RESUMEN
DSM antisocial personality disorder (ASPD) requires a retrospective diagnosis of conduct disorder-historical behavior not present in everyone with adult ASPD criteria. Using adoption study data, we examined the impact of this requirement on biological and environmental risk associations. We also compared clinical correlates of adult antisocial behavior with and without prior conduct disorder. We defined three subgroups: DSM-III ASPD (n = 30), adult antisocials without conduct disorder (n = 25), and controls (n = 142). By design, the sample had a high incidence of biological parent ASPD, which was partially confounded with fetal alcohol exposure. We compared the associations of both of these putative risk factors with subgroup membership after controlling for gender and adverse adoptive environment. We also examined differences in two sociopathy scales and the incidence of co-occurring affective, alcohol, and other substance use disorders. Finally, we explored differences in individual antisocial symptoms. Having an antisocial biological parent was a specific risk factor for ASPD. In contrast, fetal alcohol exposure, male gender, and adverse environment were associated with the adult antisocial syndrome, regardless of conduct disorder history. The two antisocial groups were similar with respect to sociopathy scales, co-occurring diagnoses, and the incidence of most individual symptoms. However, several adult and conduct disorder symptoms had significant specific associations with biological or environmental background or their interaction. Phenotypic expression of the biological-possibly genetic-risk for ASPD appears to be manifest before adulthood. The influence of other risk factors may not depend on antecedent conduct disorder. Despite this, we could not detect clinically important differences between the two sociopathic groups. The conduct disorder requirement therefore may be more relevant to etiological than clinical understanding of adult antisocial behavior.
Asunto(s)
Adopción , Trastorno de Personalidad Antisocial/complicaciones , Trastorno de la Conducta/complicaciones , Adolescente , Adulto , Trastorno de Personalidad Antisocial/diagnóstico , Trastorno de Personalidad Antisocial/etiología , Trastorno de la Conducta/diagnóstico , Femenino , Trastornos del Espectro Alcohólico Fetal/psicología , Humanos , Masculino , Persona de Mediana Edad , Padres/psicología , Embarazo , Escalas de Valoración Psiquiátrica , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Medio SocialRESUMEN
BACKGROUND: We conducted an exploratory multivariate analysis of juvenile behavior symptoms in an adoption data set. One goal was to see if a few DSM-interpretable symptom dimensions economically captured information within the data. A second goal was to study the relationships between any such dimensions, biological and environmental background, and eventual adult antisocial behavior. METHODS: The data originated from a retrospective adoption study. Probands with a biological background for parental antisocial personality or alcoholism were heavily oversampled. Symptoms were ascertained by proband and adoptive parent interview. We performed, by gender, orthogonal rotated principal component analyses of juvenile behavior disturbance symptoms (females, n = 87; males, n = 88). We used structural equation modeling to examine the relationships hypothesized above. RESULTS: For both genders, an oppositional defiant disorder (ODD) component and at least 1 conduct component emerged. Regardless of the conduct component scores, the ODD components were significant predictors of adult antisocial behavior. For males, the ODD component was predicted by an antisocial biological background, but not by scores on the Adverse Adoptive Environment Scale. The conduct components were predicted by adoptive environment alone. For females, biological background or biological-environmental interactions predicted each of the components. CONCLUSIONS: There has been little previous distinction between conduct disorder and ODD in studies of genetic and environmental influences on juvenile behavior. The study suggests that adolescent ODD symptoms may be a distinct antecedent of adult antisocial personality. In males, adolescent ODD symptoms may represent early expression of genetic sociopathic personality traits.
Asunto(s)
Adopción , Trastorno de Personalidad Antisocial/genética , Déficit de la Atención y Trastornos de Conducta Disruptiva/genética , Trastorno de la Conducta/genética , Adolescente , Adulto , Factores de Edad , Trastorno de Personalidad Antisocial/epidemiología , Trastorno de Personalidad Antisocial/psicología , Déficit de la Atención y Trastornos de Conducta Disruptiva/diagnóstico , Déficit de la Atención y Trastornos de Conducta Disruptiva/epidemiología , Hijo de Padres Discapacitados/psicología , Trastorno de la Conducta/diagnóstico , Trastorno de la Conducta/epidemiología , Femenino , Humanos , Masculino , Trastornos Mentales/epidemiología , Trastornos Mentales/psicología , Persona de Mediana Edad , Modelos Estadísticos , Análisis Multivariante , Padres/psicología , Estudios Retrospectivos , Factores Sexuales , Medio SocialRESUMEN
BACKGROUND: Since the highest risk for the development of atopic disease is in early life, environmental risk factors need to be separated from the genetic component in this high risk period. Adoptees removed at birth and placed in adoptive families present a way to separate environmental and genetic factors at this early susceptible age. METHOD: An opportunity for a pilot study of asthma and allergic rhinitis in adoptive families was presented when a psychiatrist (RC) was planning a behavioral study of young adult adoptees and their adoptive parents. A detailed questionnaire about allergic rhinitis and asthma was added after the psychiatrists' interview. Placement was not influenced by a history of allergy in adoptive or natural parents. The adoptee and at least one adoptive parent completed questionnaires in 367 families. The adoptees had been removed at birth and placed in the adoptive family within 3 months (83% within 1 month). RESULTS: Compared with adoptive families without asthma or allergic rhinitis, an adoptive mother with asthma or rhinitis, when the adoptive father was not affected, increased the risk for asthma in the adoptee (OR = 3.2, P < .0005). Asthma in the adoptive mother alone (OR = 3.2, P < .005) and allergic rhinitis alone (OR = 3.4, P < .005) increased the risk for asthma in the adoptee. Adoptive father asthma or allergic rhinitis showed a trend toward increased asthma in the adoptee (OR = 1.9, P < .1). CONCLUSION: This should be considered a pilot or feasibility study since subjects could not be examined or tested. Finding a risk for atopic respiratory disease or asthma associated with adoption by parents with asthma or allergic rhinitis suggests that further well planned adoptee studies should be made.
Asunto(s)
Adopción , Asma/epidemiología , Rinitis Alérgica Perenne/epidemiología , Rinitis Alérgica Estacional/epidemiología , Adulto , Salud de la Familia , Estudios de Factibilidad , Femenino , Humanos , Iowa/epidemiología , Masculino , Persona de Mediana Edad , Factores de Riesgo , Encuestas y CuestionariosRESUMEN
OBJECTIVES: The objective of this study is to examine the effect of fetal alcohol exposure on later substance dependence using an adoption study method. METHODS: One hundred ninety-seven adoptees were interviewed for substance abuse disorders, including nicotine, alcohol, and drug dependence. Twenty-one adoptees had mothers who drank during pregnancy. Adoptees with fetal alcohol exposure were compared with those without fetal alcohol exposure for symptoms of adult nicotine, alcohol, and drug dependence. RESULTS: Adoptee symptom counts for alcohol, drug, and nicotine dependence were higher for those exposed to alcohol in utero. The effect of fetal alcohol exposure remained after controlling for gender, biological parent alcohol dependence diagnosis, birth weight, gestational age and other environmental variables. CONCLUSIONS: Fetal alcohol exposure may produce increased risk for later nicotine, alcohol, and drug dependence. Possible effects of fetal alcohol exposure on development of adult substance use patterns needs attention in genetic studies of substance abuse.
Asunto(s)
Alcoholismo/genética , Trastornos del Espectro Alcohólico Fetal/genética , Fumar/genética , Trastornos Relacionados con Sustancias/genética , Adolescente , Adopción/psicología , Adulto , Alcoholismo/epidemiología , Alcoholismo/psicología , Comorbilidad , Femenino , Trastornos del Espectro Alcohólico Fetal/epidemiología , Trastornos del Espectro Alcohólico Fetal/psicología , Humanos , Recién Nacido , Iowa , Masculino , Embarazo , Factores de Riesgo , Fumar/epidemiología , Fumar/psicología , Medio Social , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/psicologíaRESUMEN
This article develops the topic of the genetics of aggressive and violent behavior from three directions. Firstly, evidence from twin, family, and adoption studies will establish the case for the importance of genetically transmitted factors in the genesis of aggressivity from childhood through adulthood. Secondly, evidence from adoption studies will be presented to show that some environmental conditions interact with genetic factors in such a way as to suggest that the development of aggressivity requires that both genetic and environmental factors be present. Thirdly, additional and direct evidence of genetic factors in aggressivity is presented from the perspective of molecular genetics, where underlying biochemical mechanisms associated with aggressivity have been found to be caused by specific genes in animal models with confirmation of similar physiologic mechanisms in humans.
Asunto(s)
Agresión , Trastorno de la Conducta Social/genética , Violencia , Adulto , Niño , Preescolar , Crimen , Femenino , Humanos , Masculino , Padres/psicología , Encuestas y CuestionariosRESUMEN
OBJECTIVE: State governments are exploring the potential of various forms of case management to control the costs of substance abuse treatment programs. This report describes an experimental program in one Iowa county in which clients are assessed and referred elsewhere if treatment is needed. Outcomes of clients in that county are compared with those of clients served elsewhere in the state. METHODS: All claims submitted by provider agencies to the Iowa Department of Public Health for substance abuse treatment of eligible clients in 1994 were analyzed to test the effect of the experimental intake-and-referral program on clients' utilization of outpatient treatment, rate of treatment completion, and rate of abstention at discharge from treatment. RESULTS: In the county with the experimental program, 27 percent of clients recommended for treatment actually attended, compared with 48 percent in other counties. Clients who used the experimental program were also less likely to complete treatment. These differences persisted after adjusting for baseline differences in client characteristics. CONCLUSIONS: Lower utilization arising from failure to attend recommended treatment may reduce treatment costs but is not the intended outcome of the intake-and-referral program. Failure to complete treatment also is an adverse outcome. Outcomes of various types of case management programs should be carefully evaluated before statewide implementation is considered.
Asunto(s)
Alcoholismo/rehabilitación , Manejo de Caso/organización & administración , Administración en Salud Pública , Derivación y Consulta/organización & administración , Trastornos Relacionados con Sustancias/rehabilitación , Adulto , Anciano , Alcoholismo/economía , Alcoholismo/psicología , Atención Ambulatoria/economía , Atención Ambulatoria/estadística & datos numéricos , Control de Costos , Femenino , Humanos , Iowa , Masculino , Persona de Mediana Edad , Trastornos Relacionados con Opioides/economía , Trastornos Relacionados con Opioides/psicología , Trastornos Relacionados con Opioides/rehabilitación , Admisión del Paciente , Pacientes Desistentes del Tratamiento/estadística & datos numéricos , Abuso de Sustancias por Vía Intravenosa/economía , Abuso de Sustancias por Vía Intravenosa/psicología , Abuso de Sustancias por Vía Intravenosa/rehabilitación , Trastornos Relacionados con Sustancias/economía , Trastornos Relacionados con Sustancias/psicología , Resultado del Tratamiento , Estados Unidos , Revisión de Utilización de RecursosRESUMEN
OBJECTIVE: This study used an adoption study design to separate genetic from environmental factors in the etiology of depression spectrum disease, a type of major depression characterized by families in which male relatives are alcoholic and females are depressed. The genetic etiology hypothesis of depression spectrum disease proposes that an alcoholic genetic diathesis predisposes to depression in females but alcoholism, not depression, in males. METHOD: The study examined 197 adult offspring (95 male and 102 female) of alcoholic biological parents and used logistic regression models to determine the contribution to major depression in male and female adoptees that could be explained by the genetic alcoholic diathesis combined with an environmental factor that was characterized by psychiatrically or behaviorally disturbed adoptive parents. RESULTS: Major depression in females was predicted by an alcoholic diathesis only when combined with the disturbed adoptive parent variable. The same regression model failed to predict depression in males. Other possible environmental confounding factors contributing to an increased chance of depression were found in females: fetal alcohol exposure, age at the time of adoption, and a family with an adopted sibling who had a psychiatric problem. These variables did not diminish the significance of the prediction of depression with the alcohol genetic diathesis and disturbed parent model. CONCLUSIONS: The results show that a genetic factor is present for which alcoholism is at least a marker, and which exerts its effect in women as a gene-environment interaction leading to major depression. This finding suggests that an important etiologic factor in depression spectrum disease is gene-environment interaction.
Asunto(s)
Adopción , Alcoholismo/genética , Trastorno de Personalidad Antisocial/genética , Trastorno Depresivo/etiología , Trastorno Depresivo/genética , Medio Social , Adolescente , Adulto , Alcoholismo/epidemiología , Alcoholismo/etiología , Trastorno de Personalidad Antisocial/epidemiología , Trastorno de Personalidad Antisocial/etiología , Hijo de Padres Discapacitados , Trastorno Depresivo/epidemiología , Familia , Femenino , Marcadores Genéticos , Predisposición Genética a la Enfermedad , Humanos , Modelos Logísticos , Masculino , Trastornos Mentales/epidemiología , Persona de Mediana Edad , Probabilidad , Factores SexualesRESUMEN
OBJECTIVE: The objective of this study was to evaluate the role of genetic factors in alcohol and drug dependence at various levels of DSM-IIIR psychoactive substance dependence severity. METHOD: One-hundred-and-ninety-seven adoptees (95 case adoptees with biological parental alcoholism, drug dependence or antisocial personality disorder and 102 control adoptees) were interviewed for the presence of alcohol abuse or dependence and drug abuse or dependence using the Diagnostic Interview Schedule-DIS IIIR. RESULTS: Adoptees with five or more DSM-IIIR criteria for alcohol dependence demonstrated evidence of a genetic effect using this adoption paradigm (odds ratio = 2.3, 95% C.I. (1.1, 4.9)). Adoptees with one or more DSM-IIIR criteria for drug dependence demonstrated a genetic effect (odds ratio = 2.4, 95% C.I. (1.3, 4.4). CONCLUSIONS: This study suggests genetic factors influence the risk for alcohol and drug dependence at different thresholds of severity as determined by DSM-IIIR symptom severity count.
Asunto(s)
Adopción , Alcoholismo/genética , Drogas Ilícitas , Escalas de Valoración Psiquiátrica , Psicotrópicos , Trastornos Relacionados con Sustancias/genética , Adolescente , Adopción/psicología , Adulto , Alcoholismo/diagnóstico , Alcoholismo/rehabilitación , Trastorno de Personalidad Antisocial/diagnóstico , Trastorno de Personalidad Antisocial/genética , Trastorno de Personalidad Antisocial/rehabilitación , Hijo de Padres Discapacitados/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Determinación de la Personalidad , Factores de Riesgo , Medio Social , Trastornos Relacionados con Sustancias/diagnóstico , Trastornos Relacionados con Sustancias/rehabilitaciónRESUMEN
In a sample of 102 women who had been adopted at birth, drug abuse/dependency was found by log-linear analyses to have a major pathway of genetic etiology that started with a biologic parent with antisocial personality and led to an adoptee with conduct disorder and then through aggressivity to drug abuse/dependency, as well as from conduct disorder directly to drug abuse. This result was similar to findings from a male sample collected from the same agencies and at the same time, wherein antisocial biologic parents produced aggressive and conduct-disordered off-spring, who in turn became drug abusers/dependents as adults. Results are compatible with family studies demonstrating that female drug abusers stem from deviant families and themselves demonstrate socially deviant behavior early in life. The present study shows that one element of familial factors is genetic, and that, in addition, the family environment directly affects behavior (aggressivity) that leads to drug abuse/dependency.
Asunto(s)
Adopción , Trastornos Relacionados con Sustancias/genética , Adolescente , Adopción/psicología , Adulto , Agresión/psicología , Alcoholismo/diagnóstico , Alcoholismo/genética , Alcoholismo/psicología , Trastorno de Personalidad Antisocial/diagnóstico , Trastorno de Personalidad Antisocial/genética , Trastorno de Personalidad Antisocial/psicología , Niño , Trastornos de la Conducta Infantil/diagnóstico , Trastornos de la Conducta Infantil/genética , Trastornos de la Conducta Infantil/psicología , Hijo de Padres Discapacitados/psicología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Determinación de la Personalidad , Factores de Riesgo , Medio Social , Trastornos Relacionados con Sustancias/diagnóstico , Trastornos Relacionados con Sustancias/psicologíaRESUMEN
BACKGROUND: The purpose of this study was to determine the effect of an adverse adoptive home environment on adoptee conduct disorder, adult antisocial behavior, and two measures of aggressivity, all of which are behaviors that contribute to adult antisocial personality disorder and that also are associated with increased vulnerability to drug abuse and/or dependence. METHODS: The study used an adoption paradigm in which adopted offspring who were separated at birth from biologic parents with documented (by prison and hospital records) antisocial personality disorder and/or alcohol abuse or dependence were followed up as adults. They and their adoptive parents were interviewed in person. These adoptees were compared with controls whose biologic background was negative for documented psychopathologic behavior. Subjects were 95 male and 102 female adoptees and their adoptive parents. RESULTS: Multiple regression analysis was used to measure separately genetic and environmental effects. It showed that (1) a biologic background of antisocial personality disorder predicted increased adolescent aggressivity, conduct disorder, and adult antisocial behaviors, and (2) adverse adoptive home environment (defined as adoptive parents who had marital problems, were divorced, were separated, or had anxiety conditions, depression, substance abuse and/or dependence, or legal problems) independently predicted increased adult antisocial behaviors. Adverse adoptive home environment interacted with biologic background of antisocial personality disorder to result in significantly increased aggressivity and conduct disorder in adoptees in the presence of but not in the absence of a biologic background of antisocial personality disorder. CONCLUSIONS: Environmental effects and genetic-environmental interaction account for significant variability in adoptee aggressivity, conduct disorder, and adult antisocial behavior and have important implications for the prevention and intervention of conduct disorder and associated conditions such as substance abuse and aggressivity.
Asunto(s)
Adopción , Agresión/psicología , Trastorno de Personalidad Antisocial/genética , Trastornos de la Conducta Infantil/genética , Salud de la Familia , Adulto , Alcoholismo/etiología , Alcoholismo/genética , Trastorno de Personalidad Antisocial/etiología , Niño , Trastornos de la Conducta Infantil/etiología , Susceptibilidad a Enfermedades , Femenino , Registros de Hospitales , Humanos , Masculino , Matemática , Modelos Genéticos , Modelos Estadísticos , Prisioneros/estadística & datos numéricos , Análisis de Regresión , Factores Sexuales , Medio Social , Trastornos Relacionados con Sustancias/etiología , Trastornos Relacionados con Sustancias/genéticaRESUMEN
BACKGROUND: Studies of adoptees have demonstrated that there are two genetic factors leading to alcohol abuse and/or dependence (abuse/dependence). In addition, environmental factors found in the adoptive family also predict alcohol abuse/dependency independently. One study has found evidence that a similar model of two genetic factors and independent adoptive family factors were involved in drug abuse. Our study was designed to test the hypothesis that genetic factors defined by alcohol abuse/dependency and anti-social personality disorder in biologic parents were etiologic in drug abuse/dependency and that psychiatric problems in adoptive parents were an additional factor associated with drug abuse/dependence. METHODS: A sample of 95 male adoptees, separated at birth from their biologic parents, were followed up as adults to determine their psychiatric diagnosis and their substance use/abuse in a structured interview administered blind to biologic parent diagnoses. A high-risk, case-control design was used wherein half of the adoptees came from biologic parents known to be alcohol abuser/dependent and/or have antisocial personalities (diagnoses from hospital or prison records). These adoptees were matched for age, sex, and adoption agency to a control group of adoptees whose biologic parents were not found in the hospital and prison record search. Adoptive home environment was assessed by structured interviews, including psychiatric assessment of both adoptive parents. RESULTS: Data were analyzed by log-linear modeling, which showed evidence of two genetic pathways to drug abuse/dependency. One pathway went directly from a biologic parent's alcoholism to drug abuse/dependency. The second pathway was more circuitous, and started with anti-social personality disorder in the biologic parent and proceeded through intervening variables of adoptee aggressivity, conduct disorder, antisocial personality disorder, and, eventually, ended in drug abuse/dependency. Environmental factors defined by psychiatric conditions in adoptive families independently predicted increased antisocial personality disorder in the adoptee. Adoptees born of alcohol-abusing mothers showed evidence of fetal alcohol syndrome, but controlling for this did not diminish the evidence for the direct genetic effect between an alcohol-abusing biologic parent and drug abuse/dependency in offspring. CONCLUSIONS: This study confirms the model of two independent genetic factors involved in drug abuse/dependence and previous findings that disturbed adoptive parents are associated with adoptee drug abuse/dependency.
Asunto(s)
Adopción , Familia , Trastornos Relacionados con Sustancias/genética , Adolescente , Adulto , Agresión/psicología , Alcoholismo/epidemiología , Alcoholismo/genética , Trastorno de Personalidad Antisocial/epidemiología , Trastorno de Personalidad Antisocial/genética , Estudios de Casos y Controles , Femenino , Estudios de Seguimiento , Humanos , Masculino , Modelos Genéticos , Escalas de Valoración Psiquiátrica , Factores Sexuales , Medio Social , Trastornos Relacionados con Sustancias/epidemiologíaRESUMEN
The contributions of genetic and both positive and negative environmental factors were tested in the prediction of alcohol abuse/dependence among 300 adult adoptees. No direct effects for either genetic or environmental factors were significant in the prediction of adoptee alcohol abuse/dependence. However, among women, early-life family conflict and psychopathology in the adoptive family interacted with a biological background of alcoholism. Among women with at least one alcoholic biological parent, conflict or psychopathology in the adoptive family increased the probability of alcohol abuse and/or dependence. Among men, no significant interactions were found between a biological background of alcoholism and environmental variables. Results suggest a pattern of gene-environment interaction among women.
Asunto(s)
Adopción/psicología , Alcoholismo/genética , Relaciones Interpersonales , Medio Social , Adolescente , Adulto , Alcoholismo/psicología , Trastorno de Personalidad Antisocial/genética , Trastorno de Personalidad Antisocial/psicología , Trastornos de Ansiedad/genética , Trastornos de Ansiedad/psicología , Hijo de Padres Discapacitados/psicología , Trastorno Depresivo/genética , Trastorno Depresivo/psicología , Femenino , Identidad de Género , Humanos , Masculino , Factores de Riesgo , Trastornos Relacionados con Sustancias/genética , Trastornos Relacionados con Sustancias/psicologíaRESUMEN
Clozapine has proven to be more effective than typical antipsychotics in treatment-refractory schizophrenic patients, and some evidence suggests that it may be particularly useful in treating the negative symptoms of schizophrenia. However, it is unclear whether this observation reflects improvement in "primary" or "secondary" negative symptoms. We hypothesized that a portion of clozapine's effect on negative symptoms would be related to an improvement in positive (psychotic and disorganization) symptoms, a decrease in extrapyramidal side effects (EPSE), and/or a decrease in depressive symptoms. The remainder of its effect would be related to a direct effect on the neural circuits or pathologic processes responsible for the negative symptoms. Twenty-nine treatment-refractory schizophrenics treated with clozapine for 6 weeks were studied. The core negative symptoms measured by the Scale for the Assessment of Negative Symptoms ([SANS] affective flattening, anhedonia/asociality, avolition/apathy, and alogia) all improved with clozapine treatment. Overall, there was a 31% improvement in negative symptoms, a 32% improvement in psychotic symptoms, and a 35% improvement in disorganization. The improvement in negative symptoms was correlated with improvement in disorganization, but not with improvement in psychotic symptoms, depression, or drug-induced EPSE. Although there was a correlation between improvement in negative symptoms and improvement in disorganization, there was a suggestion that the two are changing in parallel, but are independent of each other. It appears that at least a portion of clozapine's effect on core negative symptoms is mediated through a direct effect on the underlying pathophysiology of schizophrenia associated with negative symptoms.
Asunto(s)
Clozapina/uso terapéutico , Esquizofrenia/tratamiento farmacológico , Psicología del Esquizofrénico , Adulto , Enfermedad Crónica , Clozapina/efectos adversos , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/tratamiento farmacológico , Trastorno Depresivo/psicología , Relación Dosis-Respuesta a Droga , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Escalas de Valoración Psiquiátrica , Esquizofrenia/diagnósticoRESUMEN
OBJECTIVE: Clozapine, an atypical antipsychotic, has been estimated to be effective in 30% of treatment-refractory schizophrenic patients. The authors hypothesized that if a dose-response relationship was obvious for this drug, the response rate could be significantly amplified. METHOD: Following an 8-24-day dose titration phase, 29 inpatients with treatment-resistant schizophrenia diagnosed according to DSM-III-R were given a clozapine dose of approximately 400 mg/day for 4 weeks; blood samples were obtained weekly during this period. RESULTS: A receiver operator curve demonstrated that the threshold clozapine plasma concentration for therapeutic response was 350 ng/ml. Sixty-four percent of the patients with clozapine plasma concentrations greater than 350 ng/ml responded, whereas only 22% of the patients with concentrations less than 350 ng/ml responded. CONCLUSIONS: Use of clozapine blood levels as a predictor for treatment response in treatment-refractory schizophrenic patients appears worthwhile, since the measurement's sensitivity for response was 64% and the specificity for nonresponse was 78%.
Asunto(s)
Clozapina/análogos & derivados , Clozapina/sangre , Esquizofrenia/tratamiento farmacológico , Psicología del Esquizofrénico , Adulto , Antipsicóticos/uso terapéutico , Cromatografía Líquida de Alta Presión , Protocolos Clínicos , Clozapina/administración & dosificación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Escalas de Valoración Psiquiátrica , Curva ROC , Esquizofrenia/sangre , Sensibilidad y EspecificidadRESUMEN
This study used an adoption design to investigate the relationships among genetic background, environmental factors, and clinical outcome of attention deficit/hyperactivity, aggressivity, and adult antisocial personality (ASP) in a sample of 283 male adoptees. A biologic parent adjudged to be delinquent or to have an adult criminal conviction predicted increased attention deficit/hyperactivity in the adopted away sons, as well as increased adult ASP diagnosis. Aggressivity in the adoptee was predicted by attention deficit/hyperactivity, and aggressivity in turn predicted increased adult ASP. Environmental factors of socioeconomic status (SES), and psychiatric problems in adoptive family members correlated significantly with various clinical outcomes of aggressivity, attention deficit/hyperactivity, and ASP. The results suggest that attention deficit/hyperactivity should be considered a syndrome that has a variety of correlated behaviors, such as aggressivity, and that each of these correlated behaviors is influenced by different genetic and environmental factors and their interactions. Depending on the mix of factors, adult ASP can be one of the outcomes.
Asunto(s)
Adopción/psicología , Agresión/psicología , Trastorno de Personalidad Antisocial/genética , Trastorno por Déficit de Atención con Hiperactividad/genética , Medio Social , Adulto , Trastorno de Personalidad Antisocial/psicología , Trastorno por Déficit de Atención con Hiperactividad/psicología , Estudios de Seguimiento , Humanos , Masculino , Desarrollo de la Personalidad , Factores de Riesgo , Factores SocioeconómicosRESUMEN
In a sample of 286 adult male adoptees 44 met criteria for antisocial personality (ASP). Two types of biologic parent background were associated with increased incidence of ASP in offspring: those with alcohol problem and those with a criminal conviction or adjudged delinquency. ASP adoptees were also significantly more likely to be alcoholic. Log linear modeling showed that alcohol problems in a biologic parent predicted increased alcohol abuse in the adoptee and that criminality/delinquency in a biologic parent predicted adult adoptee ASP. In the log-linear model two environmental factors significantly increased adoptee ASP: (1) placement in an adoptive home where there was an alcohol problem or antisocial behavior; and (2) placement in a lower socioeconomic home when the adoptee came from a background of criminality/delinquency in a biologic parent. When the adoptee did not have this biologic background socioeconomic level appeared to have little effect on ASP incidence. The results suggest the importance of genetic-environmental interaction in the genesis of adult ASP disorder.
Asunto(s)
Adopción/psicología , Trastorno de Personalidad Antisocial/genética , Medio Social , Adulto , Alcoholismo/genética , Trastorno de Personalidad Antisocial/diagnóstico , Trastorno de Personalidad Antisocial/psicología , Humanos , Masculino , Desarrollo de la Personalidad , Pruebas de Personalidad , Factores de RiesgoRESUMEN
In contrast to studies on alcoholism, there is little documentation on familial transmission of drug abuse. This study was designed to determine whether specific familial transmission of substance abuse occurs: a greater incidence of drug abuse in probands with a family history of drug abuse than in those with a family history of alcoholism. Probands were 305 consecutively admitted patients to an inpatient chemical dependency treatment center, whose substance abuse/dependence diagnoses were based on DSM-III criteria and a structured interview. Family history data were obtained from each proband. Log linear analysis investigated the association between family and proband substance abuse. As abuse of nonalcoholic substances was significantly greater in probands with family histories of drug abuse, specific familial transmission is suggested.
Asunto(s)
Alcoholismo/genética , Trastornos Relacionados con Sustancias/genética , Adulto , Humanos , Drogas Ilícitas , Factores de RiesgoRESUMEN
This study followed a group of elderly patients (ill group) with recent onset of life-threatening or severely debilitating illness to determine development of depressive symptoms. Age- and sex-matched control patients were included for comparison. Depressive symptoms increased significantly in the group of ill male patients when compared with controls. Depressive symptoms did not show an increase in the group of ill female patients. Other variables also predicted increased depression: (1) an initial placement in nursing home, (2) a prior history of depression or higher initial level of depressive symptoms, (3) the presence of larger numbers of additional medical illnesses, and (4) following the occurrence of stressful life events. The increase in depression in the male test group was still present and significant when controlling for these additional four factors.