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We conducted a 9-cM genome scan in a large bipolar pedigree sample from the National Institute of Mental Health genetics initiative (1060 individuals from 154 multiplex families). We performed parametric and nonparametric analyses using both standard diagnostic models and comorbid conditions thought to identify phenotypic subtypes: psychosis, suicidal behavior, and panic disorder. Our strongest linkage signals (genome-wide significance) were observed on chromosomes 10q25, 10p12, 16q24, 16p13, and 16p12 using standard diagnostic models, and on 6q25 (suicidal behavior), 7q21 (panic disorder) and 16p12 (psychosis) using phenotypic subtypes. Several other regions were suggestive of linkage, including 1p13 (psychosis), 1p21 (psychosis), 1q44, 2q24 (suicidal behavior), 2p25 (psychosis), 4p16 (psychosis, suicidal behavior), 5p15, 6p25 (psychosis), 8p22 (psychosis), 8q24, 10q21, 10q25 (suicidal behavior), 10p11 (psychosis), 13q32 and 19p13 (psychosis). Over half the implicated regions were identified using phenotypic subtypes. Several regions -1p, 1q, 6q, 8p, 13q and 16p -have been previously reported to be linked to bipolar disorder. Our results suggest that dissection of the disease phenotype can enrich the harvest of linkage signals and expedite the search for susceptibility genes. This is the first large-scale linkage scan of bipolar disorder to analyze simultaneously bipolar disorder, psychosis, suicidal behavior, and panic disorder.

The purpose of this study was to examine the reasons people with an episode of Major Depression do or do not seek treatment for the episode. We interviewed 101 persons who met criteria for an RDC Major Depressive episode that lasted at least 4 weeks within 3 years of the interview date, exploring in detail the reasons they gave for seeking or not seeking treatment. GAS ratings indicated that all subjects were moderately impaired at the time of the episode. We found that 55% of the subjects did not seek treatment for this episode, while 45% did. Significant predictors of treatment seeking included a history of prior treatment, higher education, and greater episode length. Non‐seekers felt they could handle the episode themselves, did not consider it serious or did not recognize it as an illness. Seekers on the other hand felt the episode was too painful and lasted too long and caused significant disruption in their interpersonal relationships and role functioning. We discuss the implications of these findings in terms of the importance of continued educational efforts to encourage treatment seeking as well as the need for further research to explore the manner in which people decide that affective signs and symptoms have reached a threshold that leads to treatment seeking. Depression and Anxiety 4:273–278, 1996/1997. © 1997 Wiley‐Liss, Inc.

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