Kovacs M, Devlin B, Pollock M, Richards C, Mukerji P
Department of Psychiatry, University of Pittsburgh School of Medicine, Pa, USA.
Arch Gen Psychiatry. 1997 Jul;54(7):613-23. doi: 10.1001/archpsyc.1997.01830190033004.
We studied the family psychiatric history of 125 youths with childhood-onset depressive disorder (a portion of whom developed bipolar disorder) and 55 psychiatric controls with nonaffective disorder.
Probands were classified according to prospectively observed clinical course in childhood. Family psychiatric history was determined by interviewers blind to probands' diagnosis, with mothers typically informing about themselves and about remaining first- and a all second-degree adult relatives.
Families of affectively ill juveniles had 5-fold greater odds of lifetime depressive disorder and 2-fold greater odds of recurrent unipolar depressive disorder than did families of psychiatric controls. The higher risk of depression was most evident in first-degree and female relatives. Mothers of affectively ill youths were younger at onset of depression than were mothers of controls. Alcoholism and substance use disorders were more prevalent in relatives of affectively ill probands than in controls and cosegregated with familial depression. However, other covariates were more important at predicting patterns of familial depression. Familial illness patterns also varied somewhat with proband characteristics.
Child probands with affective disorder identify families enriched with affective disorder (even compared with families of psychiatric controls), suggesting that juvenile- and adult-onset forms of this condition share the same diathesis. Rates of affective illness in the families of depressed youngsters also are notably higher than population-based estimates. The findings therefore indicate that very-early-onset affective disorder is familial and that pedigrees ascertained through affectively ill children are good candidates for family and genetic studies.
我们研究了125名患有儿童期起病的抑郁症（其中一部分发展为双相情感障碍）的青少年以及55名患有非情感障碍的精神科对照者的家族精神病史。
根据前瞻性观察到的儿童期临床病程对先证者进行分类。家族精神病史由对先证者诊断不知情的访谈者确定，通常由母亲告知自己以及其他所有一级和二级成年亲属的情况。
与精神科对照者的家族相比，情感障碍青少年的家族患终生抑郁症的几率高5倍，患复发性单相抑郁症的几率高2倍。抑郁症的较高风险在一级亲属和女性亲属中最为明显。情感障碍青少年的母亲患抑郁症的发病年龄比对照者的母亲更小。酒精中毒和物质使用障碍在情感障碍先证者的亲属中比在对照者中更普遍，并且与家族性抑郁症共分离。然而，其他协变量在预测家族性抑郁症模式方面更重要。家族疾病模式也因先证者特征而有所不同。
患有情感障碍的儿童先证者所识别出的家族中情感障碍更为常见（即使与精神科对照者的家族相比），这表明这种疾病的青少年期和成年期发病形式具有相同的素质。抑郁青少年家族中的情感障碍发病率也明显高于基于人群的估计。因此，研究结果表明极早发性情感障碍具有家族性，并且通过患有情感障碍的儿童确定的家系是家族和基因研究的良好对象。
