Alphaherpesvirus-associated disease in greater bilbies (Macrotis lagotis).

CASE REPORT: A captive breeding colony of 9 greater bilbies (Macrotis lagotis) exhibited mild upper respiratory signs and sudden deaths with 100% mortality over a 2-week period. Histologically, acute necrotising and erosive epithelial lesions throughout the upper respiratory system and bronchi were associated with eosinophilic intranuclear inclusion bodies. Inclusions were also present in hepatocytes and adrenocortical cells, but were not always associated with necrosis. Transmission electron microscopy of lung sections revealed nucleocapsids forming arrays within some nuclei. A pan-herpesvirus PCR yielded a 440-bp product, with sequencing confirming homology with the alphaherpesviruses. Viral culture in a marsupial cell line resulted in cytopathic effect consistent with an alphaherpesvirus. CONCLUSION: This is the first report of a herpesvirus-associated disease in greater bilbies.

Obsessive-compulsive disorder and separation anxiety co-morbidity in early onset panic disorder.

BACKGROUND: This study was undertaken to examine the relationship between anxiety co-morbidity and age of onset of panic disorder. METHODS: Age of onset of panic disorder and co-morbid anxiety disorders were assessed among 201 panic disorder probands with childhood separation anxiety disorder, obsessive-compulsive disorder, obsessive-compulsive symptoms, social phobia and specific phobia as part of a clinician-administered lifetime diagnostic interview. A generalized linear model was used to test the association between each anxiety co-morbidity and age of panic disorder onset while simultaneously controlling for the potential confounding effects of sociodemographic characteristics and other psychiatric co-morbidity. RESULTS: Earlier onset of panic disorder was found in patients with co-morbid obsessive-compulsive disorder, obsessive-compulsive symptoms and separation anxiety disorder, but not simple phobia or social phobia. Patients with both childhood separation anxiety disorder and obsessive-compulsive disorder had an even earlier panic onset than those with either childhood separation anxiety disorder or obsessive-compulsive disorder. CONCLUSIONS: The association between anxiety co-morbidity and earlier onset of panic disorder is specific to obsessive-compulsive disorder and childhood separation anxiety disorder.

Similarities and differences by race/ethnicity in changes of HIV seroprevalence and related behaviors among drug injectors in New York City, 1991-1996.

OBJECTIVE: To measure differences and similarities in the prevalence of HIV infection and of related risk and protective behaviors among New York City black, white, and Hispanic drug injectors during a period of decreasing HIV prevalence. METHODS: Drug injectors were interviewed at a drug detoxification clinic and a research storefront in New York City from 1990 to 1996. All subjects had injected drugs within the last six months. Phlebotomy for HIV testing was conducted after pretest counseling. Analysis compares the first half (period) of this recruitment interval with the second half. RESULTS: HIV seroprevalence declined among each racial/ethnic group. In each period, white drug injectors were significantly less likely to be infected than either blacks or Hispanics. Similar declines were found in separate analyses by gender, length of time since first injection, and by recruitment site. After adjustment for changes in sample composition over time, blacks and Hispanics remained significantly more likely to be infected than whites. Interactions indicate that the decline may be greatest among Hispanics and slowest among blacks. A wide variety of risk behaviors declined in each racial/ethnic group; and syringe exchange use increased in each group. Few respondents reported injecting with members of a different racial group at their last injection event. CONCLUSIONS: HIV prevalence and risk behaviors seem to be falling among each racial/ethnic group of drug injectors. Black and Hispanic injectors continue to be more likely to be infected. Declining prevalence among whites poses some risk of politically based decisions to reduce prevention efforts. Overall, these results show that risk reduction can be successful among all racial/ethnic groups of drug injectors and suggest that continued risk reduction programs may be able to attain further declines in infection rates in each group.

Risk behavior and HIV infection among new drug injectors in the era of AIDS in New York City.

OBJECTIVE: To examine HIV risk behavior and HIV infection among new initiates into illicit drug injection in New York City. DESIGN AND METHODS: Cross-sectional surveys of injecting drug users (IDUs) recruited from a large detoxification treatment program (n=2489) and a street store-front research site (n=2630) in New York City from 1990 through 1996. Interviews covering demographics, drug use history, and HIV risk behavior were administered; serum samples were collected for HIV testing. Subjects were categorized into two groups of newer injectors: very recent initiates (just began injecting through 3 years) and recent initiates (injecting 4-6 years); and long-term injectors (injecting > or = 7 years). RESULTS: 954 of 5119 (19%) of the study subjects were newer injectors, essentially all of whom had begun injecting after knowledge about AIDS was widespread among IDUs in the city. New injectors were more likely to be female and white than long-term injectors, and new injectors were more likely to have begun injecting at an older age (median age at first injection for very recent initiates, 27 years; median age at first injection for recent initiates, 25 years; compared with median age at first injection for long-term injectors, 17 years). The newer injectors generally matched the long-term injectors in frequencies of HIV risk behavior; no significant differences were found among these groups on four measures of injection risk behavior. HIV infection was substantial among the newer injectors: HIV prevalence was 11% among the very recent initiates and 18% among the recent initiates. Among the new injectors, African Americans, Hispanics, females, and men who engaged in male-male sex were more likely to be infected. CONCLUSIONS: The new injectors appear to have adopted the reduced risk injection practices of long-term injectors in the city. HIV infection among new injectors, however, must still be considered a considerable public health problem in New York City.

Panic disorder and social phobia: effects of comorbidity on familial transmission.

The aim of this study was to examine effects of comorbidity of panic disorder and social phobia on familial transmission of each of these disorders. Rates of panic disorder and social phobia were compared in directly interviewed relatives of four proband groups: (1) panic disorder, (2) social phobia, (3) panic disorder and social phobia, and (4) never ill controls. Anxiety disorder probands had no additional lifetime anxiety disorder comorbidity. The familial pattern of the comorbid (panic disorder and social phobia) probands resembled that of the panic disorder group: an increased rate of panic disorder but not social phobia as compared to relatives of controls. Relatives of social phobia probands had an increased rate of social phobia but not panic disorder. These data indicate that social phobia in individuals who subsequently develop panic disorder: (1) differs with respect to familial transmission from social phobia which occurs without lifetime anxiety comorbidity; and (2) may be nonfamilial and/or causally related to panic disorder. Additional studies in larger epidemiologic samples are required to assess generalizability of these findings.

Specificity in familial aggregation of phobic disorders.

BACKGROUND: To investigate whether each of three DSM-III-R phobic disorders (simple phobia, social phobia, and agoraphobia with panic attacks) is familial and "breeds true." DESIGN: Rates of each phobic disorder were contrasted in first-degree relatives of four proband groups: simple phobia, social phobia, agoraphobia with panic attacks, and not ill controls. Phobia probands were patients who had one of the phobia diagnoses but no other lifetime anxiety comorbidity. RESULTS: We found moderate (two- to fourfold increased risk) but specific familial aggregation of each of the three DSM-III-R phobic disorders. CONCLUSIONS: These results support a specific familial contribution to each of the three phobia types. However, conclusions are limited to cases occurring without lifetime anxiety comorbidity and do not imply homogeneity within categories.

Generalized social phobia. Reliability and validity.

OBJECTIVE: To investigate the reliability and validity of DSM-III-R "generalized" social phobia by examining interrater agreement and comparing patients with generalized and "nongeneralized" social phobia on demographic characteristics, clinical variables, and familial social phobia. DESIGN: Two senior clinicians classified 129 patients attending an anxiety clinic as having DSM-III-R social phobia that is generalized (fears most social situations) or nongeneralized (less than most) based on independent narrative review. RESULTS: Good reliability was achieved (kappa = 0.69). Patients with generalized social phobia were more often single, had earlier onsets of social phobia, had more interactional fears, and had higher rates of atypical depression and alcoholism. Familial social phobia was more common among patients with generalized social phobia than patients with nongeneralized social phobia and controls, with no difference between the latter two groups. CONCLUSIONS: Generalized social phobia (1) can be distinguished reliably from nongeneralized social phobia, (2) is a valid subtype, and (3) may characterize a familial form of the disorder.

Sodium lactate response and familial risk for panic disorder.

OBJECTIVE: The authors used the family study method to test the hypothesis that sodium lactate response defines two subtypes of panic disorder. METHOD: Rates of panic disorder in 142 first-degree relatives of patients who responded to sodium lactate, 88 first-degree relatives of patients who did not respond to sodium lactate, and 231 first-degree relatives of never mentally ill subjects were compared. RESULTS: No difference in familial transmission of panic disorder was found between the two patient groups. CONCLUSIONS: The findings do not support the notion that panic disorder subtypes are associated with lactate sensitivity.

Childhood separation anxiety disorder in patients with adult anxiety disorders.

The authors examined the relation between retrospectively reported childhood separation anxiety disorder and adult DSM-III-R anxiety disorders in 252 outpatients at an anxiety disorders research clinic. The prevalence of childhood separation anxiety disorder was significantly greater among patients with two or more lifetime adult anxiety disorder diagnoses than it was among patients with only one anxiety disorder, suggesting that childhood separation anxiety disorder may be a risk factor for multiple anxiety syndromes in adulthood.

Effects of informant mental disorder on psychiatric family history data.

OBJECTIVE: In family history interviews, mentally ill individuals ascribe their own disorders to relatives more frequently than informants who are not ill. Whether this reflects increased or decreased reporting accuracy remains unknown. This study addressed this issue by examining the sensitivity and specificity of diagnoses based on information from different types of informants classified by their own illness status. METHOD: Both members of 2,193 pairs of individuals participating in a psychiatric family study were directly interviewed. One individual in each pair (the informant) also provided family history data about the other (the subject). Informant-subject pairs were grouped according to the illness status of the informant based on the direct interview. Patterns of ascription of mental illness to subjects by groups of ill and not-ill informants were then compared with the subjects' psychiatric status based on direct interview. RESULTS: For depression, alcoholism, panic disorder, and "any diagnosis," ill informants demonstrated significantly increased sensitivity in family history reports when compared to never-mentally-ill informants; specificity, by contrast, was always significantly reduced. For each disorder, the aggregate disorder rate derived from family history reports was closer to the rate derived from direct interviews if information from ill informants as a group was used. CONCLUSIONS: The sensitivity and specificity of family history information appears to vary systematically with informant mental illness status. This may introduce a serious bias into psychiatric family study data, leading to overestimation of the strength of the tendency for mental disorders to "run in families." Family studies that rely on the informant method in their diagnostic evaluations should be aware of this problem.

Familial transmission of panic disorder: effect of major depression comorbidity.

This study assesses the effect of major depressive disorder (MDD) comorbidity on familial transmission of panic disorder (PD). The following questions are addressed: (1) is PD familial, i.e., do relatives of patients with PD show an increased risk for PD? (2) do PD and MDD share a common diathesis, i.e., do relatives of patients with PD without MDD show an increased risk for MDD? (3) is lifetime comorbid PD with MDD conjointly familial, i.e., do relatives of patients with PD and MDD show an increased risk for the combined syndrome? Subjects were: (1) 152 relatives of 54 anxiety clinic patients with PD and MDD; (2) 193 relatives of 72 patients with PD without MDD; (3) 231 relatives of 77 not ill controls. Relatives were interviewed by clinicians, and best estimate DSM-III-R diagnoses were formulated by senior staff. Relatives of PD with MDD (13%) and PD without MDD probands (9%) showed significantly higher rates of PD than relatives of controls (3%). Relatives of PD with MDD probands (37%) showed significantly higher rates of MDD than relatives of PD without MDD (24%) and controls (21%), with no difference between the latter two groups. Relatives of PD with MDD probands (9%) showed significantly higher rates of PD with MDD than relatives of PD without MDD (3%) and controls (1%). We conclude that: (1) PD is familial; (2) PD in the absence of MDD does not incur increased risk of MDD to relatives; and (3) PD with MDD may represent a distinct, complex syndrome.

A comparison of treated and untreated simple phobia.

The authors compared 25 treated and 58 untreated subjects with simple phobia uncomplicated by other lifetime anxiety disorders. The treated individuals reported more phobias involving dogs and cats, elevators, and transportation; most had multiple phobias; and many experienced panic attacks in the context of their phobias. The untreated individuals typically reported only one phobia, which was often related to blood-injury and was seldom complicated by panic symptoms.

A direct interview family study of social phobia.

Risks for DSM-III-R anxiety and affective disorders and "subdisorder" (nonimpairing) irrational social fears, among directly interviewed first-degree relatives (n = 83) of probands who met criteria for social phobia but for no other lifetime anxiety disorder diagnosis, were contrasted to risks for disorder among similarly evaluated relatives (n = 231) of never mentally ill controls. Relatives of social phobia probands had a significantly increased risk for social phobia (16% vs 5%, relative risk = 3.12) but not for other anxiety disorders. These results suggest a familial contribution to the development of some cases of social phobia. The specificity of the pattern of intergenerational transmission is consistent with the current nosologic distinction between social phobia and other anxiety disorders.