Personality disorder comorbidity in panic disorder patients with or without current major depression

To investigate the relationship between current or past major depressive disorder (MDD) on comorbid personality disorders in patients with panic disorder, we compared the comorbidity of personality disorders using the Structured Clinical Interview for DSM-III-R personality disorders (SCID-II) in 34 panic disorder patients with current MDD (current-MD group), 21 with a history of MDD but not current MDD (past-MD group), and 32 without lifetime MDD comorbidity (non-MD group). With regard to personality disorders, patients in the current-MD group met criteria for at least one personality disorder significantly more often than patients in the past-MD group or the non-MD group (82.4% vs. 52.4% and 56.3%, respectively). The current-MD group showed statistically significantly more borderline, dependent, and obsessive-compulsive personality disorders than the past-MD group or non-MD group. With stepwise regression analyses, number of MDD episodes emerged as an indicator of the comorbidity of cluster C personality disorder and any personality disorders. Future studies should determine whether aggressive treatment of comorbid personality disorders improves the outcome (e.g., lowers the likelihood of comorbid MDD) of patients with panic disorder.     

Panic disorder versus panic disorder with major depression: Defining and understanding differences in psychiatric morbidity

The present study examined the impact of comorbid major depressive disorder (MDD) on psychiatric morbidity, panic symptomatology and frequency of other comorbid psychiatric conditions in subjects with panic disorder (PD). Four hundred thirty-seven patients with PD were evaluated at intake as part of a multicenter longitudinal study of anxiety disorders; 113 of these patients were also in an episode of MDD. Patients were diagnosed by DSM-III-R criteria utilizing structured clinical interviews. The 113 PD/MDD patients were compared with the 324 remaining PD subjects regarding panic symptoms at intake, sociodemographic, quality of life and psychiatric morbidity variables. Differences in frequency of other comorbid Axis I psychiatric disorders were assessed at intake; personality disorders were evaluated twelve months after intake. The results revealed that PD/MDD patients exhibit increased morbidity and decreased psychosocial functioning as compared to PD patients. Personality disorders were more prevalent in the PD/MDD group at six month follow-up assessment; the PD/MDD group also had an increased frequency of posttraumatic stress disorder (PTSD) and more comorbid Axis I anxiety disorders as compared to the PD group. The total number and frequency of panic symptoms was highly consistent between the two patient groups. Depression and Anxiety 5:12–20, 1997. © 1997 Wiley-Liss, Inc.     

Clinical differentiation between major depression only, major depression with panic disorder and panic disorder only. Childhood, personality and personality disorder

A consecutive sample of 298 nonpsychotic psychiatric outpatients was classified according to DSM-III and divided into 4 diagnostic groups: pure major depression, mixed major depression/panic disorder, pure panic disorder and a remaining group of other disorders. The patients' report of childhood relationship to parents and siblings, family atmosphere, their own personality characteristics as children and precipitating events were compared in the various groups. In addition, differences in personality and frequencies of personality disorders were investigated by means of various instruments. Our results show that the type of relationship to parents in childhood differed in the various groups. The mother seems to be the most crucial person for the development of depression, the father for the development of panic disorder. Patients with major depression are more obsessive and patients with panic disorder more infantile and avoidant with less control of their personality. Finally, patients with mixed conditions are more in accordance with the DSM-III anxious personality disorder cluster.     

Associations between LSAMP gene polymorphisms and major depressive disorder and panic disorder

The purpose of this case–control genetic association study was to explore potential relationships between polymorphisms in the limbic system-associated membrane protein (LSAMP) gene and mood and anxiety disorders. A total of 21 single-nucleotide polymorphisms (SNPs) from the LSAMP gene were analyzed in 591 unrelated patients with the diagnoses of major depressive disorder (MDD) or panic disorder (PD) and in 384 healthy control subjects. The results showed a strong association between LSAMP SNPs and MDD, and a suggestive association between LSAMP SNPs and PD. This is the first evidence of a possible role of LSAMP gene in mood and anxiety disorders in humans.     

Relationship between perfectionism,personality disorders and agoraphobia in patients with panic disorder

OBJECTIVE: In earlier reports, we found that perfectionism might be involved in the development and/or maintenance of agoraphobia in panic disorder. The present report extends this work by examining the relationship between perfectionism and comorbidity with personality disorders in panic disorder patients with agoraphobia (PDA) and those without agoraphobia (PD). METHOD: We examined comorbidity of personality disorders by Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) and assessed perfectionism using multidimensional perfectionism scale in 56 PDA and 42 PD patients. RESULTS: The PDA group met criteria for at least one personality disorder significantly more often than the PD group. With stepwise regression analyses, avoidant and obsessive-compulsive personality disorders emerged as significant indicators of perfectionism in patients with panic disorder. CONCLUSION: These findings suggest that perfectionism in panic disorder patients may be more common in those with comorbid personality disorders, and may be an important target for preventive and therapeutic efforts.     

Patterns of comorbidity in panic disorder and major depression: findings from a nonreferred sample

Previous findings in referred adult samples document major depression as having important moderating effects on the patterns of comorbidity for panic disorder and major depression. This study evaluated whether these patterns of comorbidity are moderated by referral bias. Panic disorder (PD) and major depression (MD) were used to predict the risk for comorbid psychiatric disorders and functional outcomes using data from a large sample of adults who had not been ascertained on the basis of clinical referral (N=1,031). Participants were comprehensively assessed with structured diagnostic interview methodology to evaluate childhood and adult comorbid psychiatric disorders. PD increased the risk for anxiety disorders, independently of MD. MD increased the risk for mania, antisocial personality disorder, psychoactive substance use disorder, disruptive behavior disorders, overanxious disorder, social phobia, and generalized anxiety disorder, independently of PD. These results extend to nonreferred samples' previously reported findings documenting that MD has important moderating effects on patterns of comorbidity for PD and indicate that patterns of comorbidity for PD are not due to referral bias.     

DSM-III-R Axis I and II disorders in agoraphobic patients with and without panic disorder

Patients attending an inpatient phobia treatment program were diagnosed for DSM-III-R Axis I and II disorders, using the Structured Clinical Interview for DSM-III-R Disorders, and completed a set of self-report instruments. They were divided into 3 groups: (a) those who met the criteria for panic disorder with agoraphobia (n= 57), (b) those who met the criteria for agoraphobia without a history of panic disorder (n= 21), and (c) those who met criteria for other anxiety disorders, but not for panic/agoraphobia (n= 14). On Axis I, more of the panic with agoraphobia than of the agoraphobia without panic patients had obsessive-compulsive disorder. On Axis II, no significant differences between the agoraphobic patients with and without panic occurred. However, the number of hysterical traits was related to the presence of panic disorder among the agoraphobic patients. Avoidant and dependent traits were related to symptom severity.     

Patterns of psychiatric and physical comorbidities associated with panic disorder in a nationwide population‐based study in Taiwan

Chen Y‐H, Lin H‐C. Patterns of psychiatric and physical comorbidities associated with panic disorder in a nationwide population‐based study in Taiwan. Objective: This study aims to document a range of risk of psychiatric and physical comorbidities among PD patients using a nationwide population‐based dataset in Taiwan. Method: A total of 3672 patients with at least three consensus diagnoses with PD were included, together with 18 360 matched controls without PD. Logistic regression analyses were performed after adjusting for sociodemographic characteristics. Results: After adjusting for the patients’ sex, age and geographic region, patients with PD were more likely to have major depressive disorder (OR = 23.45), bipolar disorder (OR = 15.54), cardiac dysrhythmia (OR = 15.12), coronary heart disease (OR = 7.69), myocardial infarction (OR = 6.55), irritable bowel syndrome (OR = 4.82), peptic ulcers (OR = 4.30), cerebrovascular disease (OR = 3.61), hypertension (OR = 3.31), epilepsy (OR = 3.07), hepatitis (OR = 2.70), hyperlipidemia (OR = 2.20), asthma (OR = 2.17), schizophrenia (OR = 2.14), neoplasms (OR = 2.02), renal disease (OR = 1.89) and diabetes (OR = 1.26), compared to patients in the comparison cohort. Conclusion: We conclude that PD is associated with an array of psychiatric and physical illnesses.     

Characterological depression in patients with narcissistic personality disorder

Abstract

Background: Depressive symptoms often occur in patients with personality disorders. Along the lines of the precious concepts of reactive and melancholic forms of depression, two different patterns of depressive symptoms can be identified. Reactive forms of depression is considered to be related to dysfunction of emotional regulation and social functioning, and to personality disorders. This study aimed at exploring the pattern of depressive symptoms in patients with Narcissistic Personality Disorder (NPD) compared to a group of depressed patients without Personality Disorder (PD). The Newcastle Diagnostic Depression Scale (NDDS) is a clinical instrument designed to differentiate reactive depression from melancholic depression.

Method: The study investigated patterns of depressive symptoms in 117 out-patients, divided into two groups. One group containing 56 patients with depressive symptoms by no PD and the other group comprised of 61 patients with depressive symptoms and NPD. The participants were interviewed using the Newcastle Diagnostic Depression Scale.

Results: There was a significant difference between the groups, as the NPD group suffered from reactive forms of depression. The NPD group showed a pattern of depressive symptoms characterized by fluctuation of the depressive state, without time demarcation of depressive episode, ruminations preoccupied with hostility and accusatory feelings towards other, but not self-accusatory feelings, fluctuation suicidal ideation triggered by external events accompanied by parasuicidal behavior, lack of neuro-vegetative symptoms such as insomnia with early wakening, loss of appetite and weight loss. The No PD group showed the opposite pattern.

Conclusion: Based on these results NDDS is considered to be an applicable instrument for identifying personality pathology in patients with depressive symptoms, by recognizing the specific pattern. This is thought to be important for adequate treatment planning.     

Personality traits and escitalopram treatment outcome in major depression

Background: Selective serotonin re-uptake inhibitors (SSRI) have proven to be effective in treatment of depression. Still, treatment efficacy varies significantly from patient to patient and about 40% of patients do not respond to initial treatment. Personality traits have been considered one source of variability in treatment outcome.

Aim: Current study aimed at identifying specific personality traits that could be predictive of treatment response and/or the dynamics of symptom change in depressive patients.

Method: In a sample of 132 outpatients with major depressive disorder (MDD) treated with an SSRI-group antidepressant escitalopram, the Swedish universities Scales of Personality (SSP) were used in order to find predictive personality traits. For the assessment of the severity of depressive symptoms and the improvement rates, the Hamilton Depression Scale (HAM-D) and Montgomery-Åsberg Depression Rating Scale (MADRS) were used.

Results: Escitalopram-treated MDD patients with higher social desirability achieved more rapid decrease in symptom severity. None of the studied traits predicted the end result of the treatment.

Conclusion: The findings suggest that specific personality traits may predict the trajectory of symptom change rather than the overall improvement rate.     

History of separation anxiety in patients with panic disorder and depression and normal controls

The frequency and severity of separation anxiety for subjects with panic disorder and major depression was compared with that for normal controls. The subjects were diagnosed according to DSM-III criteria. Each subject completed a questionnaire consisting of 9 items derived from DSM-III criteria for separation anxiety disorder. The incidence of separation anxiety and its severity were significantly higher for the panic disorder subjects than for normal controls but there was no significant difference between depressed and panic disorder subjects. Panic disorder subjects with a history of separation anxiety disorder had a significantly earlier onset of panic attacks.     

Personality traits in patients with idiopathic pain disorder

In the present study, patients with idiopathic pain syndromes have been compared to healthy volunteers, patients with neurogenic pain syndromes and depressed patients as concerns stable personality traits. The personality traits were assessed by means of the Karolinska Scales of Personality (KSP). Patients with idiopathic pain syndromes were found to have high scores on scales measuring Muscular tension, Social desirability, Psychasthenia and Socialization. They had also high scores on the Inhibition of aggression factor. They had low scores on Impulsivity, Monotony avoidance, Indirect aggression, Verbal aggression and Suspicion. As compared to depressed patients, the pain patients were much more controlled, with higher scores on Socialization and Social desirability scales and like depressed patients with a tendency to inhibit aggression. Thus, as compared to depressed patients, the pain patients had less open anxiety but the same degree of muscular tension.     

Urinary phenylacetic acid in panic disorder with and without depression

Phenylacetic acid (PAA) excretion was measured in 39 patients who met criteria for panic disorder; 9 of these also had major depression, and 30 did not. Patients with panic and depression excreted 66 +/- 23 mg/day of PAA, an amount significantly lower than in normal controls; patients with panic disorder but without depression excreted 104 +/- 23 mg/day of PAA (not significantly lower than controls). The results support previous studies indicating that PAA excretion is a marker for depressive disorder.     

重性抑郁障碍或双相障碍患者抑郁发作伴随躁狂症状的临床特征

目的:了解重性抑郁障碍(MDD)或双相障碍抑郁发作患者出现躁狂症状的频率和程度。方法:对52例经简明国际神经精神访谈(MINI)、符合《美国精神障碍诊断与统计手册》第4版(DSMIV)重性抑郁障碍或双相障碍抑郁发作的患者,采用情感障碍评估量表(ADE)评估患者本次抑郁发作中出现的躁狂症状。结果:52例患者中有36例重性抑郁障碍,16例为双相障碍抑郁发作。至少有1条躁狂症状的患者达86.5%(n=45),至少有3条躁狂症状的患者占32.7%(n=17),而没有任何躁狂症状的患者仅占13.5%(n=7)。结论:抑郁发作患者大多存在不同程度的躁狂症状,及时识别这些症状,对诊断与治疗有指导意义。情感障碍评估量表是一个值得应用的评估情感发作的工具。     

QT wave dispersion in patients with panic disorder

Objective QT dispersion (QTd), defined as the maximal inter-lead difference in QT intervals on 12 leads of the surface electrocardiogram (ECG), reflects the regional heterogeneity of ventricular repolarization and has been suggested as an important marker for risk of arrhythmia in addition to the QT interval. Some investigators proposed that it might be a predisposing factor for arrhythmic events and sudden death. Thus, we aimed to investigate whether QTd differs in patients with panic disorder from that in healthy controls. Methods In 40 panic disorder patients and 40 healthy controls, Qmax, Qmin, and QTd values were measured. In addition, the Hamilton depression rating scale and the panic agoraphobia scale were scored for both patients and healthy volunteers. Results Qmax and Qmin values in the panic disorder patients were significantly higher than those in healthy controls. The mean corrected QTd was significantly greater in the patients than in the controls. One-way analysis of covariance (ANCOVA; using left atrial size, age and heart rate as covariates) also corrected the significant difference. In addition, ANCOVA revealed a significant main effect for the diagnosis, indicating a significantly higher QTd for patients compared with controls. Conclusion QTd might be associated with panic disorder. Future studies in larger samples evaluating the effects of treatment are required.     

The relationship of DSM-III-R personality disorder to clinical variables in patients with major depression: Possible difference between personality disorder clusters

Abstract The relationship of DSM-III-R personality disorder (PD) to demographic and clinical variables was investigated based on 96 consecutive outpatients with major depression. No significant difference in the variables was found between those with and those without PD. Those with PD from each cluster were compared with those without PD in terms of the variables. In these comparisons many relationships of PD to the variables were found, and these relationships were different between the three PD clusters detailed in DSM-III-R. Patients with cluster B PD demonstrated a prominent uniqueness in his/her relationship to the variables. This uniqueness was similar to what had been reported previously with regard to patients with PD. There was no significant difference in the variables between those with cluster C PD and those without PD. Those with cluster A PD may have a negative family history of affective disorders.     

Personality disorder diagnoses using DSM-III-R in a Japanese clinical sample with major depression

To investigate the availability of DSM-III-R Axis-II diagnoses in Japan, DSM-III-R personality disorders (PDs) were diagnosed in a large sample of Japanese out-patients with major depression. The SCID-II was administered to 118 consecutive out-patients with major depression. In general, the frequency of PD according to DSM-III-R criteria in this study was within the range of frequencies reported in North American and European studies. However, schizoid and narcissistic PDs were more frequent in this study. DSM-III-R diagnoses of PD would also be potentially useful for assessing personality disturbance in Japan. The DSM-III-R criteria for schizoid and narcissistic PDs may not be suitable for Japanese samples.     

Low novelty-seeking differentiates obsessive-compulsive disorder from major depression

OBJECTIVE: To make a direct comparison of patients with obsessive-compulsive disorder (OCD) and major depression (MD) and a normal control group in terms of the Temperament and Character Inventory (TCI) personality dimensions. METHOD: Additionally to 43 patients with primary OCD, 43 MD patients and 43 normal subjects who were matched against the OCD patients for sex and age filled out the TCI. RESULTS: Compared to the controls, the OCD and MD patients scored significantly higher on harm avoidance and significantly lower on self-directedness and co-operativeness. The OCD patients scored significantly lower on novelty-seeking than the MD patients and the controls. CONCLUSION: Whereas OCD and MD share similar personality deviations on harm avoidance, self-directedness and co-operativeness, OCD is distinguishable from MD in terms of low novelty-seeking. Low novelty-seeking may have a profound relationship to the specific aetiology of OCD.