema on enrollment in a longitudinal epidemiologic study later reported consulting a doctor for asthma when they were older than 60 years of age. The average age at which the diagnosis was reported was 70.8 years, after a mean follow-up of 8.5 years. Findings on enrollment in the newly diagnosed subjects with asthma are compared with findings in the 1145 subjects who provided follow-up information when they were older than age 60 years but had never developed asthma. At the time of enrollment, most subjects later diagnosed as having asthma already had wheezing symptoms, suggesting at least a mild asthmatic state, and many subjects had impaired ventilatory function, a positive allergy skin test (especially in association with rhinitis), and blood eosinophilia. Thirty-five percent of the subjects recalled "respiratory trouble before age 16" despite denying prior asthma. The likelihood of a new asthma label was very closely related to the age-sex-standardized serum-IgE level before diagnosis. Newly diagnosed subjects with asthma demonstrated much greater rates of decline in FEV1 than control subjects or than subjects who already had known asthma on enrollment. We conclude that (1) symptoms suggesting asthma are usually present for many years before the diagnosis of the disease in elderly subjects, (2) the serum-IgE level is closely related to the likelihood of a subsequent asthma diagnosis, even in this age group, and (3) a rapid fall in lung function often occurs around the time of initial diagnosis.     

Hemispheric asymmetry in depression and mania. A longitudinal QEEG study in bipolar disorder.

BACKGROUND: previous research has been inconclusive about the nature of hemispheric asymmetry in emotional processing. METHOD: 13 patients with DSM-IV bipolar disorder received repeated QEEGs over 2 years in different mood states. Z-score measures of asymmetry were assessed. RESULTS: asymmetry in frontotemporal slow-wave activity appeared to be in opposite directions in depression compared to mania/hypomania. CONCLUSIONS: mood change in bipolar disorder is associated with change in QEEG asymmetry. LIMITATIONS: study of larger numbers of more homogenous patients under similar conditions is needed. CLINICAL RELEVANCE: study of mood state-dependent asymmetry changes in bipolar disorder may lead to better understanding of hemispheric processing of emotion.     

早发型和晚发型情感性精神障碍父母育龄及胎次效应比较研究

为了解早发型与晚发型情感性精神障碍之间父母育龄及胎次效应有否差异，用Ｈａｌｄａｍｅ和Ｓｍｉｔｈ方法进行了比较研究，结果表明，晚发型无父母育龄及胎次效应，早发型父母育龄及胎次效应。这种效应为父母年龄越大、胎次越高，易患情感性精神障碍。提示早发型与晚发型情感精神障碍之间具有遗传异质性。     

Age of onset in affective disorder: its correlation with hereditary and psychosocial factors

BACKGROUND: Affective disorders probably have a multifactorial aetiology, both biological and psychosocial factors may be of importance at onset as well as at relapses. The aim of the study was to investigate how the age of onset of bipolar and unipolar disorder relates to family history of affective disorder, early parental separation and life events. A second purpose of this study was to analyze the importance of life events preceding the first and subsequent episodes of affective disorder. METHODS: The case records of 282 patients (161 females/121 males; mean age 56) were investigated. They all had a DSM-IV based diagnosis of either bipolar I/II (67%) or unipolar (33%) disorder. Variables, such as family history, early parental loss and life events according to Paykel life events scale, were examined. RESULTS: We found a significantly lower age of onset in bipolar patients with a family history of affective disorder (28.9 vs. 33.9 years). Bipolar patients with preceding life events had a higher age of onset (33.1 vs. 28.3 years). Moreover, bipolar patients with heredity, had less life events at onset. For the bipolar, as well as the unipolar group, life stressors more frequently preceded the first episode of affective disorder than the subsequent episodes. Limitations: The major limitation of this study is the retrospective approach, with e.g. difficulties to decide whether a life event plays a role in aetiology of affective disorder or is its consequence. CONCLUSIONS: Bipolar patients with high constitutional vulnerability have an earlier age of onset and need less stress factors to become ill. Better knowledge about the stress- and the vulnerability-factors in affective disorder might contribute to development of individually tailored therapeutic strategies in future.     

Debt, income and mental disorder in the general population

BACKGROUND: The association between poor mental health and poverty is well known but its mechanism is not fully understood. This study tests the hypothesis that the association between low income and mental disorder is mediated by debt and its attendant financial hardship.MethodThe study is a cross-sectional nationally representative survey of private households in England, Scotland and Wales, which assessed 8580 participants aged 16Revised, the Schedule for Assessment in Neuropsychiatry (SCAN), the Alcohol Use Disorder Identification Test (AUDIT) and other measures. Detailed questions were asked about income, debt and financial hardship. RESULTS: Those with low income were more likely to have mental disorder [odds ratio (OR) 2.09, 95% confidence interval (CI) 1.681.97) and vanished when other sociodemographic variables were also controlled (OR 1.07, 95% CI 0.7710.3). CONCLUSIONS: Both low income and debt are associated with mental illness, but the effect of income appears to be mediated largely by debt.