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.     

Axis I and II comorbidities in subjects with and without nocturnal panic

Our purpose in this study was to compare the prevalence and pattern of Axis I and II comorbidities between patients with and without nocturnal panic (NP) attacks. One hundred and sixteen subjects with panic disorder (PD; according to DSM-IV criteria) were included: We assessed Axis I and II comorbidities using the Structured Clinical Interview for DSM-IV Axis I and II disorders, respectively. Of the sample, 27.6% of subjects had recurrent nocturnal panic attacks (NP group). Subjects with NP did not differ from those without in any sociodemographic or clinical characteristics. In the sample (94 subjects), 81% had at least one lifetime comorbid Axis I disorder, without significant differences between subjects with and without nocturnal panic even when considering comorbidity rates for single disorders; a trend toward significance was found for anorexia nervosa and somatization disorder, which both were more frequent among subjects with NP. Concerning Axis II disorders, 49.1% of the sample (57 subjects) met the criteria for at least one personality disorder, without significant differences between patients with and without NP. No significant differences were detected in comorbidity rates for any single Axis II personality disorder. Personality might play a relevant role in influencing treatment approaches to PD, but it does not appear to be a differential focus of concern in patients with compared to those without NP.     

Moderators and mediators among panic, agoraphobia symptoms, and suicidal ideation in patients with panic disorder

Objectives

The most important change of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) is the use of dimensional approach to assess the severity of symptoms across different diagnosis. There are 2 purposes in this study: the first purpose was to identify the proportion of outpatients with panic disorder who have suicidal ideation. The second aim was to examine the relationships among panic, agoraphobic symptoms, and suicidal ideation in patients with panic disorder, adjusting by age, social support, and alcohol use.

Methods

Sixty patients with panic disorder were recruited from outpatient psychiatric clinics in southern Taiwan. Suicidal ideation in the preceding 2 weeks was measured. The Panic and Agoraphobic Symptoms Checklist, Social Support Scale, Questionnaire for Adverse Effects of Medication for Panic Disorder, and Social Status Rating Scale were used to understand the severity of panic and agoraphobia, social support, drug adverse effects, and social status. Significant variables from the univariate analysis were included in a forward regression model. Then, we used structural equation modeling to fit the model.

Results

We found that 31.7% of outpatients with panic disorder had had suicidal ideation in the preceding 2 weeks. Multiple regression analysis showed that younger age, current alcohol use, more severe panic symptoms, and less social support were associated with suicidal ideation. In addition, the structural equation model illustrated the recursive model from panic to agoraphobia and suicidal ideation. Agoraphobia had no association with suicidal ideation. Panic symptom was a mediator to suicidal ideation but not agoraphobic symptoms.

Conclusions

A high proportion of patients with panic disorder had suicidal ideation. We found that panic symptoms, social support, age, and alcohol use affected suicide and could be identified. The 3-level model from panic to agoraphobia revealed that panic was a predictor of agoraphobia and agoraphobia was not a predictor of panic. This verified the evolution of the diagnostic view of the DSM. Panic symptom was a mediator to suicidal ideation. With the dimensional model in DSM-V, panic symptoms can be used as a marker for greater morbidity and severity.     

Co-occurrence of Axis I and Axis II disorders in female and male patients with panic disorder with agoraphobia

Objective

The aim of this study is to compare female and male patients with panic disorder with agoraphobia (PDA) for the co-occurring Axis I and Axis II (personality) disorders, to better understand sex differences in PDA.

Methods

The Structured Clinical Interview for Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV) Axis I Disorders, Clinician Version and the Structured Clinical Interview for DSM-IV Axis II Personality Disorders were administered to 157 consecutive outpatients (112 females and 45 males) with principal diagnosis of PDA, who sought treatment at the 2 anxiety disorders clinics. Women and men with PDA were then compared with regard to the type and frequency of the co-occurring Axis I and Axis II disorders.

Results

Women with PDA had a statistically greater tendency to receive co-occurring Axis I diagnoses and a greater number of Axis I diagnoses than men. Such a difference was not found for personality disorders. However, no sex difference was found for the mean number of co-occurring Axis I and Axis II diagnoses per patient. There were significantly more women with at least one co-occurring anxiety disorder. Women had a significantly higher frequency of specific phobia, whereas men were diagnosed with hypochondriasis and past alcohol abuse or dependence significantly more often. With regard to Axis II disorders, the only significant sex difference pertained to the higher frequency of dependent personality disorder among women.

Conclusions

The results of this study suggest that there are more similarities than differences between sexes in the co-occurring Axis I and Axis II disorders. Still, the relatively specific relationships between PDA and excessive alcohol use in men and between PDA and dependent personality traits and personality disorder in women seem important and have implications for clinical practice and treatment.     

Patterns of axis II comorbidity in early-onset versus late-onset panic disorder in Japan

Early onset of psychiatric disorders has been reported to be associated with increased familial risk or more severe clinical symptoms. In this study, we specifically examine the association between clinical severity and early versus late onset in panic disorder. We hypothesize the existence of differences in rates of axis II disorders in these two groups that will relate to clinical severity. Subjects were a consecutive clinical case series of 105 panic disorder patients (age, 18.3 to 70.9 years). Thirty-one panic disorder patients were classified as early onset (age of onset < or = 25 years) and 74 as late onset (age of onset >25). We compared symptomatology and rates of comorbid axis II disorders (diagnosed by structured clinical interview) between the early- and the late-onset groups. We found a statistically significant increase in the number of suicide attempts and likelihood of comorbid axis II disorders in the early-onset group compared to the late-onset group. In logistic regression analyses, cluster B personality disorders (PDs), especially borderline and histrionic, were statistically significantly associated with the presence of suicide attempts. The following limitations are present: first, we have not taken into consideration comorbidity of other axis I disorders, especially major depression. Second, there is imprecision associated with efforts to date the onset of panic disorder retrospectively. We conclude that comorbid axis II disorders are more likely to occur in early-onset panic disorder patients. Cluster B PDs, especially borderline or histrionic, may be associated with a high frequency of suicide attempts in this group. In clinical practice, efforts to aggressively detect and treat axis II disorders in early-onset panic disorder patients are warranted.     

Static and dynamic connectomics differentiate between depressed patients with and without suicidal ideation

Neural circuit dysfunction underlies the biological mechanisms of suicidal ideation (SI). However, little is known about how the brain's “dynome” differentiate between depressed patients with and without SI. This study included depressed patients (n = 48) with SI, without SI (NSI), and healthy controls (HC, n = 30). All participants underwent resting‐state functional magnetic resonance imaging. We constructed dynamic and static connectomics on 200 nodes using a sliding window and full‐length time–series correlations, respectively. Specifically, the temporal variability of dynamic connectomic was quantified using the variance of topological properties across sliding window. The overall topological properties of both static and dynamic connectomics further differentiated between SI and NSI, and also predicted the severity of SI. The SI showed decreased overall topological properties of static connectomic relative to the HC. The SI exhibited increases in overall topological properties with regard to the dynamic connectomic when compared with the HC and the NSI. Importantly, combining the overall topological properties of dynamic and static connectomics yielded mean 75% accuracy (all p < .001) with mean 71% sensitivity and mean 75% specificity in differentiating between SI and NSI. Moreover, these features may predict the severity of SI (mean r = .55, all p < .05). The findings revealed that combining static and dynamic connectomics could differentiate between SI and NSI, offering new insight into the physiopathological mechanisms underlying SI. Furthermore, combining the brain's connectome and dynome may be considered a neuromarker for diagnostic and predictive models in the study of SI.     

伴或不伴自杀意念的抑郁症患者脑白质体积的研究

目的 探讨伴或不伴自杀意念的抑郁症患者与健康对照者脑白质体积的差异。方法 纳 入 2021 年 1— 8 月在深圳市康宁医院抑郁障碍科住院的 60 例抑郁症患者,通过贝克自杀意念量表（BSI） 得分分为抑郁症伴自杀意念组（n=30）与抑郁症不伴自杀意念组（n=30）,同时纳入健康对照者 30 名。患 者在入院后 1 周内完成结构磁共振扫描。采用 17 项汉密尔顿抑郁量表（HAMD-17）和汉密尔顿焦虑量 表（HAMA）评估抑郁症患者的抑郁、焦虑严重程度。采用 Pearson 线性相关分析差异脑区体积与 HAMD- 17 得分、HAMA 得分、总病程的相关性。结果 3 组受试者白质相对体积比较,差异有统计学意义 （F=3.173,P＜ 0.05）,其中抑郁症伴自杀意念组患者白质相对体积小于健康对照组［（32.35±1.80）cm3比 （33.50±1.96）cm3 ］,差异有统计学意义（P＜ 0.05）。抑郁症不伴自杀意念组小脑上叶（右侧小脑 1 区）及 小脑下叶（右侧小脑 2、7b、8 区）的白质体积大于健康对照组,差异有统计学意义（P＜ 0.05）。抑郁症伴 自杀意念组小脑下叶（右侧小脑 2、8 区）的白质体积大于健康对照组,差异有统计学意义（P＜ 0.05）。抑 郁症伴自杀意念组右侧颞上回、左侧脑岛、右侧丘脑、右侧中央前回、左侧中央前回的白质体积小于健 康对照组,差异有统计学意义（P＜ 0.05）。Pearson 相关性分析显示,小脑下叶（右侧小脑 7b、8 区）白质体 积与HAMA得分呈负相关（r=-0.419,P=0.021）,右侧颞上回白质体积与HAMD-17得分呈正相关（r=0.377, P=0.04）,右侧丘脑白质体积与总病程呈负相关（r=-0.368,P=0.046）。结论 伴或不伴自杀意念的抑郁 症患者的大脑白质结构发生广泛改变,主要表现在小脑、颞叶、脑岛、丘脑和中央前回等脑区,颞叶、脑 岛、丘脑及中央前回的变化可能与自杀意念的发生有关。     

Amygdala functional connectivity in female patients with major depressive disorder with and without suicidal ideation

Background

Major depressive disorder (MDD) is a known major risk factor for suicide and is one of the most common mental disorders. Meanwhile, gender differences in suicidal behavior have long been recognized including the finding that women have higher rates of suicidal ideation and/or suicidal behavior than men. The mechanism underlying suicide ideation in female patients with MDD remains poorly understood. The aim of the present study was to examine possible suicidal behavior-related neural circuitry in female MDD.

Methods

In this study, 15 female participants with the first-episode MDD with suicidal ideation and 24 participants with the first-episode MDD without suicidal ideation as well as 39 female participants in a healthy control (HC) group, ranging in age from 18 to 50 years, underwent resting-state functional magnetic resonance imaging. The whole-brain amygdala resting-state functional connectivity (rsFC) was compared among these three groups.

Results

Compared with female participants with the first-episode MDD without suicidal ideation and those in the HC group, female participants with the first-episode MDD with suicidal ideation showed a significant difference in rsFC between the amygdala and precuneus/cuneus (p?<?0.05, corrected). No significant difference in amygdala–precuneus/cuneus rsFC was observed between female patients with the first-episode MDD without suicidal ideation and the HC group (p?<?0.05, corrected).

Conclusions

Our findings suggest that suicidal ideation in female patients with the first-episode MDD may be related to an abnormality in amygdala neural circuitry. The abnormality in amygdala–precuneus/cuneus functional connectivity might present the trait feature for suicide in women with the first-episode MDD. The precuneus/cuneus may be an important region related to suicide and require future study.

     

Axis I and Axis II psychiatric disorders in patients with fibromyalgia

ObjectiveTo determine the current prevalence of Axis I and Axis II psychiatric disorders in patients with fibromyalgia.MethodThe study sample includes 103 patients with fibromyalgia and 83 control subjects. Axis I and Axis II disorders were determined by structured clinical interviews.ResultsThe rate of any Axis I psychiatric disorder (47.6% vs. 15.7%), major depression (14.6% vs. 4.8%), specific phobia (13.6% vs. 4.8%), any Axis II disorder (31.1% vs. 13.3%), obsessive–compulsive (23.3% vs. 3.6%) and avoidant (10.7% vs. 2.4%) personality disorders were significantly more common in the patient group compared to the control group.ConclusionOur results suggest that a considerable proportion of patients with fibromyalgia also present with Axis I and Axis II psychopathologies.     

Psychiatric comorbidity and suicidal ideation in psoriasis,melanoma and allergic disorders

Objective: Psychiatric disorders and suicide risk (especially in psoriasis) are frequent and disabling conditions in patients with skin diseases. The aim of this study was to examine the risk of suicide and stressful life events in a sample of patients with skin disease.

Methods: A sample of 242 dermatological patients (142 women and 100 men), 112 of which had psoriasis, 77 had melanoma, and 53 were suffering with chronic allergic diseases. Patients were administered the MINI International Neuropsychiatric Interview (MINI), Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), and the Columbia-Suicide Severity Rating Scale (C-SSRS). Patients were also asked about their experiences with stressful life events.

Results: Patients with psoriasis were more likely to have a history of psychiatric disorders (36.6% vs. 13.2% χ²₍₁₎?=?9.55; p?=?0.002) compared to patients with allergies. Specifically, patients with psoriasis more likely had a diagnosis of a mood disorder (16.1% vs. 3.9% χ²₍₁₎?=?6.85; p?=?0.009; 16.1% vs. 0% χ²₍₁₎?=?9.56; p?=?0.002) and reported past suicidal ideation (33.9% vs. 15.6% χ²₍₁₎?=?7.89; p?=?0.005; 33.9% vs. 18.9% χ²₍₁₎?=?3.96; p?=?0.047) as compared to those with melanoma and allergy.

Conclusions: The results from this study suggest that patients affected by psoriasis have an increased risk of psychiatric comorbidities and suicidal ideation compared to those who have other dermatological disorders.     

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.     

Suicide attempts and suicidal ideation: links with psychiatric comorbidity in eating disorder subjects

Additional psychiatric disorders in eating disorders patients may contribute to the risk of suicide and suicide attempts. The aim of this study was to examine associations between Axes I and II comorbidity and suicidality in a large sample of women currently suffering from an eating disorder (ED). In a sample of 288 women (87 anorexia nervosa, 158 bulimia nervosa, 43 eating disorders not otherwise specified) psychiatric comorbidity of Axes I and II was determined using the Structured Clinical Interview for DSM-IV. Histories of attempted suicide were explored in a structured interview. Suicidal ideation was determined by means of the SCL-90. Past suicide attempts were reported by 26%. Subjects with a purging type ED more frequently had a history of attempted suicide than subjects with a nonpurging type ED. A history of suicide attempts was associated with higher levels of Axes I and II comorbidity, in particular with affective disorders and Cluster B personality disorders. Current suicidal ideation was generally linked with higher levels of all types of Axes I and II comorbidity. Eating disorders are serious psychiatric disorders associated with high levels of comorbidity and suicidality. Incorporating a comprehensive psychiatric evaluation into the clinical assessment of ED patients is important for the assessment of suicidality and for the provision of adequate treatments.     

Differences in Axis I and II comorbidity between bipolar I and II disorders and major depressive disorder

OBJECTIVE: To obtain a comprehensive view of differences in current comorbidity between bipolar I and II disorders (BD) and (unipolar) major depressive disorder (MDD), and Axis I and II comorbidity in BD in secondary-care psychiatric settings. METHOD: The psychiatric comorbidity of 90 bipolar I and 101 bipolar II patients from the Jorvi Bipolar Study and 269 MDD patients from the Vantaa Depression Study were compared. We used DSM-IV criteria assessed by semistructured interviews. Patients were inpatients and outpatients from secondary-care psychiatric units. Comparable information was collected on clinical history, index episode, symptom status, and patient characteristics. RESULTS: Bipolar disorder and MDD differed in prevalences of current comorbid disorders, MDD patients having significantly more Axis I comorbidity (69.1% vs. 57.1%), specifically anxiety disorders (56.5% vs. 44.5%) and cluster A (19.0% vs. 9.9%) and C (31.6% vs. 23.0%) personality disorders. In contrast, BD had more single cluster B personality disorders (30.9% vs. 24.6%). Bipolar I and bipolar II were similar in current overall comorbidity, but the prevalence of comorbidity was strongly associated with the current illness phase. CONCLUSIONS: Major depressive disorder and BD have somewhat different patterns in the prevalences of comorbid disorders at the time of an illness episode, with differences particularly in the prevalences of anxiety and personality disorders. Current illness phase explains differences in psychiatric comorbidity of BD patients better than type of disorder.     

Melancholia and axis II comorbidity

This study assessed whether the rates of comorbid personality disorders differed between DSM-IV melancholic and nonmelancholic major depressive disorder. We evaluated 260 consecutive depressed outpatients (140 women [53.8%]; mean age, 39.01 +/- 10.4 years) with DSM-III-R major depressive disorder (MDD). MDD was diagnosed with the use of the Structured Clinical Interview for DSM-III-R-Patient Edition (SCID-P); enrolled patients were required to have a score >/= 16 on the 17-item Hamilton Rating Scale for Depression (HAM-D-17). The presence of the melancholic subtype of major depression was determined with the use of a DSM-IV checklist, while the presence of personality disorders was assessed using the Structured Clinical Interview for DSM-III-R-Personality Disorders (SCID-II). Of the 102 (39.2%) patients who met criteria for melancholic depression and the 158 (60.7%) who did not, there were no significant differences in age, gender, or rates of personality disorder diagnoses. We observed no significant difference in rates of individual personality disorder clusters between melancholic and nonmelancholic depressed patients. Our findings of comparable rates of comorbid personality disorders between melancholic and nonmelancholic depression are consistent with the decision made by the DSM-IV task force to drop the DSM-III-R melancholic feature criterion of "no significant personality disturbance before first major depressive episode" as they challenge the usefulness of trying to establish such absence of premorbid personality features in acutely depressed patients.     

Axis II comorbidity in substance abusers

OBJECTIVE: To assess the complex relationship between substance abuse and personality disorders, the authors determined the prevalence of personality disorders in a group of middle-class substance abusers and compared the subjects who had personality disorders with those who did not. METHOD: The subjects were drawn from patients consecutively admitted to an inpatient substance abuse program in a private psychiatric hospital; they were the first 100 who agreed to participate. Substance dependence was diagnosed according to DSM-III-R, and the patients were assessed with the Structured Clinical Interview for DSM-III-R Personality Disorders, Alcohol Use Inventory, MMPI, Health and Daily Living Form, Shipley Institute of Living Scale, and measures of chemical use and life satisfaction. RESULTS: Of the 100 substance abusers, 57 had personality disorders. These patients differed significantly from the 43 patients without personality disorders in several ways: they had greater involvement with illegal drugs, had different patterns of alcohol use, had greater psychopathology, were less satisfied with their lives, and were more impulsive, isolated, and depressed. CONCLUSIONS: Because of the marked differences between the substance abusers with and without personality disorders, a uniform approach to substance abuse treatment may be inadequate.     

Axis I and Axis II diagnoses in patients with chronic idiopathic urticaria

OBJECTIVE: This study presents the current prevalence of Axis I and Axis II psychiatric diagnoses and factors associated with the existence of Axis I psychiatric disorders in patients with chronic idiopathic urticaria (CIU). METHOD: The study sample was composed of 89 patients with CIU and 64 control subjects. Axis I and Axis II psychiatric disorders were ascertained by means of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition and the Structured Clinical Interview for DSM, Revised Third Edition Personality Disorders, respectively. RESULTS: Of patients with CIU, 44 (49.4%) had at least one Axis I diagnosis, and 40 (44.9%) had at least one personality disorder. The most common Axis I disorder was obsessive-compulsive disorder (25.8%), and the most common Axis II disorder was obsessive-compulsive (30.3%) personality disorder in patients with CIU. Obsessive-compulsive disorder, major depression, obsessive-compulsive and avoidant personality disorders were more prevalent in patient group compared to control group. Obsessive-compulsive and avoidant personality disorders were related to the existence of Axis I disorders in patients with CIU. CONCLUSION: Psychiatric morbidity seems to be a frequent healthy problem in patients with CIU.     

Executive functioning in depressed patients with suicidal ideation

OBJECTIVE: Suicidal thinking has been associated with cognitive rigidity, however, not all depressed patients contemplate suicide. Therefore, we hypothesized that compared with depressed subjects without suicidal ideation, depressed individuals with suicidal ideation would display poorer performance on measures of executive functioning that involve mental flexibility. METHOD: In-patients with a current major depressive episode who had no current suicidal ideation (n=28) were compared with those who had current suicidal ideation (n=5) on measures of executive functioning and two neurocognitive tests that predominantly assess non-frontal regions. RESULTS: Compared with non-suicidal depressed patients, depressed suicidal patients performed significantly worse on several measures of executive functioning after controlling for age, IQ, severity of depression and prior suicide attempts. The two groups performed similarly on tests that predominantly assess non-frontal regions. CONCLUSION: Depressed individuals contemplating suicide have cognitive rigidity, which does not appear to be a global brain dysfunction. Suicidal mental states may result from dysfunctional executive decision-making that is associated with the frontal lobe.     

当前有和无自杀观念的难治性抑郁症临床特征的比较

目的对当前有和无自杀观念的难治性抑郁症患者的临床特征进行对照分析。方法按最近1周有无自杀观念将327例难治性抑郁症患者分为自杀观念组(n=59)和无自杀观念组(n=268),比较其人口学和临床特征,并对自杀观念的危险因素进行Logistic回归分析。结果自杀观念组的目前年龄、首次发病年龄、17项汉密尔顿抑郁量表(HAMD-17)、汉密尔顿焦虑量表(HAMA)、临床大体印象量表(CGI)和HAMD-24的绝望感条目的评分均明显高于无自杀观念组(P0.05),自杀观念组的精神病性症状(OR=4.03,P0.05)、不典型症状(OR=7.53,P0.01)和躯体疾病共病(OR=11.19,P0.01)明显多于无自杀观念组。回归分析结果显示,HAMD-17总分(OR=1.19,P0.01)、绝望感(OR=2.13,P0.01)、不典型症状(OR=1.44,P0.05)和躯体疾病共病(OR=2.84,P0.05)与自杀观念相关。结论有自杀观念的难治性抑郁症具有一定的人口学和临床特征,应对其进行综合评估和干预。