In an attempt to study predisposition to bipolar manic-depressive disorder, we developed a behavioral paradigm to identify persons at risk for various forms of the disorder. We provide a theoretical discussion for denning bipolar disorder within the broader framework of common human diseases and then employ this framework to derive dimensions of bipolar disorder that define its distinctness from the normal phenotype. These dimensions (behavioral and nonbehavioral features of disorder) are operationalized in the form of a self-report inventory which estimates the probability that an individual is at risk. Five external validation studies using nontest criteria are presented, including interview, roommate, family history, clinical characteristics, and longitudinal mood rating investigations. Results indicate that the inventory serves as a promising first-stage case identification procedure for bipolar disorder when employed in a research context. To date, most research on human disorders has focused on the pathophysiology underlying signs and symptoms (Depue & Evans, 1981). If comprehensive models of etiology are to be derived, however, other

The present study explored the prevalence and types of psychopathology exhibited by the adolescent and young-adult offspring (ages 15-21) of patients with bipolar affective disorder. The major hypothesis of the study was that the offspring of bipolar patients would be characterized by an increased rate of cyclothymia. Subjects included 37 offspring of patients with bipolar affective disorder and 22 offspring of patients with nonaffective psychiatric disorders. Offspring received structured diagnostic interviews, conducted by interviewers unaware of parental diagnosis. Anonymous diagnoses were derived based on Research Diagnostic Criteria. The offspring of bipolar parents exhibited significantly higher rates of affective disorder, in general, and cyclothymia, in particular, than did the offspring of nonaffective psychiatric controls. The offspring groups did not differ on rates of nonaffective disorders. These results provide further support for a continuum model of bipolar disorder, in which cyclothymia is viewed as a mild form of full syndromal bipolar illness.In the past few years, there has been a burgeoning of interest in the offspring of parents with affective disorders (Beardslee, Bemporad, Keller, & Klerman, 1983;Kestenbaum, 1982;Morrison, 1983;Orvaschel, 1983). This interest stems from three major sources: (a) the high prevalence of affective disorders (Boyd & Weissman, 1982) and the fact that these disorders are particularly common during the child-rearing years (Coryell & Winokur, 1982;Weissman, 1979) indicate that large numbers of children are raised in families with an affectively disordered parent (Berg, Butler, Houston, & McGuire, 1984;Moss & Plewis, 1977;Richman, 1978); (b) familial-genetic studies indicate that offspring of parents with affective disorders are at

Results demonstrate the feasibility and usefulness of an online intervention for carers. Further examination of the efficacy of the intervention for both carers and individuals with AN is warranted.

In order to investigate the contribution of environmental events to the occurrence of serious suicide attempts, patients were interviewed about the events that occurred to them or their spouse in the 12 months previous to the actual suicide attempt. Several methodological improvements relative to previous events and suicide research were incorporated in the study. Only primary depressive attempters (n= 14) were selected, and for purposes of comparison, a primary depressive control group (n = 14) was selected. Moreover, seriousness of suicide attempt was quantified and assessed in each patient, and only moderately or severely serious attempters were chosen. The results showed that the occurrence of serious suicide attempts is strongly associated with an increased rate of independent events (events not influenced by the patient's behavior, decisions, or disorder) in the year preceding the attempt, and that a particularly high density of such events between episodic onset and the attempt may serve as the direct initiator of an attempt. Our data also suggest that exit events, where an important social support is lost to the patient, may play a particularly significant role in initiating an attempt. Moreover, the findings suggest that the presence of social support may buffer the impact of exit events and thereby reduce suicidal risk. Implications of our findings for the highest risk period of suicide are discussed.

Recent studies have provided strong support for the convergent validity of the General Behavior Inventory (GBI), a case identification inventory for chronic subsyndromal affective disorders (cyclothymia and dysthymia). Fewer data are available, however, on the ability of the GBI to distinguish chronic subsyndromal affective disorders from other forms of psychopathology. In order to address this issue, outpatients with cyclothymia (n = 9), dysthymia (n = 26), nonchronic major depression (n = 16), and nonaffective psychiatric disorders (n = 30) were compared on the GBI. Diagnoses were derived blind to GBI scores using structured diagnostic interviews and DSM-III criteria. The inventory significantly discriminated cyclothymes and dysthymes from patients with nonchronic major depressions and nonaffective disorders. Using the cutoff score that maximized GBI-diagnosis concordance, the inventory correctly classified 88% of the sample. All of the cyclothymes, 92% of the dysthymes, 87% of the patients with nonaffective psychiatric disorders, and 75% of the nonchronic major depressives were correctly classified by the inventory. These data provide strong support for the discriminant validity of the GBI.

The incidence and clinical characteristics of DSM‐III Schizotypal Personality Disorder (SPD) were explored in a series of 76 consecutive outpatients. Ten patients (13.2%) met DSM‐III criteria for SPD. Patients with SPD were significantly more likely to receive a diagnosis of drug abuse or dependence and tended to exhibit a higher rate of major affective disorders than did the non‐SPD group. Patients with SPD were rated as significantly more severely disturbed than non‐SPD patients on the Global Assessment Scale for the current episode and the worst lifetime episode of disorder. In addition, SPD patients were significantly more likely to have histories of psychiatric hospitalization and attempted suicide and first received treatment at a significantly younger age than did non‐SPD patients. These results indicate that SPD is relatively common in outpatient settings and is associated with particularly severe psychopathology.

Only 61% of adults being treated for anorexia nervosa (AN) were willing to allow their carer to be contacted by researchers in order to ask them to complete questionnaires over the duration of treatment and follow-up. Significant reductions in eating psychopathology from those being treated for AN was followed by significant reductions in their carers' distress some 12 months later. Reductions of carers' distress was associated with only a small effect size and may indicate that more clinically significant reductions requires individualised support for the carers. Carers whose significant other had a lower body mass index at baseline received most benefit in terms of symptom reduction at 12-month follow-up, which may indicate a need to clarify a carer's expectations of the recovery process.

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