Infant mental health and variability of parental depression symptoms.

OBJECTIVE: To examine the course of mothers' depression symptoms in association with child and family functioning beyond that explained by diagnostic status. METHOD: A longitudinal high-risk design with 16 months of course-of-illness follow-up was used. Structured clinical and family interviews, direct observation of child social-emotional competence, and parent reports of child behavior problems were included. RESULTS: Parameters of maternal symptom patterns across time were associated with child and family functioning. Most of these effects remained when presence/absence of major depression diagnosis was covaried. CONCLUSIONS: The trajectory of symptoms over time is important to consider in studies of children at risk and may also help to inform how illness in infancy and early childhood is conceptualized.

The unipolar-bipolar distinction in the characterological mood disorders.

The present study explored the validity of the unipolar-bipolar distinction in the characterological mood disorders. Thirteen cyclothymic and 32 primary early-onset dysthymic outpatients, diagnosed according to DSM-III-R, were compared on demographic, clinical, personality, and family history variables. The cyclothymics exhibited significantly higher levels of depressive symptomatology and extraversion and had a higher rate of bipolar I disorder in their first-degree relatives than the dysthymics. In addition, a significantly greater proportion of cyclothymics than dysthymics had a family history of drug abuse. The groups did not differ significantly on gender, overall rates of affective disorders in relatives, or a number of symptoms which have been reported to distinguish unipolar and bipolar depressives. Although these data require replication due to the small sample and large number of analyses conducted, they provide at least partial support for extending the unipolar-bipolar distinction to the characterological mood disorders.

Identifying chronic affective disorders in outpatients: validation of the General Behavior Inventory.

The validity of the General Behavior Inventory (GBI) in screening outpatients for chronic unipolar and bipolar affective conditions was evaluated. The GBI was administered to 492 consecutive patients at a university clinic and a community mental health center. Using a stratified random sampling plan, 167 patients were selected and administered blind structured diagnostic interviews. In addition, unipolar depressives were followed up 6 months after the initial evaluation. Overall, the GBI exhibited fair-to-good positive predictive power and good-to-excellent negative predictive power. In addition, GBI scores in the case range were consistently associated with poor outcome at the 6-month follow-up. These findings suggest that the GBI may provide an economical means of screening for chronic unipolar and bipolar affective conditions in outpatient settings.

Double depression and episodic major depression: demographic, clinical, familial, personality, and socioenvironmental characteristics and short-term outcome.

The authors compared 31 outpatients with double depression to 50 outpatients with episodic major depression. Patients with double depression exhibited significantly greater impairment, more severe depressive symptoms, greater comorbidity, more personality disturbance, lower levels of social support, more chronic strains, and higher rates of bipolar II and nonbipolar affective disorders in first-degree relatives. In addition, in a 6-month follow-up, the patients with double depression were significantly less likely to recover, and a higher proportion experienced hypomanic episodes than did patients with episodic major depression. These data provide strong support for the clinical significance of double depression.

Social referencing in infancy: a glance at fathers and marriage.

Social referencing refers to the tendency of a person to look to a significant other in an ambiguous situation in order to obtain clarifying information. The aims of the study were to assess the extent to which infants use fathers as referencing targets, and to assess the familial context that might mediate referencing to both parents. 40 11-month-old infants were observed once with their mothers and once with their fathers in a 15-min social referencing situation that involved entrance of a female stranger as the ambiguous stimulus. Infants used their fathers and mothers as referencing targets to an equal extent. Additionally, marital satisfaction was found to be a significant modifier of referencing. A hierarchical regression analysis indicated that paternal marital satisfaction predicted social referencing to fathers as well as to mothers; no effect was found for maternal marital satisfaction alone. This suggests that in order to better understand early socioemotional development, it is necessary to consider the interdependence among various relationships within the family.

The early--late onset distinction in DSM-III-R dysthymia.

DSM-III-R recently introduced early-late and primary-secondary subtypes of dysthymia. The present study explored the validity of the DSM-III-R early-late onset distinction by comparing early- and late-onset primary dysthymics on demographic, clinical and familial variables and short-term outcome. Compared to the late-onset dysthymics, the early-onset group had higher lifetime rates of superimposed major depressive episodes and anxiety disorders, had sought treatment significantly more frequently, had a higher rate of major affective disorders in first-degree relatives, and exhibited higher levels of depression throughout the course of a 6-month follow-up study. These data provide preliminary support for the validity of the DSM-III-R early-late onset distinction in dysthymia.

Endurance exercise and pregnancy outcome.

The interaction between maternal endurance exercise at or above a minimal conditioning level, prior to and during pregnancy, and pregnancy outcome was examined prospectively in our obstetrical populace using epidemiologic techniques. Over a 3-month interval all women registering for antepartum care were interviewed. Those planning to continue exercise during pregnancy were re-interviewed between the 28th and 34th gestational weeks. A detailed review of clinical records was used for outcome assessment. Women who continued endurance exercise at or near preconceptual levels during pregnancy gained less weight (-4.6 kg), delivered earlier (-8 d), and had lighter-weight offspring (-500 g) than those who stopped exercising prior to the 28th week. The latter group gained 2.2 kg more weight but delivered similar birthweight infants at a similar gestational age as their sedentary controls.

Endometritis related to Chlamydia trachomatis infection.

A 23-year-old woman had endometritis due to Chlamydia trachomatis infection. Chlamydia trachomatis was cultured from endometrial tissue obtained by biopsy, and elevated levels of serum antibodies, including IgM antibodies, to C. trachomatis were found. Cervical secretions were also positive for antibody. After treatment with tetracycline, endometrial cultures for C. trachomatis were negative and endometrial inflammation disappeared. Chlamydia trachomatis has been implicated in salpingitis, cervicitis, urethritis, and peritonitis, This case shows that endometritis may also result from C. trachomatis infection and in such instances may be a contributing factor in infertility.