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1 The Department of Psychiatry, Washington University School of Medicine, Saint Louis, Missouri 63110
Data from five previously published series of affective disorder have been analysed for morbid risk of affective illness in parents, siblings, and children of probands who were separated by age, sex, and whether bipolar (demonstrating mania in their history or occurring in a first-degree relative) or unipolar (demonstrating one or more depressions and without a history of mania in a first-degree relative).
Significant differences in parental morbid risks were found between younger and older onset probands. Analogous bipolar parental differences were not significant. The finding of lower morbid risk for parents of late onset unipolar probands could possibly be attributed to faulty ascertainment.
Significant sex differences in morbid risk were found in both unipolar and bipolar groups. In the bipolar group, brothers of female probands showed a lower risk than sisters, but sons and daughters of female bipolar probands showed equal morbid risks. This was in contrast to the unipolar group where brothers of female probands had a lower risk than sisters, but daughters of female probands had a higher risk than sons. The contrasting patterns in children of female bipolar and unipolar probands is a hitherto undescribed finding and suggests a different type of inheritance for unipolar disorder. The morbid risks for bipolar probands' relatives is consistent for the most part with the X-linked dominant inheritance described by Reich, Clayton, and Winokur (1969). The pattern of morbid risks in children and parents of unipolar probands is incompatible with an X-linked dominant hypothesis. To account for the marked preponderance of ill females associated with female probands we postulate the presence of two groups of unipolar illness: one in which males and females have equal morbid risks, and the other in which the illness is sex-limited to females.
Submitted on April 17, 1969
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