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Biomedical subjects

M M Weissman

Publications and source records attributed to M M Weissman.

At least 55 records · Page 3Linked to original sources
PubMed1999

Maternal smoking during pregnancy and psychopathology in offspring followed to adulthood.

OBJECTIVE: To extend findings from several independent reports of an association between maternal smoking during pregnancy and attention-deficit hyperactivity disorder, conduct disorder, and substance abuse in the offspring. METHOD: This is a 10-year longitudinal study of offspring assessed at 3 points in time into adulthood. Fifty offspring of mothers who reported smoking at least 10 cigarettes almost daily during pregnancy and 97 offspring of mothers who reported never smoking during pregnancy were studied. Psychiatric diagnosis in offspring was assessed blind to parental diagnosis. RESULTS: There was a greater than 4-fold increased risk of prepubertal-onset conduct disorder in boys and a greater than 5-fold increased risk of adolescent-onset drug dependence in girls whose mothers smoked 10 or more cigarettes almost daily during pregnancy. These findings could not be explained by maternal substance abuse during pregnancy, parental psychiatric diagnosis, family risk factors, prenatal and early developmental history of offspring, postnatal maternal smoking, or smoking in the offspring. CONCLUSIONS: Maternal smoking during pregnancy may have a long-term effect on specific psychopathology in offspring. The underlying pathophysiology of nicotine on the fetus requires study. The findings suggest the importance of programs aimed at smoking prevention and cessation in women during pregnancy.

Adolescent↗
PubMed1999

Lack of genetic linkage or association between a functional serotonin transporter polymorphism and panic disorder.

Given the efficacy of medications that interact with the serotonin transporter (5-HTT) in the treatment of panic disorder, we have used a family-based design to test for genetic association and linkage between panic disorder and a functional polymorphism in the promoter of the gene for 5-HTT. In this study, 340 individuals in 45 families, as well as 74 haplotype relative risk 'trios' were genotyped at the polymorphic locus, which consists of a 44 base pair deletion/insertion. There were no significant differences in allele frequencies or occurrence of genotypes within the triads. No linkage between the 5-HTT polymorphism and panic disorder was observed in the multiplex families, using a variety of simulations for dominant and recessive models of inheritance. Recent reports suggest an association between the 5-HTT polymorphism and anxiety-related traits, as measured with personality assessment. The results reported here provide evidence that the genetic basis of panic disorder may be distinct from anxiety-related traits assessed by personality inventories in normal populations.

Alleles↗
PubMed1999

Sibling aggregation for psychopathology in offspring of opiate addicts: effects of parental comorbidity.

Applied a new analytic approach within the high-risk paradigm, the analysis of sibling aggregation, to identify homogeneous subtypes of familial risk for psychopathology and addiction. All sibling pairs participating in a study of offspring of opiate-addicted parents were identified and their aggregation for psychiatric disorders was determined using pairwise odds ratios, an analytic technique used in genetic epidemiology. Sibling aggregation was most notable for depressive and anxiety disorders but only in the presence of comorbid depressive disorders in the parents. Parental comorbid alcoholism did not impact sibling aggregation. We emphasize methodological implications of this approach for addressing issues of phenotypic and etiologic heterogeneity in the study of developmental risk for substance abuse.

Adolescent↗
PubMed1999

Physical health problems in depressed and nondepressed children and adolescents of parents with opiate dependence.

The increased risk of physical health problems in adult depressed patients has been shown in numerous studies. A recent study of the offspring of depressed parents found similar associations. The purpose of this study is to examine the strength and specificity of the association between depression and physical health problems in children and adolescents whose parents are dependent upon opiates. The sample consisted of offspring ages 6-17 (mean age 11 years) of opiate addicts who had a history of major depressive disorder (MDD; n = 28); other mood disorders (n = 31); no history of mood disorders but other psychiatric disorders (n = 92); or no history of psychiatric disorder (n = 127). Detailed psychiatric assessment and medical history of the offspring by direct interview with the offspring and an informant were obtained blind to parental diagnosis. After controlling for possible confounders, there was an increased risk of dermatological disorders, headache, other neurological/neuromuscular disorders, bronchitis, other respiratory disorders and hospitalizations for nonsurgical procedures in offspring with MDD, as compared to nonpsychiatrically ill controls. The offspring with other mood disorders had a slightly elevated risk. Major depression in children and adolescents whose parents are dependent on opiates is associated with increased risk of physical health problems. This finding is consistent with other reports and the timing of the physical health problems requires further study.

Adolescent↗
PubMed1998

Results of a genome-wide genetic screen for panic disorder.

Panic disorder is characterized by spontaneous and recurrent panic attacks, often accompanied by agoraphobia. The results of family, twin, and segregation studies suggest a genetic role in the etiology of the illness. We have genotyped up to 23 families that have a high density of panic disorder with 540 microsatellite DNA markers in a first-pass genomic screen. The thirteen best families (ELOD > 6.0 under the dominant genetic model) have been genotyped with an ordered set of markers encompassing all the autosomes, at an average marker density of 11 cM. Over 110,000 genotypes have been generated on the whole set of families, and the data have been analyzed under both a dominant and a recessive model, and with the program SIBPAIR. No lod scores exceed 2.0 for either parametric model. Two markers give lod scores over 1.0 under the dominant model (chromosomes 1p and 20p), and four do under the recessive model (7p, 17p, 20q, and X/Y). One of these (20p) may be particularly promising. Analysis with SIBPAIR yielded P values equivalent to a lod score of 1.0 or greater (i.e., P < .016, one-sided, uncorrected for multiple tests) for 11 marker loci (2, 7p, 8p, 8q, 9p, 11q, 12q, 16p, 20p and 20q).

Adolescent↗
PubMed1998

Familial aggregation of delusional depression: re-examination in a recent family study.

BACKGROUND: Delusional (D-MDD) and nondelusional depression (ND-MDD) differ in clinical presentation, biological abnormalities, course of illness, and treatment response. Family data, however, have been less consistent regarding differential risk both for any major depression (MDD) and specifically D-MDD in relatives of D-MDD probands. In an earlier family study, we observed a 1.5-fold increase in rates of any MDD, specificity of transmission of D-MDD, and increased rates of bipolar disorders in relatives of D-MDD compared to relatives of ND-MDD probands. In a new family study, we attempted to replicate these findings. METHOD: A family study of 361 directly interviewed adult first-degree relatives (FDRs) of 163 probands (118 with MDD and 45 screened normal controls) was used to examine familial aggregation of any MDD, D-MDD, and bipolarity by proband delusional status. RESULTS: Compared to FDRs of ND-MDD probands, FDRs of D-MDD probands were at modestly increased risk for any MDD. These results were unaffected by adjustment for proband ascertainment source, comorbidity, or whether probands had chronologically primary MDD. There was a trend toward increased rates of broadly defined bipolarity (bipolar I, bipolar II, or cyclothymia) in FDRs of D-MDD compared to FDRs of ND-MDD probands. CONCLUSION: Results from the present study were broadly consistent with those from our previous work. While other lines of evidence for D-MDD as a distinct subtype are more compelling than family data, it would be of methodologic interest to identify sources of inconsistency across studies in findings concerning the familial aggregation of delusional depression.

Adolescent↗
PubMed1998

A diagnostic aid for detecting (DSM-IV) mental disorders in primary care.

This study was designed to develop and validate a new computerized version of the Symptom Driven Diagnostic System for Primary Care (SDDS-PC) and examine its feasibility in primary care practice. One thousand and one patients (ages 18-70) coming for routine care to Kaiser-Permanente were screened on a self-administered symptom scale for major depression, alcohol and drug dependence, generalized anxiety, panic and obsessive compulsive disorders, and suicidal behavior. The screen was followed up by a brief diagnostic interview, administered by a nurse, which yielded a one-page summary of positive symptoms and a provisional computer-generated diagnosis for the physician. The physician reviewed the summary results and made a diagnosis. The nurse and physician were blind to the screen results. Patients were reinterviewed within 96 hours by a mental health professional (MHP) blind to previous results. The nurses' interviews ranged between 1.5 and 3.5 minutes for a screened positive diagnosis. Agreement between the nurse and physician diagnoses was excellent to moderate. Disagreement was usually in the direction of the physician ruling out major mental disorders in favor of subsyndromal or medical explanations. Only rarely did physicians diagnose disorders not detected by the nurse interview. Agreement between physician and MHP was moderate. Physicians using the SDDS-PC seldom made diagnoses that were not confirmed by the independent assessment of the MHP. The SDDS-PC may facilitate recognition of psychiatric disorders and minimize the physician's time in information gathering.

Adolescent↗
PubMed1998

General medical problems among the offspring of depressed parents: a 10-year follow-up.

OBJECTIVE: To examine the association between both parental and offspring depression and the general medical problems of a sample of offspring at high and low risk for depression. METHOD: Offspring (n = 222) from families with either depressed or nondepressed parents were followed up for a period of 10 years. Data collected included psychiatric diagnoses derived from direct semistructured interviews and history of general medical problems and hospital visits. Rates of medical problems and hospitalizations were calculated, and offspring were stratified by depression status of both parent and offspring. RESULTS: In analyses controlled for sociodemographic factors, offspring depression status was associated with a history of genitourinary disorders, headaches, respiratory disorders, other disorders, and hospitalizations in the offspring, and parental depression was associated with a history of unconsciousness and hospitalization in the offspring. After subjects were stratified by parental depression, significant associations between offspring depression and medical problems were found for only those offspring with a depressed parent. CONCLUSIONS: These findings suggest that a history of parental depression increases the risk for medical problems and hospitalization among depressed offspring. The co-occurrence of general medical and psychological problems among offspring of depressed parents may have implications for the treatment of both depression and comorbid medical disorders.

Adolescent↗
PubMed1998

Onset of psychopathology in offspring by developmental phase and parental depression.

OBJECTIVE: To determine the differential effects of parental major depression (MDD) on psychopathology of childhood, adolescent, and early-adult onset in offspring. METHOD: One hundred eighty-two offspring from 91 families in which one or more parents or neither parent had MDD were followed for more than 10 years and blindly reassessed by means of a structured diagnostic instrument. RESULTS: Parental MDD is associated with increased risk in offspring of childhood-onset MDD (eightfold), anxiety disorder (threefold), conduct disorder (fivefold), and early-adult-onset MDD (fivefold) but not adolescent-onset MDD, where there is a marked increase in risk, particularly in girls, regardless of parental diagnosis. These findings were not explained by parental comorbidity, but the association with MDD was explained by parental age at onset of MDD--there was a 13-fold increase in childhood-onset MDD and a 7-fold increase in adult-onset MDD in offspring of parents with MDD of early (before age 30 years) onset. CONCLUSION: Childhood- and early-adult-onset MDD may be etiologically homogeneous and familial subtypes. The reason for the high incidence of adolescent-onset MDD, particularly in girls, regardless of parental diagnosis, needs to be determined. The childhood offspring of depressed parents are a potential target for evaluation, especially when the parent had an early-onset depression.

Adolescent↗
PubMed1998

Psychopathology in children of parents with opiate dependence and/or major depression.

OBJECTIVE: To evaluate psychiatric disorders and impairment in school-age and adolescent children of opiate-dependent patients. METHOD: One hundred fourteen children, aged 6 to 17 years, of 69 white methadone maintenance patients with (n = 30) and without (n = 39) major depression were evaluated for DSM-III-R diagnoses by the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Epidemiologic version and best estimate, and by measures of functioning (Children's Global Assessment Scale, Social Adjustment Inventory for Children and Adolescents, WISC, Peabody Picture Vocabulary Test), and compared with children of historical controls without substance abuse history. RESULTS: Sons of opiate addicts with major depression were at increased risk for conduct disorder and global, social, and intellectual impairment compared with sons of opiate addicts without major depression and/or sons of controls with neither drug dependence nor depression. Sons of opiate addicts without major depression differed little from controls. Daughters of opiate addicts did not differ from controls in rates of disorders but had poorer social adjustment and nonverbal intelligence. CONCLUSIONS: Children of opiate-dependent patients, particularly sons of addicts with depression, may be at risk for a developmental path toward antisocial personality and poor social and intellectual functioning. Treatment settings such as methadone maintenance might afford an opportunity for primary and secondary prevention, both through early detection of childhood disorders and treatment of parental drug dependence and psychopathology.

Adolescent↗
PubMed1997

Familial aggregation and phenomenology of 'early'-onset (at or before age 20 years) panic disorder.

BACKGROUND: While early age at onset has been associated with increased familial risk, increased clinical severity, and distinctive patterns of comorbidity in a range of psychiatric disorders, it has received limited attention in panic disorder, both in family studies and with respect to clinical presentation. METHODS: A family study of 838 adult first-degree relatives of 152 probands in 3 diagnostic groups (panic disorder with or without major depression, subdivided by age at onset at or before 20 and after 20 years, and screened normal controls) was used to examine familial aggregation of panic disorder by proband age at panic disorder onset. Phenomenology of panic disorder in ill probands and their affected adult first-degree relatives was investigated as a function of proband panic disorder onset at or before 20 vs after 20 years of age. RESULTS: Compared with adult first-degree relatives of normal controls, the risks of panic disorder in adult first-degree relatives of probands with panic disorder onset at or before 20 and after 20 years of age were increased 17-fold and 6-fold, respectively. These findings were not explained by the numerous potential confounding factors that we tested. Age at panic disorder onset did not appear to be specifically transmitted within families. The clinical presentation of panic disorder differed little in either probands or affected relatives by proband age at onset. CONCLUSION: The strikingly elevated risk of panic disorder in relatives of probands with panic disorder onset at or before 20 years of age suggests that age at onset may be useful in differentiating familial subtypes of panic disorder and that genetic studies of panic disorder should consider age at onset.

Adolescent↗
PubMed1997

The cross-national epidemiology of panic disorder.

BACKGROUND: Epidemiological data on panic disorder from community studies from 10 countries around the world are presented to determine the consistency of findings across diverse cultures. METHOD: Data from independently conducted community surveys from 10 countries (the United States, Canada, Puerto Rico, France, West Germany, Italy, Lebanon, Taiwan, Korea, and New Zealand), using the Diagnostic Interview Schedule and DSM-III criteria and including over 40,000 subjects, were analyzed with appropriate standardization for age and sex differences among subjects from different countries. RESULTS: The lifetime prevalence rates for panic disorder ranged from 1.4 per 100 in Edmonton, Alberta, to 2.9 per 100 in Florence, Italy, with the exception of that in Taiwan, 0.4 per 100, where rates for most psychiatric disorders are low. Mean age at first onset was usually in early to middle adulthood. The rates were higher in female than male subjects in all countries. Panic disorder was associated with an increased risk of agoraphobia and major depression in all countries. CONCLUSIONS: Panic disorder is relatively consistent, with a few exceptions, in rates and patterns across different countries. It is unclear why the rates of panic and other psychiatric disorders are lower in Taiwan.

Adolescent↗
PubMed1997

Offspring of depressed parents. 10 Years later.

BACKGROUND: There have been numerous studies that have shown that offspring of depressed parents are at a high risk for major depressive disorder (MDD) and impairment. None have followed up the offspring into adulthood to obtain more precise estimates of risk. METHOD: One hundred eighty-two offspring from 91 families, in which 1 or more parents had MDD (high risk) or in which neither parent was depressed (low risk), were blindly reassessed in the third follow-up, using a structured diagnostic instrument 10 years after their initial identification. RESULTS: Compared with the offspring for whom neither parent was depressed, the offspring of depressed parents had increased rates of MDD, particularly before puberty, and phobias (both at approximately a 3-fold risk), panic disorder, alcohol dependence (at a 5-fold risk), and greater social impairment. The peak age at onset for MDD in both high- and low-risk offspring ranged from 15 to 20 years. The peak age at onset for anxiety disorder was considerably earlier, especially in female offspring in the high-risk group. The onset of alcohol dependence in the offspring in the high-risk group peaked in adolescence and then after the age of 25 years. The depressed offspring of depressed parents, compared with nondepressed parents, had more serious and impairing depressions during the follow-up period but were less likely to go for treatment. CONCLUSIONS: The offspring of depressed parents are a high-risk group for onset of anxiety disorder and MDD in childhood, MDD in adolescence, and alcohol dependence in adolescence and early adulthood. The findings support the potential value of early detection in the offspring of depressed parents.

Adaptation, Psychological↗
PubMed1997

Panic disorder with smothering symptoms: evidence for increased risk in first-degree relatives.

Klein's (1993: Arch Gen Psychiatry 50:306-317) "false suffocation alarm" theory of spontaneous panic attacks posits that central receptors compare CO2, O2, and lactate levels and trigger panic when an impending "false" state of suffocation is detected. Several investigators have found abnormalities of respiratory physiology in subjects with panic disorder. Twin and family studies have suggested that both panic disorder and tidal volume response to CO2 are inherited. We hypothesized that, if smothering symptoms are a marker for a hypersensitive suffocation detector and if this hypersensitivity is familial, then relatives of panic subjects with smothering symptoms would have higher rates of panic with smothering than relatives of panic subjects without smothering. We conducted a family study involving 104 panic disorder probands and 247 of their interviewed first-degree relatives. Probands and their relatives were interviewed using the Schedule for Affective Disorders and Schizophrenia--Lifetime Version for Anxiety Disorders to determine their panic disorder and smothering symptom status. Relatives of panic probands with smothering symptoms had an almost threefold higher risk for panic and an almost sixfold higher risk for panic with smothering symptoms when compared with relatives of panic probands without smothering. We conclude that panic disorder with smothering symptoms may be a subtype of panic disorder associated with increased familial risk and may be a group of interest to genetic investigators. These findings provide the first empiric evidence from a family study in support of Klein's false suffocation alarm theory of spontaneous panics.

Adult↗
PubMed1997

The morbidity of insomnia uncomplicated by psychiatric disorders.

The morbidity of sleep problems has been well documented; however, they are frequently associated with and are symptomatic of several psychiatric disorders. It is unclear how much of the morbidity can be accounted for by the associated psychiatric and substance abuse disorders and medical problems, and how much by the sleep problems per se. Sleep problems may also be an early sign of a psychiatric problem. This paper reports data from an epidemiologic community survey of over 10,000 adults living in three U.S. communities. A structured diagnostic assessment of psychiatric disorders as well as assessment of the presence of insomnia not due to medical conditions, medication, drug or alcohol abuse, and a 1-year follow-up were completed. Persons with insomnia in the past year without any psychiatric disorders ever (uncomplicated insomnia); with a psychiatric disorder in the past year (complicated insomnia); and with neither insomnia nor psychiatric disorders ever were compared on treatment utilization and the first onset of a psychiatric disorder in the subsequent year. Eight percent of those with uncomplicated as compared with 14.9% with complicated insomnia and 2.5% with neither had sought treatment from the general medical sector for emotional problems in the 6 months prior to the interview. The rates of treatment sought from the psychiatric specialty sector were 3.8%, 9.4%, and 1.2%, respectively. These differences were significant after controlling for sociodemographic characteristics and were sustained when the persons were interviewed 1 year later. Uncomplicated insomnia was also associated with an increase in risk for first onset of major depression, panic disorder, and alcohol abuse over the following year. Insomnia, even in the absence of psychiatric disorders, is associated with increased use of general medical and mental health treatment for emotional problems and for the subsequent first onset in the following year of some psychiatric disorders. Early diagnosis and treatment of uncomplicated insomnia may be useful.

Adult↗
PubMed1997

False positive results: a challenge for psychiatric screening in primary care.

OBJECTIVE: The goal of this study was to characterize primary care patients with false positive results on screens for mental disorders. METHOD: A sample of 1,001 primary care patients completed self-administered screens and structured interviews for DSM-IV diagnoses. RESULTS: A substantial proportion of the patients with false positive screen results for at least one diagnosis met the diagnostic criteria for other psychiatric disorders. They also had significantly greater functional impairment and higher rates of recent use of mental health services than the subjects with true negative results on the screens. CONCLUSIONS: Although the positive predictive values of screens for specific mental disorders are in line with those of other medical screens, false positive results are not uncommon. This may be due in part to the sensitivity of brief screening instruments to nonspecific symptoms. The results suggest that as with other screens used in primary care, patients with false positive results on screens for mental disorders should receive clinical attention.

Adolescent↗