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.     

Emotion recognition in schizophrenic and depressed inpatients

The performance of schizophrenic inpatients (N = 14), depressed inpatients (N = 15), and normal hospital employees (N = 15), all females, was compared on Izard's (1971) test of emotion recognition. Subjects were required to match photographs of facial expressions of emotion with the correct label for the emotion. The average numbers of errors of four types were examined: Positive or neutral emotions mislabelled as other positive or neutral emotions; positive or neutral emotions mislabelled as negative; negative emotions mislabelled as positive or neutral; and negative emotions mislabelled as other negative emotions. The principal findings were (1) the schizophrenics were less accurate than normals, but they were not less accurate than the depressives, nor were they less accurate on negative than positive or neutral emotions; (2) the depressives did not display any form of negative bias in emotion recognition; and (3) both groups of inpatients were less accurate than normals when they labelled an emotion as positive or neutral, but not when they labelled it as negative. Implications of the results for the etiology and maintenance of schizophrenia and depression were noted.     

Assessing depressive symptoms across cultures: Italian validation of the CES-D self-rating scale

Although several self-rating scales for depression have been proposed in the past two decades, very few have been validated on non-English-speaking populations. The present study was carried out in northern Italy in order to examine the validity of the CES-D self-rating scale for depression in another language and culture. The scale was used with 40 depressives and 40 normals who were matched. The Hamilton Rating Scale for Depression (HRSD) was used as an additional test of concurrent validity. The results show that the CES-D is a valid measure in that it sensitively discriminates between depressed patients and normals and presents satisfactory correlations with the observer rating scale (HRSD) in both groups. The scale in its Italian translation is likely to be helpful in the assessment of depression of Italian immigrants in North America and Australia, especially in those whose English is poor.     

Self-referent rating of personality trait adjectives in mild depression]

The purpose of this study was to examine whether those who were mildly depressed and those who were not differed in terms of their self-referent processing of personal information. Twenty-four undergraduates, 12 mildly depressed and 12 normal controls, performed two types of rating tasks, structural and self-referent, on personality adjectives. The adjectives were either related to depression or not. Immediately after the rating tasks, subjects recalled as many adjectives as possible in an incidental memory task. Main results were as follows: (1) The mildly depressed showed longer response latency than the controls in making self-referent ratings, but no difference in latency was found for structural ratings. (2) Both mildly depressed and normal controls recalled more adjectives for the self-referent rating task than the structural one, and recalled more adjectives that were not related to depression than those that were.     

Disappearance of memory deficits in outpatient depressives responding to imipramine

We evaluated learning and memory in 50 depressed patients prior to and following 4 week treatment with imipramine compared to 21 normal controls tested at corresponding times. At baseline, the depressives did worse than normals on most memory tasks with the difficult memory tasks, regardless of store, modality or type of task best distinguishing between depressive and normal memory. Following imipramine treatment, responders performed better than nonresponders on the difficult memory tasks, and not significantly differently from controls on most tasks. This, as well as the fact that the responders improved to a greater degree than controls on most measures (in a few cases the difference was statistically significant) and the fact that at 4 weeks complete responders to imipramine did significantly better than partial responders to imipramine, indicates that relief from depression is highly related to improved memory functioning. The finding that complete responders to imipramine were not significantly worse than normal controls suggests that imipramine did not have significant adverse effects on memory.     

The impact of clinical depression on working memory

Introduction. Both Channon, Baker, and Robertson (1993) and Hartlage, Alloy, Vazquez, and Dykman (1993) claim that working memory impairment in depressed patients is limited to Baddeley's (1996) central executive and does not affect either the phonological loop or the visuospatial scratchpad. Our key questions were: (1) is there an impairment of working memory in depression and which elements does it effect; (2) is another major clinical group also affected and in what ways, and finally, (3) how do these groups vary when compared with each other and with normals? Thus we sought to locate a depression-specific effect and define its extent. Methods. We tested 35 depressed patients, using both 24 anxiety patients and 29 normal controls as comparisons. Several tasks were used so that we could differentiate between the three key aspects of working memory. Results. Contrary to Channon et al., we found that depression affects the allocation of attention and all elements of working memory. The depression group showed a distinct performance profile, with impairments occurring on measures of both the phonological loop and visuospatial sketch pad. On measures of central executive functioning, both depression and anxiety groups showed comparable levels of impairment when compared with the control group. Conclusions. We propose that the source of general disruption in both depressed and anxious patients may be a competition between attempts to direct attentional resources to the task in hand and away from the distractive and intrusive effects of automatic negative thoughts.     

Comparison among inpatients,outpatients, and normals on three self-report depression inventories

Used the Beck Depression Inventory, Form E of the Depression Adjective Check Lists and also the Generalized Contentment Scale to measure depression in 219 Ss, who included inpatients, outpatients, and normals. Data were analyzed using t-test comparisons of means using Bonferroni procedures. Results indicated that depression was significantly greater (for all three depression measures, patient-normal differences were significant at p <.000) in a general psychiatric patient sample than in a normal group. Inpatients were not found to be more depressed than outpatients, and females did not indicate greater depression than males. The expectation that patients diagnosed depressed would score higher on self-report depression scales than patients not diagnosed depressed received partial support. Kuder-Richardson reliabilities computed for the depression inventories were judged to be acceptably reliable. Concurrent validity was appraised by computing Pearson product-moment correlations for the scales on each of the samples. All correlations were positive and significant at p <.002.     

Lymphocyte suppressor activity in atopic eczema

Previous studies have shown that patients with atopic eczema have depressed cell-mediated immunity. Whether this defect can be attributed to abnormal suppressor cell activity or to the presence of mediators of the allergic response has not been studied before. Lymphocyte transformation was found to be enhanced in patients with mild eczema and markedly depressed in patients with severe eczema, when compared with normal controls. Pre-incubation of cultures for 48 hr without mitogen prior to transformation studies restored normal lymphocyte thymidine uptake in cells from severe atopics, suggesting a labile suppressor cell population, or a labile suppressor substance. Since mononuclear cell supernatants from patients with severe eczema failed to suppress lymphocyte transformation more than supernatants from normals, it is unlikely that the depressed lymphocyte function seen in severe eczema is due to an abnormal suppressor cell population. The possibility that mediators of the allergic response may be acting as a labile suppressor substance was evaluated by adding various concentrations of histamine, cyclic-AMP, or prostaglandin E₁ to lymphocytes undergoing mitogenesis. Histamine enhanced thymidine incorporation at low concentrations and depressed uptake at high concentrations; cyclic-AMP and prostaglandin E₁ have similar effects on transformation. It is possible that the enhancement of transformation seen in mild eczema and the depression of this response in severe eczema may be related to the concentrations or degree of allergic mediator release.     

Impaired T-cell activation in patients with systemic lupus erythematosus

Interleukin-2 (IL-2) production was studied in T lymphocytes from 32 patients with systemic lupus erythematosus (SLE) and 27 healthy volunteers. The IL-2 production by phytohemagglutinin (PHA)-stimulated cells from SLE patients was significantly depressed compared to control values, with a correlation between degree of depression and disease activity. The depressed IL-2 production by SLE T cells are largely reversed by the addition of either phorbol ester (PMA) or partially by a calcium ionophore. SLE T cells had significantly lower peak increases in intracellular free calcium ([Ca²⁺]_i) than controls after stimulation by PHA or by a monoclonal antibody against the CD3 antigen. This abnormality was found even in T cells from patients with mild disease activity or in those whose T cells produced normal amounts of IL-2. Calcium ionophore produced similar increases in [Ca²⁺]_i in SLE patients as in normals. These results suggest that a major component of the defect responsible for decreased IL-2 production by SLE lymphocytes is proximal to protein kinase C activation and may involve impaired signal transduction after activation of the antigen receptor complex.     

Sequential interactions in the marital communication of depressed men and women

Despite studies showing patterns of sequential interaction between depressed wives and their husbands, no published research has contrasted sequential interactions of depressed husbands and their wives. This study compared problem-solving interactions of 49 couples with a depressed husband, 41 with a depressed wife, and 50 normal controls. Interactions were coded using the Marital Interaction Coding System. Although no clear patterns of sequential interaction distinguished couples with a depressed wife from normal control couples, results suggested a unique pattern of interaction between depressed husbands and their spouses, whereby positive communications from the husband resulted in decreased positivity and increased negativity from their wives. Given the importance of positivity for promoting effective problem solving, this pattern appears to have important implications for couples' long-term marital satisfaction and husbands' mood regulation.     

Painful truths about depressives' cognitions

Cognitive theories assert that depressed persons' cognitions are distorted. Most of the empirical literature directly contradicts this assertion. Using a wide variety of methods to study a wide variety of cognitive processes, experiments consistently find that depressed people suffer significantly less cognitive distortion than do both normals and nondepressed psychiatric patients. It was speculated that childhood traumas predispose depression by preventing the normal formation of a defensive screen against painful realities.     

The relationship of the dexamethasone suppression test to subtypes of depression and to symptomatic severity in the elderly

Dexamethasone Suppression Tests (DSTs) were performed on 91 subjects consisting of 66 elderly outpatients diagnosed as having major depression according to RDC and 25 age- and sex-matched healthy controls. Postdexamethasone plasma cortisol levels were significantly higher in depressed patients than in normals. The depressed patients were subdivided into endogenous and nonendogenous groups by alternately, RDC and Newcastle Diagnostic Scale (NDS). A significant difference in postdexamethasone plasma cortisol levels between endogenous and nonendogenous groups was noted only when NDS was used, but this difference was found to be related to a significant difference in severity of depression.     

Defective autologous mixed lymphocyte reactions in patients with renal insufficiency--evidence for cellular and serum factors

The autologous mixed lymphocyte reaction (AMLR) was studied in 10 patients who were azotemic from renal diseases not considered to be immunologically mediated. These patients were not on chronic dialysis. The AMLR was significantly depressed in patients with azotemia when compared to the AMLR in normals. When the AMLR was performed utilizing lymphocytes from normals, the proliferative response was markedly decreased if azotemic serum was substituted for normal serum. However, when the AMLR was performed utilizing lymphocytes from azotemic patients, the proliferative response did not significantly improve if normal serum was substituted for azotemic serum. In addition, the proliferative responses of T cells to concanavalin A (Con A) and phytohemagglutinin (PHA) were not significantly depressed in azotemic patients when compared to normal controls. These data suggest that the AMLR is abnormal in azotemic patients because of an intrinsic defect in the mononuclear cells, possibly in the stimulating non-T cells, and an inhibitory factor in the serum.     

Selective inhibition of lymphocyte responsiveness to phytohaemagglutinin in patients with Reiter's syndrome.

The influence of synovial fluid from four patients with Reiter's syndrome on lymphocyte responsiveness was studied. On synovial fluid was found which specifically depressed the responsiveness of lymphocytes from patients with Reiter's syndrome to the non-specific mitogen phytohaemagglutinin (PHA). The ratio of the responsiveness of lymphocytes cultured in the presence of foetal calf serum (FCS), compared to those incubated in the Reiter's synovial fluid, was used as a measure of the depression induced by the Reiter's synovial fluid. The mean ratio for eight normals stimulated with PHA was 0-70 (range 0-35-0-96), while for eight patients with Reiter's syndrome, it was 0-13 (range 0-07-0-19). Similar studies done with concanavalin A (con A) showed no difference between lymphocytes from normals (0-73) or patients with Reiter's syndrome (0-67). Chromatography of the Reiter's synovial fluid on a Sepharose 4-B column resulted in the separation of three major fractions, one of which exhibited the inhibitory activity. When this active fraction was absorbed with Reiter's lymphocytes, a loss of the inhibitory activity of the fraction was seen. A similar absorption with normal lymphocytes had no effect. These studies demonstrate that a factor present in the synovial fluid of a patient with Reiter's syndrome reacted specifically with lymphocytes from patients with Reiter's disease and not with lymphocytes from normals. The interaction of this factor with lymphocytes from patients with Reiter's syndrome inhibited the responsiveness of these lymphocytes to PHA but not to con A.     

Influence of age and executive functioning on verbal memory of inpatients with depression

BACKGROUND: Despite many studies demonstrating memory and executive impairments in young and old depressed patients, the relationships between age, executive functioning and memory have not been evaluated in depression. The aim of this study was to investigate if older patients were more vulnerable than younger patients to the impact of depression on memory and if the differences between young and old depressed could be related to executive functioning. METHODS: Forty-nine inpatients, with unipolar and bipolar depression, ranging in age from 19 to 72 years were compared with 70 controls on a verbal memory task. Age cut-off of 45 years was used as a categorical variable to divide subjects into subgroups. A subset of patients (n=41) was also evaluated with the modified version of the Wisconsin Card Sorting Test and separated into a non-dysexecutive group and a group of patients with mild-executive impairment. RESULTS: Depressed patients exhibited memory deficits with a pattern of memory failure -- impaired free recall and normal cued recall and recognition -- interpreted as a retrieval problem. Both age and executive function influenced memory performance in depression, however neither group x age interaction nor age x executive status interaction were significant. Multiple regression analysis showed that free recall scores were related to age and psychomotor retardation in depressed patients. CONCLUSION: Age and executive functioning have different influences on the memory performance of depressed patients. Our findings support an 'executive memory decline hypothesis' in young as well as old depressed patients. The memory deficits in depression may be associated with both trait and state factors and raise questions about the long-term cognitive functioning of patients with recurrent affective disorders.     

Nocturnal temperature in affective disorder

The temperature rhythms of 9 drug-free patients with primary affective disorder were measured during depression and after recovery and compared with those of 12 normal controls. The patients had higher nocturnal temperatures and decreased 24-hour amplitudes when depressed than when they had recovered and compared to the controls. There was no evidence that the temperature minimum occurred earlier in the night in depression compared to controls. However, in 4 of 7 patients the temperature minimum occurred earlier in the night during depression compared to recovery.     

社区老年期痴呆和老年抑郁症的两年随访研究

目的：了解老年期痴呆和老年抑郁症的疾病过程和转归;动态观察老年人的认知功能变化和情绪改变。方法：以1997年患病率调查时确诊的40例痴呆和25例抑郁症病人以及1528名非病例老人作为随访对象。使用随访问卷进行访谈,诊断流程和标准同1997年。结果：40例痴呆中死亡17例,其标准化死亡比(SMR)为3．42。在23例存活的病人中,8例加重,13例病情不变,1例病情波动,1例诊断为“假性痴呆”;25例老年抑郁症中40％仍为抑郁病例,40％痊愈,20％死亡(其中1例发展为痴呆);非病例老人97年简短心理状况检查(MMSE)低分值组发生痴呆的比率高于97年MMSE分值正常组,97年GDS高分组发生抑郁的比率高于97年整体恶化量表(GDS)分值正常组。结论：老年期痴呆和老年抑郁症的预后差,死亡率高,老年人的认知功能损害与痴呆和抑郁症的发生存在一定的关联,抑郁情绪影响老人的认知功能。     

Induction of c-myc expression early in the course of B-cell activation: studies in normal humans and patients with systemic lupus erythematosus

The proliferative response of B lymphocytes to stimulation with anti-IgM antibodies and B-cell growth factors was studied in 27 patients with systemic lupus erythematosus (SLE) and 17 normal donors. In addition, the expression of messenger RNA of the proto-oncogene c-myc was also studied in B cells from SLE patients and normal donors. The proliferative response of lupus B cells to anti-IgM and B-cell growth factors as compared to normal B cells demonstrated a wide range of responses, 10 were lower than normal and 8 were either normal or supernormal. As compared to normals, expression of B-cell c-myc RNA from SLE patients was either normal or depressed. In general in patients with SLE there was a positive correlation between levels of c-myc expression and the degree of proliferation in B-cells after stimulation with anti-IgM and B-cell growth factors.     

Depressed adolescents of depressed and nondepressed mothers: tests of an interpersonal impairment hypothesis

Two groups of depressed youngsters were compared. From an interpersonal perspective, it was hypothesized that depressed adolescents of depressed mothers would have significantly more interpersonal dysfunction than depressed youngsters of nondepressed mothers. In a large community sample of youth and their families, 65 depressed offspring of women with histories of a major depressive episode or dysthymia were compared with 45 depressed offspring of never-depressed women. As predicted, after controlling for current symptoms and family social status variables, depressed offspring of depressed mothers displayed significantly more negative interpersonal behaviors and cognitions compared with depressed offspring of nondepressed mothers, but they did not differ on academic performance. Implications concerning mechanisms, course, and consequences of different forms of adolescent depression are presented.     

The concept of post-traumatic mood disorder

Post-traumatic stress disorder (PTSD) is frequently comorbid with depression. A number of studies have been conducted to compare individuals suffering from comorbid PTSD and depression with individuals suffering from PTSD alone or depression alone. Comorbidity of PTSD and depression is associated with more severe symptoms as well as higher levels of disability compared to individuals with PTSD alone. A severity of overall symptoms is three to fivefold greater in subjects with comorbid PTSD and depression compared to those with PTSD alone. The comorbid group is five times more likely to manifest functional impairment compared to those diagnosed with PTSD alone. Patients with comorbid PTSD and depression have higher depression, impulsivity, and hostility scores and are significantly more likely to make a suicide attempt compared to subjects with depression alone. Depressed subjects with comorbid PTSD tend towards earlier age of first hospitalization and a higher number of hospitalizations compared to depressed individuals without comorbid PTSD. Lower affinity of alpha-2 adrenoreceptors and higher plasma tyrosine availability to the brain are associated with comorbid PTSD and depression, but not with PTSD alone. Individuals with comorbid PTSD and depression do not exhibit the classic rapid eye movement sleep architectural modifications associated with depression, despite the fact that several other psychophysiological indices of dysphoria are detectable in their sleep. In fenfluramine challenge studies, depressed patients with comorbid PTSD have lower plasma cortisol compared to depressed patients without comorbid PTSD. Cortisol levels increase with age and the number of previous major depressive episodes is a predictor of the cortisol response to fenfluramine administration in depressed patients without PTSD, but not in depressed patients with comorbid PTSD. Depressed subjects with comorbid PTSD have higher cerebrospinal fluid homovanillic acid levels compared with depressed subjects without comorbid PTSD. Thus, studies suggest that patients suffering from comorbid PTSD and depression differ clinically and biologically from individuals with PTSD alone or depression alone. It is possible that some or all individuals diagnosed with comorbid PTSD and depression have a separate psychobiological condition that can be termed "post-traumatic mood disorder". Future clinical and neurobiological studies may not only advance our understanding of the role of environmental and genetic factors in the etiology and pathogenesis of stress-related disorders, but also be useful in refining conceptions of stress-related disorders themselves and possible approaches to the treatment of these conditions.