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Background Pathological gambling (PG) is a prevalent and impairing public health problem. In this study we assessed age at onset in men and women with PG and compared the demographic and clinical picture of early- vs. later-onset individuals. We also compared age at onset in PG subjects and their first-degree relatives with PG. Method Subjects with DSM-IV PG were recruited during the conduct of two non-treatment clinical studies. Subjects were evaluated with structured interviews and validated questionnaires. Early-onset was defined as PG starting prior to age 33 years. Results Age at onset of PG in the 255 subjects ranged from 8 to 80 years with a mean (SD) of 34.0 (15.3) years. Men had an earlier onset than women. 84% of all subjects with PG had developed the disorder by age 50 years. Early-onset subjects were more likely to be male, to prefer action games, and to have substance use disorders, antisocial personality disorder, attention deficit/hyperactivity disorder, trait impulsiveness, and social anxiety disorder. Later-onset was more common in women and was associated with a preference for slots and a history of sexual abuse. Conclusions Age at onset of PG is bimodal and differs for men and women. Early-onset PG and later-onset PG have important demographic and clinical differences. The implications of the findings are discussed.

Objectives: Retrospective and cross-sectional studies of seasonal variation of depressive symptoms in unipolar major depression have yielded conflicting results. We examined seasonal variation of mood symptoms in a long-term prospective cohort – the Collaborative Depression Study (CDS). Methods: The sample included 298 CDS participants from five academic centers with a prospectively derived diagnosis of unipolar major depression who were followed for at least ten years of annual or semi-annual assessments. Generalized linear mixed models were utilized to investigate the presence of seasonal patterns. In a subset of 271 participants followed for at least 20 years, the stability of a winter depressive pattern was assessed across the first two decades of follow-up. Results: A small increase in proportion of time depressed was found in the months surrounding the winter solstice, although the greatest symptom burden was seen in December through April with a peak in March. The relative burden of winter depressive symptoms in the first decade demonstrated no relationship to that of the second decade. The onset of new episodes was highest October through January, peaking in January. Conclusions: There exists a small but statistically significant peak in depressive symptoms from the month of the winter solstice to the month of the spring equinox. However, the predominance of winter depressive symptoms did not appear stable over the long-term course of illness.

The purpose of this study was to determine whether the preponderance of data support a continuum hypothesis of the psychoses or a concept of separate, autonomous illnesses. Patients (N = 70) were hospitalized for nonmanic psychoses, given structured interviews and a dexamethasone suppression test (DST), and diagnosed according to the Research Diagnostic Criteria (RDC). Patients were then evaluated at 7 year and 6 years with a structured interview. Diagnoses were made at three points of time: intake, 1 year, and 6 years. The patients were divided into groups that had a consistent (over the three points) set of affective disorder diagnoses (affective disorder or schizoaffective disorder, mainly affective [AD group]) and those that had a consistent set of schizophrenic diagnoses (schizophrenic or schizoaffective disorder, mainly schizophrenic [S group]). A third group (inconsistently diagnosed) consisted of subjects who at one point were diagnosed in the AD group and at another in the S group. A series of discriminant function analyses suggested that the AD group differs widely from the S group; and the inconsistently diagnosed group most closely resembled the AD group. The family background of the inconsistent group was similar to that of the AD group. The DST and outcome showed that the inconsistent group was more like the AD group than the S group. Using the characteristics of the medical model—clinical picture, outcome, laboratory tests, and family history—the group that was inconsistent with regard to diagnosis over time appeared similar to the AD group. Taking the follow-up evaluation into account, the data favor the possibility that patients who have a variable clinical diagnosis overtime do not suffer from schizophrenia.

We examined rates of mental disorders in relatives of 569 unipolar depressed patients. Probands were divided into three groups: primary depression (never secondary; N = 327), secondary depression (never primary; N = 191), and complicated depression (both primary and secondary episodes of depression; N = 51). We obtained blind family study diagnoses (direct interview) for 1,152 relatives and family history diagnoses (information from proband, with or without information from another relative) for 3,617 relatives. There was no increase in risk for major affective disorder in relatives of probands with primary depression as compared to the other two groups. The risks for several nonaffective diagnoses were increased in the families of patients with secondary depression (as were the risks for secondary depression). The family data for patients with complicated depressions were similar to those with secondary depression. We may conclude that secondary depression is a common finding in patients with nonaffective mental disorders, and shows no increased familial aggregation except increased frequency of nonaffective disorders which themselves are associated with secondary depression.

We rated the presence or absence of every DSM-III personality criteria in a cohort of 131 non-psychotic subjects. Ratings were based on the Structured Interview for DSM-III Personality Disorders (SIDP) which was administered to each patient and a knowledgable informant. Diagnositc overlap of the personality disorders (PD) was examined. Sensitivity, specificity, predictive value—positive and negative, and interrater reliability was calculated for each criteria item of each personality disorder. Problems in reliability of DSM-III personality disorders can be traced to specific criteria within those disorders that are associated with low reliability and/or low predictive value positive when compared to the other criteria used to define the personality disorder. Improvements are suggested. We were unable to demonstrate a significantly greater enhancement of reliability among criteria structures using a polythetic classification over those using monothetic classification despite a trend favoring the former. This study agrees with others that find a great deal of overlap between borderline PD and histrionic PD as defined in DSM-III. Passive-aggressive PD is very rare in the absence of some other PD. Paranoid and schizoid personality disorders were also rare though this may reflect the fact that individuals with these disorders rarely seek treatment.

The importance of delusions to tricyclic antidepressant response prediction implies a biological difference between delusional and non-delusional depression. Because the dexamethasone suppression test has proved useful as an external validator of depressive subtypes, we compared dexamethasone suppression test responses in depressed inpatients with and without delusions. The difference in rates of nonsuppression across these groups did not reach significance. Familial subtypes of primary unipolar depression were significantly associated with the presence of delusions: patients with pure depressive disease were much more likely to be delusional than were patients with depression spectrum disease. Furthermore, familial pure depressive disease patients with delusions were significantly more likely to escape dexamethasone suppression than were other unipolar depressed patients with delusions. We conclude that familial subtyping predicts both the likelihood of delusions and dexamethasone nonsuppression. A subdivision of primary unipolar depression by familial subtypes, therefore, appears more valid than a subdivision by presence of delusions.