Quality of life and anxiety and depressive disorder comorbidity

The present investigation evaluated the relations among anxiety and depressive disorder comorbidity and quality of life (QOL) by utilizing self-report measures of life satisfaction and functional disability. Participants were 94 individuals who were presented for treatment at an outpatient anxiety disorders clinic and 26 nonclinical participants. Results indicated that participants diagnosed with anxiety disorders reported lower QOL than did nonclinical participants. Anxiety disorder comorbidity did not additionally impact QOL; however, presence of a depressive disorder comorbid with an anxiety disorder did negatively impact QOL as these individuals reported significantly more functional disability and less life satisfaction than did individuals with anxiety disorders alone or those without a psychiatric diagnosis. These results highlight the negative nature of anxiety disorders and improve clarification on the role of diagnostic comorbidity on QOL among those with an anxiety disorder.     

Differential patterns of lifetime multiple anxiety disorder comorbidity between Latino adults with bipolar I and major depressive disorders

BACKGROUND: To determine the lifetime rates of panic disorder, obsessive-compulsive disorder (OCD), social phobia, and posttraumatic stress disorder (PTSD) among adult Latino patients with major depressive disorder (MDD) and bipolar disorder (BPD), and whether there are dose-response relationships between loading for comorbid anxiety disorders, the probability of having BPD, and attributes of severity of illness. METHODS: In a public sector clinic for the indigent located in a semiclosed rural community, 187 consecutively presenting affectively ill Latino patients were evaluated by use of the Structured Clinical Interview for DSM-IV. Polarity and the lifetime prevalence of panic disorder, OCD, social phobia, and PTSD were determined. Logistic regression was used to test associations. Trends in positive predictive values (PPVs) and likelihood ratios were assessed to determine whether dose-response relationships existed between loading for comorbid anxiety disorders and the likelihood of having BPD as opposed to MDD, psychosis, suicidal ideation, and suicide attempts. Results: Of 187 subjects, 118 (63.1%) had MDD and 69 (36.9%) had BPD. The odds ratio of a patient with BPD, relative to MDD, of having panic disorder was 4.6 (p< .0001), OCD 7.6 (p< .0001), social phobia 6.0 (p< .0001) and PTSD 5.3 (p< .0001). The PPV of having BPD was 91.3% and of having psychotic features 83.0% if one had all four anxiety disorders. There was a dose-response relationship between loading for comorbid anxiety disorders and the likelihood of having had a suicide attempt (but not suicidal ideation). CONCLUSIONS: As previously reported by us for juvenile patients, Latino adults with BPD had a remarkably high risk of having each anxiety disorder relative to patients with MDD. The results indicate that the risk of having BPD, having a psychosis, and making a suicide attempt becomes increasingly great as the number of comorbid anxiety disorders increases. These data, which are consistent with the notion of anxious bipolarity, provide further support for a possible anxious diathesis in bipolar disorder.     

Generalized anxiety disorder with comorbidity. Treatment with pregabalin

The efficacy of pregabalin in treating generalized anxiety disorder (GAD) has been shown in recent studies. Our experience and case reports in the present publication indicate that pregabalin can be an effective therapeutic option for patients with GAD and comorbid psychiatric disorders. Treatment with pregabalin should also be considered in patients with partial remission of GAD or intolerability of SSRI or SNRI.     

Familiality of major depressive disorder and patterns of lifetime comorbidity. The NEMESIS and GenMood studies

Background  

Major depressive disorder (MDD) aggregates in families and is associated with high rates of lifetime axis-I comorbidity. This study examined whether familiality of MDD is associated with the presence of specific comorbid disorders, which might be an important factor to be taken into account in MDD treatment and research into MDD etiology.     

Diagnosis of multiple anxiety disorders predicts the concurrent comorbidity of major depressive disorder

Purpose

It has been established that a single anxiety disorder (AD) is more likely to be comorbid with other ADs as well as major depressive disorder (MDD). However, little is known about the comorbidity risks of MDD in patients with double or multiple ADs in comparison with those with a single AD. In this study, we estimated the comorbidity risks of MDD in patients with multiple ADs.

Method

The subjects were 217 consecutive outpatients with any ADs who were comprehensively diagnosed using the Mini International Neuropsychiatric Interview. The comorbidity rates of MDD in subjects with 2 or more ADs were compared with those in subjects with a single AD.

Results

The comorbidity rates of MDD in subjects with a single AD (n = 119), 2 ADs (n = 75), and 3 or more ADs (n = 23) were 20.1%, 45.3%, and 87.0%, respectively. The relative risks of the comorbidity of MDD in subjects with 2 and with 3 or more ADs compared with those with a single AD were 3.3 (95% confidence interval, 1.7-6.3) and 26.4 (95% confidence interval, 8.2-118.7), respectively. Generalized anxiety disorder was associated with a higher comorbidity rate of MDD in subjects with a single AD but not in subjects with 2 or more ADs.

Conclusion

The results showed that the presence of multiple ADs strongly predicts comorbidity with MDD in an exponential manner, suggesting that we should pay attention to the fact that patients with multiple ADs are more likely to be comorbid with MDD.     

重性抑郁障碍与双相障碍患者的共病研究

目的:调查重性抑郁障碍(MDD)和双相障碍患者(BD)精神科共病情况。方法:采用横断面调查方法,对2011年3月至8月符合美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)诊断标准的141例重性抑郁障碍和52例双相障碍患者进行一般情况问卷及国际神经精神科简式访谈问卷(MINI)调查。结果:重性抑郁障碍组和双相障碍组精神科共病率分别为30.0%和28.8%,两组共病率差异无统计学意义(χ2=0.016,P>0.05);两组共病焦虑障碍最为常见,其共病率分别为27.0%和15.4%,差异无统计学意义(χ2=2.799,P=0.094);共病酒精依赖或物质滥用差异有统计学意义(χ2=6.405,P=0.011)。结论:重性抑郁障碍和双相障碍与其他精神科疾病存在广泛共病,尤以焦虑障碍多见。     

Headache and anxiety–depressive disorder comorbidity: the HADAS study

Neurological Sciences - Psychiatric comorbidity (prevalence and types) was tested in a naturalistic sample of adult patients with pure migraine without aura, and in two control groups of patients,...     

Generalized anxiety disorder within the course of major depressive disorder: examining the utility of the DSM‐IV hierarchy rule

Background: The current Diagnostic and Statistical Manual of Mental Disorders (DSM‐IV‐TR) specifies that generalized anxiety disorder (GAD) should not be diagnosed if it occurs exclusively during an episode of a major depressive disorder (MDD) or another mood disorder. This hierarchy rule was intended to promote diagnostic parsimony, but may result in the loss of important clinical information. The goal of this study was to compare individuals with MDD, comorbid MDD and GAD, and GAD within the course of MDD at intake and 12‐month follow‐up on self‐report measures, clinician ratings, and rates of comorbidity. Methods: Participants were divided into three diagnostic groups: MDD without GAD (n=124), comorbid MDD and GAD (n=59), and GAD within the course of MDD (n=166). All the participants completed a semi‐structured clinical interview and self‐report measures assessing psychopathology, temperament, and functional impairment. A subset of the total sample completed a follow‐up assessment of 12 months postintake. Results: Individuals with comorbid MDD and GAD and GAD within the course of MDD reported more psychopathology, negative affect, and functional impairment at intake than individuals with MDD only. The presence of GAD at intake, however, did not differentially predict symptom severity, functional impairment, or the presence of comorbidity at 12‐month follow‐up. Conclusions: Cross‐sectional findings indicate that individuals with GAD within the course of MDD experience levels of psychopathology, functional impairment, and comorbidity similar to those found in individuals with comorbid GAD and MDD. Preliminary longitudinal findings, however, suggest that the presence of GAD in patients with MDD does not have prognostic significance. Depression and Anxiety, 2009. © 2009 Wiley‐Liss, Inc.     

Generalized anxiety disorder vs. panic disorder. Distinguishing characteristics and patterns of comorbidity.

In order to examine the validity of the distinction between generalized anxiety disorder (GAD) and panic disorder (PD) we compared 41 subjects with GAD and 71 subjects with PD. The GAD subjects had never had panic attacks. In contrast to the symptom profile in PD subjects suggestive of autonomic hyperactivity, GAD subjects had a symptom pattern indicative of central nervous system hyperarousal. Also, subjects with GAD had an earlier, more gradual onset of illness. In terms of coexisting syndromes, GAD subjects more often had simple phobias, whereas PD subjects more commonly reported depersonalization and agoraphobia. GAD subjects more frequently had first-degree relatives with GAD, whereas PD subjects more frequently had relatives with PD. A variety of measures indicated that our GAD subjects had a milder illness than those with PD. Also, fewer GAD subjects gave histories of major depression than did PD subjects. Among GAD subjects, coexisting major depression was associated with simple phobia and thyroid disorders and among PD subjects, comorbid depression was associated with social phobia and hypertension. Our findings indicate that the separation of GAD from PD is a valid one. They also indicate that, within disorders, unique patterns of comorbidity may exist that are important both clinically and theoretically.     

Familiality of major depressive disorder and gender differences in comorbidity

Objective: Gender differences exist in the prevalence and psychiatric comorbidity of major depressive disorder (MDD). This study investigates whether familiality of MDD contributes to observed gender differences in comorbidity. Method: Familial (f‐MDD) and non‐familial (nf‐MDD) MDD cases from a population sample were assessed for comorbid dysthymia, anxiety disorders and alcohol‐related disorders using the Composite International Diagnostic Interview (CIDI). Logistic regression analyses were performed to examine the effect of f‐MDD on gender differences in comorbidity, adjusted for confounders. Results: Women with f‐MDD reported significantly more comorbid dysthymia and generalized anxiety disorder (GAD) than their male counterparts; women with nf‐MDD reported significantly more comorbid simple phobias and agoraphobia than their male counterparts. Gender differences in comorbid panic disorder and alcohol‐related disorders occurred independently of the familial load. Adjustment for age of onset, severity and recurrence of MDD did not change these results. Conclusion: Models to explain comorbidity patterns of MDD differ by gender. Familiality of MDD should be taken into account.     

Glial fibrillary acidic protein in late life major depressive disorder: an immunocytochemical study

OBJECTIVES: Depression is a common psychiatric disorder in late life. Cerebrovascular disease has been postulated as an important aetiological factor in many cases (the "vascular depression" hypothesis). Consistent with this, an inflammatory response, most probably representing ischaemia, has been reported with increases in intercellular adhesion molecule 1 (ICAM-1), in the dorsolateral prefrontal cortex (DLPFC) in postmortem tissue from elderly depressed subjects. As ischaemia is known to cause astrogliosis, this study has further tested the "vascular depression hypothesis" by investigating the distribution of the astrocytic marker glial fibrillary acidic protein (GFAP) in the DLPFC and in the anterior cingulate cortex (ACC). METHODS: Postmortem tissue was obtained from 20 elderly patients with a history of major depressive disorder (MDD) and 20 control subjects. Sections were stained for GFAP using standard immunocytochemistry. Sets of images were obtained from all cortical layers in the DLPFC and ACC with the exception of layer IV in the ACC, and from gyral and deep white matter in both regions. The percentage of the area of each image occupied by GFAP was calculated using true colour image analysis, and mean values obtained for each region examined. RESULTS: Immunoreactivity for GFAP was low in grey matter (for example, Mean (SEM) 0.76 (0.2)% in DLPFC layer V in depressed subjects), but higher in white matter (for example, 12.02 (2.2)% in DLPFC deep white matter in depressed subjects). Pronounced gliosis was observed within grey matter in a few cases only. GFAP immunoreactivity was significantly higher in layer I of the DLPFC in depressed subjects 15.8 (2.6)% than in controls 9.7 (1.3)% (t=2.2; df=27.5, p=0.04). No difference was detected in any other region. CONCLUSIONS: The data suggest any increase in GFAP in elderly MDD patients is limited to layer 1 of the DLPFC. These results provide some support for the vascular depression hypothesis and further implicate DLPFC abnormalities in depression.     

Generalized Anxiety Disorder and major depressive disorder comorbidity in the National Survey of Mental Health and Well-Being

We report population data on DSM-IV Generalized Anxiety Disorder (GAD) from the Australian National Survey of Mental Health and Well-Being, obtained from a nationwide household survey of adults using a stratified multistage sampling process. A response rate of 78.1% resulted in 10,641 persons being interviewed. Diagnoses were made using the Composite International Diagnostic Interview. The interview was computerised and conducted by trained lay interviewers. We investigated comorbidity between GAD and major depressive disorder (MDD). The results indicate that sociodemographic correlates of GAD, and associated disablement and service use, are influenced by the presence of a comorbid depressive disorder but cannot be fully explained by the presence of that disorder. In addition, GAD was confirmed as significantly disabling, even as a single disorder. We conclude that the results are consistent with the view that GAD has a significant and independent impact on the burden of mental disorders.     

Serum lipid concentrations in patients with comorbid generalized anxiety disorder and major depressive disorder.

OBJECTIVE: To examine the lipid levels in a sample of patients with comorbid generalized anxiety disorder (GAD) and major depressive disorder (MDD). METHODS: Serum lipid concentrations were examined in 40 patients with both GAD and MDD, in 27 patients with MDD only, in 26 patients with GAD only, and in 24 healthy control subjects. RESULTS: All mean serum cholesterol concentrations are presented in Table 1. The mean serum total cholesterol concentration in patients with both GAD and MDD was significantly higher than in MDD-only patients, GAD-only patients, and control subjects. The triglyceride concentration was also significantly higher in patients with both GAD and MDD than in MDD-only patients, GAD-only patients, and control subjects. Patients with both GAD and MDD had a lower mean high-density lipoprotein cholesterol (HDL-C) concentration than did patients with GAD only and control subjects. The serum concentration of low-density lipoprotein cholesterol (LDL-C) was higher in patients with both GAD and MDD than in patients with MDD only and GAD only and healthy control subjects. CONCLUSIONS: Our findings indicate that the patients with both GAD and MDD have increased serum cholesterol, triglyceride, and LDL-C and reduced HDL-C levels. These patients may have a greater risk of mortality from coronary artery disease (CAD) than do patients with either depression or anxiety disorder.     

Open-label tiagabine monotherapy for major depressive disorder with anxiety

OBJECTIVE: Gamma-aminobutyric acid (GABA) plays a key role in the pathophysiology and treatment of depression and anxiety. Tiagabine, a selective GABA reuptake inhibitor (SGRI) that enhances normal GABA tone, was evaluated for its efficacy and safety in the treatment of depression comorbid with significant anxiety. METHOD: In this 8-week, single-center, open-label study, adults with DSM-IV-diagnosed major depressive disorder and significant anxiety (i.e., "anxious depression") received tiagabine monotherapy, initiated at 4 mg/day and titrated for optimum response as tolerated to a maximum dose of 20 mg/day. Symptoms, function, and adverse events were assessed at regular intervals. Patients were entered from April 2002 to February 2003. RESULTS: Nineteen patients entered the study and 15 met criteria for intent-to-treat analyses. Of those, 6 (40%) discontinued treatment and 9 (60%) completed the 8-week protocol. Tiagabine significantly improved depression, as shown by a reduction in mean +/- SD Hamilton Rating Scale for Depression scores from baseline (31.9 +/- 6.1) to endpoint (17.0 +/- 12.4; p = .002). Categorical response rate was 47% (N = 7). Tiagabine also significantly improved anxiety (Hamilton Rating Scale for Anxiety baseline score of 22.7 +/- 4.9 vs. endpoint score of 12.5 +/- 8.8; p = .002). The mean +/- SD final daily dose was 12.8 +/- 5.8 mg. The most commonly reported adverse events were dizziness, headache, and gastrointestinal upset/nausea. CONCLUSION: These results suggest the potential of the SGRI tiagabine in the treatment of depression with anxiety. Large, placebo-controlled trials are needed.     

Cognitive processes of generalized anxiety disorder in comorbid generalized anxiety disorder and major depressive disorder

This study examines how cognitive variables, which play a central role in the development and maintenance of generalized anxiety disorder (GAD), manifest themselves when GAD and major depressive disorder (MDD) are comorbid. Thirty-two participants were divided into two groups, a group of individuals with a principal diagnosis of comorbid GAD and MDD and a group of people with a principal diagnosis of GAD without MDD. Groups were compared using four cognitive variables: intolerance of uncertainty, poor problem orientation, cognitive avoidance, and beliefs about worry. Our results show that the group of individuals with a principal diagnosis of comorbid GAD and MDD were more intolerant of uncertainty, presented poorer problem orientation, and displayed more cognitive avoidance. The cognitive implications of these results are discussed, and diagnostic criteria are presented to facilitate the differential diagnosis between both groups.     

Children with prepubertal-onset major depressive disorder and anxiety grown up

BACKGROUND: The continuity in adulthood of major depressive disorder (MDD) first arising before puberty is largely unknown. This information could guide early treatment and clarify the appropriateness of including children with MDD in genetic studies. METHODS: Eighty-three subjects with onset of MDD, 44 subjects with anxiety disorder and no MDD, and 91 subjects with no evidence of past or current psychiatric disorders were assessed by two psychiatrists before puberty (Tanner stage < III) and were evaluated 10 to 15 years later as adults by an independent team without knowledge of the initial diagnosis. RESULTS: The clinical outcome of children with prepubertal-onset MDD in adulthood includes a high risk of suicide attempts (nearly 3-fold compared with normal controls and 2-fold compared with children with anxiety) and bipolar disorder. Compared with controls, both the children with MDD and those with anxiety went on to have increased risk of substance abuse and conduct disorder but not other disorders, increased use of longterm psychiatric and medical services, and overall impaired functioning. Children with prepubertal-onset MDD with a recurrence of MDD during follow-up had higher rates of MDD in their first-degree relatives. CONCLUSIONS: There is high morbidity in clinically referred children with prepubertal-onset MDD and anxiety, but continuity and specificity of MDD or anxiety disorder in adulthood is less clear. Caution is warranted in selecting clinically referred children with prepubertal-onset MDD for inclusion in genetic studies unless they have a family history of MDD and recurrence of MDD over time.     

老年焦虑抑郁障碍共病54例临床研究

目的 探讨老年焦虑抑郁障碍的临床特征、诊断及治疗方法.方法 选取54例符合入组标准及排除标准的患者进行临床研究,归纳临床症状并进行统计分析.用汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表(HAMD)进行评分,对比治疗前后的评分变化,并以HAMA和HAMD减分率判定疗效.结果 老年焦虑障碍多与抑郁共病,躯体主诉多为其主要特点.治疗后第2周末开始起效,疗效随时间延长同步上升,治疗后第2、4、8周末HAMA、HAMD量表评分与治疗前比较,有显著性差异(P ＜0.05,P＜0.01).药物及心理治疗的总有效率90.75％.结论 老年焦虑障碍多与抑郁共病,及时干预治疗效果满意.