Biomedical subjects

K K Bucholz

Publications and source records attributed to K K Bucholz.

At least 19 recordsLinked to original sources

PubMed1999

Evaluation of ADHD typology in three contrasting samples: a latent class approach.

OBJECTIVE: To identify subtypes of attention-deficit/hyperactivity disorder (ADHD) and characterize them as either categorical or continuous; to investigate familial resemblance for ADHD among sibling pairs; and to test the robustness of all results by using contrasting data sets. METHOD: Latent class analysis was applied to the ADHD symptom profiles obtained from parents or best informant about their offspring in 3 samples: a population-based set of female adolescent twins (724 monozygotic pairs, 594 dizygotic pairs) and male (N = 425) and female (N = 430) child and adolescent offspring ascertained from high-risk alcoholic families. RESULTS: Latent class analysis revealed 2 categories of clinically significant ADHD which were replicated in all 3 study groups: a subtype with high endorsements of ADHD inattention symptoms and a second combined type with high endorsements of both inattention and hyperactivity-impulsivity items. Both appeared to be continuous across all 3 data groups. The high-risk families contained a class in which members heavily endorsed the ADHD "fidget" item but not other ADHD items. A large proportion of the monozygotic sibs (80%) versus a smaller proportion of dizygotic sibs (52%) were assigned to the same latent class. Among the high-risk children and adolescents, 51% of the female and 41% of the male siblings were concordant for class membership. CONCLUSIONS: The pattern of latent classes suggested that ADHD consists of an inattentive and a combined subtype, within each of which lies a dimensional domain. These analyses further support that genetic factors are significant determinants of latent class membership.

Adolescent↗

PubMed1999

Clinical implications for four drugs of the DSM-IV distinction between substance dependence with and without a physiological component.

OBJECTIVE: The DSM-IV work group asked researchers and clinicians to subtype substance dependent individuals according to the presence or absence of physiological symptoms. A recent report from the Collaborative Study on the Genetics of Alcoholism demonstrated that among alcohol-dependent men and women, a history of tolerance or withdrawal was associated with a more severe clinical course, especially for individuals with histories of alcohol withdrawal. This article evaluates similar distinctions among subjects in the collaborative study who were dependent on marijuana, cocaine, amphetamines, or opiates. METHOD: Structured interviews gathered information from 1,457 individuals with a lifetime diagnosis of marijuana dependence, 1,262 with histories of cocaine dependence, 647 with amphetamine dependence, and 368 subjects with opiate dependence. For each drug, the clinical course was compared for subjects whose dependence included a history of withdrawal (group 1), those dependent on each drug who denied withdrawal but reported tolerance (group 2), and those who denied both tolerance and withdrawal (group 3). RESULTS: The proportion of dependent individuals who denied tolerance or withdrawal (group 3) ranged from 30% for marijuana to 4% for opiates. For each substance, individuals in groups 1 and 2 evidenced more severe substance-related problems and at least a trend for greater intensities of exposure to the drug; those reporting withdrawal (group 1) showed the greatest intensity of problems. CONCLUSIONS: The designation of dependence in the context of tolerance or withdrawal identifies individuals with more severe clinical histories. These results support the importance of the designation of a physiological component to dependence, especially for people who have experienced a withdrawal syndrome.

Adult↗

PubMed1998

Suicidal behaviour: an epidemiological and genetic study.

BACKGROUND: Psychiatric history, familial history of suicide attempts, and certain traumatic life events are important predictors of suicidal thoughts and behaviour. We examined the epidemiology and genetics of suicidality (i.e. reporting persistent suicidal thoughts or a plan or suicide attempt) in a large community-based sample of MZ and DZ twin pairs. METHOD: Diagnostic telephone interviews were conducted in 1992-3 with twins from an Australian twin panel first surveyed in 1980-82 (N = 5995 respondents). Data were analysed using logistic regression models, taking into account twin pair zygosity and the history of suicidality in the respondent's co-twin. RESULTS: Lifetime prevalence of suicidal thoughts and attempts was remarkably constant across birth cohorts 1930-1964, and across gender. Major psychiatric correlates were history of major depression, panic disorder, social phobia in women, alcohol dependence and childhood conduct problems. Traumatic events involving assault (childhood sexual abuse, rape or physical assault) or status-loss (job loss, loss of property or home, divorce), and the personality trait neuroticism, were also significantly associated with suicide measures. Prevalence of serious suicide attempts varied as a function of religious affiliation. After controlling for these variables, however, history of suicide attempts or persistent thoughts in the respondent's co-twin remained a powerful predictor in MZ pairs (odds ratio = 3.9), but was not consistently predictive in DZ pairs. Overall, genetic factors accounted for approximately 45% of the variance in suicidal thoughts and behaviour (95% confidence interval 33-51%). CONCLUSIONS: Risk of persistent suicidal thoughts and suicide attempts is determined by a complex interplay of psychiatric history, neuroticism, traumatic life experiences, genetic vulnerability specific for suicidal behaviour and sociocultural risk or protective factors.

Adult↗

PubMed1998

Common genetic risk factors for conduct disorder and alcohol dependence.

The association between retrospectively reported childhood conduct disorder (CD) and a history of alcohol dependence (AD) was examined in a sample of 2,682 male, female, and unlike-sex adult twin pairs. There was a strong association between CD and AD in both men (tetrachoric r = .34, odds ratio = 2.8) and women (tetrachoric r = .53, odds ratio = 9.9). Genetic factors accounted for most of the association between CD and AD liability in men and women, with the remainder of the association being due to nonshared individual-specific environmental factors. Genetic influences common to CD and AD accounted for 17% and 35% of the genetic variation in AD liability in men and women, respectively, and accounted for 11% and 23% of the total variation in AD liability in men and women, respectively. The results suggest that there are common genetic risk factors for CD and AD or that CD itself is an important genetically influenced risk factor for AD.

Adult↗

PubMed1998

Latent class and factor analysis of DSM-IV ADHD: a twin study of female adolescents.

OBJECTIVE: In an attempt to validate the current DSM-IV criteria for attention-deficit/hyperactivity disorder (ADHD) in females and to determine whether symptoms are continuously distributed or categorically discrete, the authors performed factor and latent class analysis on ADHD symptom data from a large general population of adolescent female twins (1,629 pairs). METHOD: A structured diagnostic assessment of DSM-IV ADHD was completed with at least one parent of 1,629 pairs by telephone. ADHD symptoms from 1,549 pairs were subjected to latent class and factor analysis. RESULTS: Latent class and factor analyses were consistent with the presence of separate continuous domains of inattention (ATT), hyperactivity-impulsivity (H-I), and combined ATT with H-I problems. Severe latent classes corresponding to the predominantly inattentive, predominantly hyperactive-impulsive, and combined types were identified with lifetime prevalence estimates of 4.0%, 2.2%, and 3.7%, respectively. Membership in the severe ATT class predicted academic problems, family problems, and referral to health care providers. Membership in the H-I and combined classes also predicted impaired social relationships. CONCLUSIONS: These results suggest that DSM-IV ADHD subtypes can be thought of as existing on separate continua of inattention, hyperactivity-impulsivity, and combined type problems. Membership in any of there severe ADHD latent classes did not preclude academic excellence, but it was associated with different types of impairment and health care-seeking behavior. These data have implications in the areas of diagnosis, classification, treatment, and research.

Adolescent↗

PubMed1998

Long-term reliability and validity of alcoholism diagnoses and symptoms in a large national telephone interview survey.

The long-term reliability and validity of telephone lay interview assessments of alcoholism were examined in the context of a large national community-based survey of over 8,000 male Vietnam era veterans. A subsample of 146 men was interviewed twice by telephone using the same structured interview an average of 15 months apart to evaluate the long-term reliability of alcoholism symptoms and diagnoses. In addition, a search of Department of Veterans Affairs patient treatment files of inpatient hospitalizations between 1970 and 1993 yielded a subsample of 89 interviewed men with a past discharge diagnosis of alcohol dependence. The test-retest reliability of alcohol abuse and alcohol dependence diagnoses was good, with kappa coefficients of 0.74 and 0.61, respectively. The reliability of individual alcoholism symptoms was fair to good, with kappas of 0.46 to 0.67. Ninety-six percent of individuals identified by Department of Veterans Affairs patient treatment files as having an alcohol dependence diagnosis were correctly diagnosed by the telephone interview. The results of the present study provide additional evidence for the long-term reliability and validity of lifetime alcoholism diagnoses, and suggest that the reliability and validity of telephone interview assessments of alcoholism are as good as that of an in-person interview. Telephone administration of structured psychiatric interviews appears to be an attractive alternative to in-person interviewing for gathering information about alcoholism and alcohol-related problems.

Adult↗

PubMed1998

Clinical relevance of the distinction between alcohol dependence with and without a physiological component.

OBJECTIVE: DSM-IV indicates that diagnoses of substance dependence should be further characterized with regard to the presence of a physiological component, defined by tolerance or withdrawal. This study evaluated the possible meaning of this distinction in alcohol-dependent men and women. METHOD: As part of the Collaborative Study on the Genetics of Alcoholism, structured interviews were carried out with 3,395 DSM-III-R-defined alcohol-dependent individuals divided into 2,949 subjects (86.9%) with evidence of tolerance and/or withdrawal (group 1), 51.3% of whom evidenced withdrawal symptoms, and 446 subjects (13.1%) without a physiological component (group 2). Data were evaluated to determine differences between the two groups. RESULTS: Group 1 reported greater severity of alcohol dependence as demonstrated by a larger maximum number of drinks in 24 hours, more persons reporting binges, more alcohol-related life problems, more relevant DSM-III-R criteria endorsed, more physiological complications, and more alcohol-related emotional/psychiatric symptoms such as depression and anxiety. Each of these severity indicators for problems in group 1 was significant in the presence of the others in a logistic regression, and similar items remained significant when tolerance alone, withdrawal alone, or their combination was used as the criterion for group 1 membership; however, for withdrawal a larger proportion of the variance was explained by the predictor variables. The regression results were independent of gender, proband status, and history of antisocial personality disorder. CONCLUSIONS: The results support the clinical relevance of distinguishing between alcohol-dependent patients with and without a physiological component. The data indicate a potential advantage to limiting that definition to withdrawal only.

Adult↗

PubMed1998

The clinical course of alcohol-related problems in alcohol dependent and nonalcohol dependent drinking women and men.

OBJECTIVE: This article examines the differences in the clinical course of alcohol dependence in men and women, interpreting results in light of the gender differences in nonalcoholics and potential findings from the general population. METHOD: As part of the Collaborative Study on the Genetics of Alcoholism (COGA) protocol, a detailed semistructured interview was administered to 1,085 alcohol dependent women and 2,120 alcohol dependent men, along with 1,936 women and 1,233 men who were drinkers but not alcoholic. Subjects were alcohol dependent probands, controls, and relatives of each. RESULTS: The men's and women's rank orders of alcohol-related life events were similar for alcohol dependent subjects, with a rho (rho) of .95, a figure that remained constant even when only primary alcoholics were considered. In general, those items for which the two genders evidenced differences in either the mean age of occurrence or the proportion of people who experienced an event were similar to gender differences in drinking among nonalcoholics or the literature on the general population. These included for women a lower maximum number of drinks per day, a 1- to 2-year later onset of several early alcohol-related problems and fewer years between the onset of problems and seeking help. Female alcoholics also showed a lower proportion with legal, job or personal problems related to alcohol. There were also high levels of similarity (p = .76, p > .001) for 28 life events related to alcohol for 1,936 women and 1,233 men who were drinkers but not alcohol dependent. CONCLUSIONS: Overall, the time course of alcohol-related problems for men and women were more similar than different. While there was evidence of a "telescoping" of the time between the onset of problems and treatment for women, the gender differences in ages of onset of events were relatively small. These data support the conclusion that, after considering gender differences in drinking in society, there is little evidence that the natural history of alcohol dependence in women is substantially different than in men.

Adult↗

PubMed1998

A family-based analysis of whether the functional promoter alleles of the serotonin transporter gene HTT affect the risk for alcohol dependence.

A population association between a regulatory variation in the promoter of the serotonin transporter gene (HTT) and severe alcohol dependence was recently reported. We analyzed this potential association in a large number of systematically ascertained families in the United States; these families had at least three first-degree relatives who were alcohol-dependent. Analyses focused on individuals defined as alcohol-dependent by criteria from ICD-10 and on subsets of these individuals reporting withdrawal-related symptoms. Application of the transmission disequilibrium test did not provide support for either linkage or association between this functional polymorphism and alcohol dependence; there was no significant bias in the transmission of either allele to the alcohol-dependent offspring. We also report that African Americans differ from Caucasians in allele frequencies for this polymorphism.

Adult↗

PubMed1998

ADH genotypes and alcohol use and dependence in Europeans.

We have tested for effects of alcohol dehydrogenase (ADH) genotypes on self-reported alcohol consumption and symptoms of alcohol dependence, recorded on three occasions up to 15 years apart, in 377 male and female subjects of European descent. ADH2 genotype had significant effects on both consumption and dependence in the men, but not in the women. The effects of ADH3 genotype were considerably less than those of ADH2, but significant results could be demonstrated when the combined genotypes were considered. The direction of the effects on alcohol consumption and dependence risk were consistent with reports on Asian subjects, and with the in vitro properties of ADH isoenzymes. As with previous studies on the relationship between ADH type and alcohol use, population stratification cannot be excluded as a contributing factor in these results.

Adolescent↗

PubMed1998

Linkage of an alcoholism-related severity phenotype to chromosome 16.

There is substantial evidence for a significant genetic component to the risk for alcoholism. In searching for genes that contribute to this risk, the diagnostic criteria for alcohol dependence may not be the optimal phenotype; rather, creation of a more homogeneous phenotype will lead to a more homogeneous genetic etiology. Items from the Semi-Structured Assessment for the Genetics of Alcoholism collected from 830 individuals in 105 alcoholic families were used in a latent class analysis to identify a more homogeneous alcoholism-related phenotype. A four-class solution was chosen: class 1, unaffected group; class 2, mildly problematic group; class 3, moderately affected group; and class 4, severely affected group. Classes 3 and 4 had higher symptom endorsement probabilities than classes 1 and 2 for items reflecting severe alcohol dependence, and were combined to provide enough sibling pairs for genetic linkage analysis. A total of 291 markers distributed throughout the genome, with an average intermarker distance of 14 cM, were genotyped. Linkage analysis was performed to detect loci underlying classes 3 and 4, the moderately and severely affected alcoholics, of whom 88% met the Collaborative Study of the Genetics of Alcoholism, and >99% met ICD-10 criteria for alcohol dependence. Evidence for a locus on chromosome 16, near the marker D16S675, was found with a maximum multipoint lod score of 4.0. Analysis of additional markers on chromosome 16 yielded a lod score of 3.2, narrowed the critical region, and placed the gene between D16S475 and D16S675 in a 15 cM interval.

Adult↗

PubMed1997

Genetic and environmental contributions to alcohol dependence risk in a national twin sample: consistency of findings in women and men.

BACKGROUND: Genetic influences on alcoholism risk are well-documented in men, but uncertain in women. We tested for gender differences in genetic influences on, and risk-factors for, DSM-III-R alcohol dependence (AD). METHOD: Diagnostic follow-up interviews were conducted in 1992-3 by telephone with twins from an Australian twin panel first surveyed in 1980-82 (N = 5889 respondents). Data were analysed using logistic regression models. RESULTS: Significantly higher twin pair concordances were observed in MZ compared to DZ same-sex twin pairs in women and men, even when data were weighted to adjust for over-representation of well-educated respondents, and for selective attrition. AD risk was increased in younger birth cohorts, in Catholic males or women reporting no religious affiliation, in those reporting a history of conduct disorder or major depression and in those with high Neuroticism, Social Non-conformity, Toughmindedness, Novelty-Seeking or (in women only) Extraversion scores; and decreased in 'Other Protestants', weekly church attenders, and university-educated males. Controlling for these variables, however, did not remove the significant association with having an alcoholic MZ co-twin, implying that much of the genetic influence on AD risk remained unexplained. No significant gender difference in the genetic variance in AD was found (64% heritability, 95% confidence interval 32-73%). CONCLUSIONS: Genetic risk-factors play as important a role in determining AD risk in women as in men. With the exception of certain sociocultural variables such as religious affiliation, the same personality, sociodemographic and axis I correlates of alcoholism risk are observed in women and men.

Adult↗

PubMed1997

Modeling genetic and environmental influences in the etiology of conduct disorder: a study of 2,682 adult twin pairs.

The etiology of conduct disorder (CD) was examined retrospectively in a sample of 2,682 male, female, and unlike-sex adult twin pairs from the community-based Australian Twin Register. Model-fitting analyses indicated a substantial genetic influence on risk for CD, accounting for 71% of the variance (95% confidence interval [CI] = 32-79%). There was not a statistically significant effect of the shared environment in the best-fitting model of CD, but a modest effect of the shared environment on the risk for CD could not be rejected (95% CI = 0-32%). The magnitude of genetic and environmental influences for CD liability did not vary significantly for boys and girls, and the specific genetic and environmental mechanisms important for the development of CD appeared to be largely the same for both sexes. The fit of a multiple-threshold model raises the possibility that CD may not necessarily be a discrete entity but rather an extreme of the normal variation in conduct-disordered behavior found in the general population.

Adult↗

PubMed1997

Participation bias in a sexuality survey: psychological and behavioural characteristics of responders and non-responders.

BACKGROUND: Few studies of sexual attitudes and behaviour have quantified the direction and magnitude of participation bias, primarily because information on non-responders is difficult to obtain in cross-sectional surveys. METHOD: Australian adult twins (n = 9112) aged 17-52 years enrolled in a national, longitudinal research register were asked to participate in a postal survey concerning their sexual behaviour and attitudes. Individual consent was determined by separate return of a consent form; 27% explicitly refused, 19% initially agreed to receive a questionnaire, but subsequently did not return consent forms and 52% explicitly consented. Participation data were matched to social, psychological and behavioural information in a longitudinal data set. RESULTS: People who explicitly consented had higher levels of education, attended church less often, had less conservative sexual attitudes and voting preferences, were more likely to smoke cigarettes and drank alcohol more often than people who explicitly refused. On standard personality scales, responders were more novelty-seeking and reward-dependent and less harm-avoidant than refusers. Structured psychiatric telephone interview data from 3674 individuals showed that, compared to refusers, responders had higher lifetime prevalence of major depression, alcohol dependence and childhood conduct disorder and also reported an earlier age at first sexual intercourse and higher rates of sexual abuse. In general, those who had initially agreed to receive the sex questionnaire but were subsequently lost were more similar to consenters than to refusers. CONCLUSIONS: Effect sizes on most measures were small. The broad profile suggests that postal surveys of sexual attitudes and behaviour may overestimate sexual liberalism, activity and adversity, although this bias should not seriously compromise population estimates.

Adolescent↗

PubMed1997

Periods of abstinence following the onset of alcohol dependence in 1,853 men and women.

OBJECTIVE: Data from both laboratory experiments and retrospective histories of alcoholics indicate that alternations between periods of abstinence and heavy drinking are common in the course of alcoholism. This article examines the prevalence, chronological characteristics and clinical features associated with periods of abstinence in a large sample of alcohol dependent men and women. METHOD: As part of the Collaborative Study on the Genetics of Alcoholism (COGA), semistructured personal interviews were used to gather data on the course of alcoholism in 1,853 alcohol dependent men and women. Data were evaluated regarding the characteristics of alcoholics with and without periods of abstinence lasting 3 or more months, and the course of these periods over time were evaluated separately for subjects with one, two, three or four episodes of abstention. RESULTS: Despite a relatively high threshold of 3 months for defining an abstinence period, 62.3% of the subjects had at least one such episode, including 55.6% of the 1,853 alcoholics for whom complete data were available. Those alcohol dependent subjects with periods of abstention had an average (+/- SD) of 1.7 +/- 0.99 such periods, and 43% of abstainers had two or more. Logistic regression analyses revealed that the predictors of history of abstention were female gender (odds ratio [OR] = 1.78), older age at interview (OR = 1.04 per year), younger age of onset of alcoholism (OR 0.93 per year), ever having been married (OR = 1.45), the number of DSM-III-R dependence items endorsed (OR = 1.03 per item) and attendance in AA (OR = 2.82). Among abstainers, a period lasting 5 or more years was predicted by older age (OR = 1.03 per year) and AA participation (OR = 3.23), but also by more years of alcoholism (OR = 1.06 per year), white racial background (OR = 1.79) and the absence of history of having been a proband (OR = 3.39). CONCLUSIONS: Periods of abstinence of 3 or more months were commonly observed in the course of alcohol dependence. This information is important for clinicians who need to avoid inappropriate stereotypes of alcoholism and who wish to educate their alcohol dependent patients about the course of this disorder.

Adult↗

PubMed1997

Nicotine withdrawal in women.

Associations between self-report symptom profiles for nicotine withdrawal, personality (TPQ, EPQ-R), life-time history of psychopathology and smoking history were examined in data obtained from 553 female adult Australian twins (246 regular smokers), aged 32-48 years, who had participated in a telephone interview survey that included life-time assessments of smoking history, nicotine dependence and symptoms of withdrawal. Two hundred and two respondents were from high-risk pairs where either the respondent or the respondent's co-twin had reported a life-time history of alcohol dependence; 351 were from control pairs. Latent class analysis was used to identify subtypes ('classes') of smokers reporting similar withdrawal symptom profiles. Three major classes were identified which appeared to represent a continuum from mild to severe nicotine withdrawal. Smokers from the severe withdrawal class were best characterized by hands shaking and by the prominence of depressive features. There were marked increases in life-time alcohol dependence rates as a function of severity class. In contrast, significantly elevated rates of major depression, conduct disorder and anxiety disorder were observed only among smokers from the most severe withdrawal class. Neuroticism was the only personality factor strongly associated with the development of withdrawal symptoms.

Adult↗

PubMed1997

The life-time rates of three major mood disorders and four major anxiety disorders in alcoholics and controls.

AIMS: While psychiatric symptoms are common in the general population and even more prevalent in alcoholics, their clinical implications are not clear. The goal of this study was to establish the life-time rates of several independent and concurrent mood and anxiety disorders in alcoholics, controls and their relatives. DESIGN: Structured interviews were administered to alcoholics entering treatment, their relatives, and controls. SETTING: The study was carried out in six different centers in the United States as part of the Collaborative Study on the Genetics of Alcoholism (COGA). PARTICIPANTS: Data were gathered from 2713 alcohol dependent subjects (probands and their alcoholic relatives) and 919 controls. MEASUREMENTS: The timeline-based Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA) interview was administered face to face by trained, closely supervised interviewers. The life-time rates for concurrent and independent disorders were determined for three DSM-III-R major mood and four major anxiety disorders. FINDINGS: Some form of independent mood disorder was seen during the life-time in slightly fewer alcoholics than controls (14.0% and 17.1%), but alcoholics did show higher rates of independent bipolar disorder (2.3% vs. 1.0%). The life-time rate for independent anxiety disorders was significantly higher in alcoholics than controls (9.4% vs. 3.7%), with most of the differential related to panic disorder (4.2% vs. 1.0%) and social phobia (3.2% vs. 1.4%), but no significant group differences for agoraphobia or obsessive-compulsive disorder. In general, these findings regarding mood and anxiety disorders were reflected in close relatives. CONCLUSIONS: The large majority of alcohol-dependent men and women in this sample did not have any of the independent mood or anxiety disorders evaluated here. However, there was evidence of enhanced risks among alcoholics for independent bipolar, panic and social phobic disorders. Studies which do not distinguish carefully between independent and concurrent mood and anxiety disorders in alcoholics are likely to report much higher rates of co-morbid psychiatric disorders than those that distinguish between the two types of syndromes.

Adult↗

PubMed1996

Is a history of alcohol problems or of psychiatric disorder associated with attrition at 11-year follow-up?

Although rarely available, detailed analyses of attrition in psychiatric surveys are important because surveys of this type might be more vulnerable to follow-up losses. In this report the demographic characteristics, as well as history of alcohol problems and psychiatric disorders of responders were compared to nonresponders in an 11-year follow-up study. Data revealed few differences between responders and nonresponders. Men, those less educated, and low users of medical care were more likely to be nonresponders, as were those reporting driving trouble when drinking or a history of barbiturate abuse or dependence. A history of other psychiatric disorders was not associated with nonresponse. Refusal conversion did not change the findings; those who were converted (25% of initial refusals) had demographic characteristics, symptoms of alcohol abuse, and psychiatric histories comparable to those who resisted conversion. These findings suggest that efforts to convert refusals to responders might not be necessary. The results also support community psychiatric research by providing evidence that those with a history of psychiatric disorder are not more difficult to recruit than their unaffected counterparts.

Adolescent↗