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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

With the advent of DSM-III-R, the diagnostic criteria for generalized anxiety disorder (GAD) shifted in emphasis from the autonomic arousal to the cognitive component of the disorder, namely worry. The Penn State Worry Questionnaire was developed to assess the trait of worry and has proven to be a reliable and valid measure in a series of studies largely based on college student samples. The purpose of the present study was to assess the psychometric properties and utility of the PSWQ in a clinical sample of 436 anxiety disorder patients and 32 normal controls. Factor analysis indicated that the PSWQ assesses a unidimensional construct. Furthermore, the PSWQ evidenced quite favorable internal consistency using GAD patients and each of the other anxiety disorder groups and normal controls. The validity of the PSWQ was supported by an analysis indicating that the measure distinguished. GADs from each of the other anxiety disorder groups including those with obsessive-compulsive disorder. Moreover, correlations between the PSWQ and measures of anxiety, depression, and emotional control supported the convergent and discriminant validity of the measure. Collectively, the findings speak favorably to the use of the PSWQ in research examining the nature and treatment of GAD and the processes of normal and pathological worry.
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PMID:Psychometric properties of the Penn State Worry Questionnaire in a clinical anxiety disorders sample. 154 Jan 10

The rates of comorbid personality disorders in patients with panic disorder are reported to be elevated, have an adverse impact on the response to treatment, and increase the likelihood of relapse on treatment discontinuation. We examined the rates of personality disorders in panic disorder patients in a longitudinal, naturalistic study of panic disorder. Of 100 panic disorder patients studied, 42 met criteria for at least one personality disorder as determined by the Personality Disorder Questionnaire-Revised (PDQ-R). The presence of a personality disorder as determined by the PDQ-R was associated with a past history of childhood anxiety disorders, comorbidity with other anxiety disorders and depression, and a chronic, unremitting course of panic disorder in adulthood. The presence of a personality disorder in these patients was not significantly associated with a history of physical or sexual abuse in childhood. Our findings support the notion that an anxiety diathesis, demonstrated by significant difficulties with anxiety in childhood, influences the development of apparent personality dysfunction in panic patients. In other cases, personality pathology may reflect the presence of comorbid anxiety disorders or depression. The association of personality disorder in panic patients with a more unremitting course of illness underscores the importance of axis II pathology in understanding the longitudinal course of panic disorder.
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PMID:Personality disorders in patients with panic disorder: association with childhood anxiety disorders, early trauma, comorbidity, and chronicity. 154

The validity of the general neurotic syndrome, a combination of anxiety, depression and dependent personality disorder, was examined in a 2-year study of outpatients with dysthymic, panic and generalized anxiety disorder diagnosed using a structured interview schedule. The general neurotic syndrome, found in a third of the patients, was associated with greater mental disorder and a significantly worse outcome than patients without the syndrome. It did not, however, predict response to treatment. Further analysis revealed that the general neurotic syndrome was a better predictor of short- and long-term outcome than any other variable apart from initial psychopathology score. It is argued that the syndrome may represent a personality diathesis that makes the individual more vulnerable to both anxiety and depressive symptoms.
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PMID:The general neurotic syndrome: a coaxial diagnosis of anxiety, depression and personality disorder. 156 91

Obsessive compulsive disorder is now recognized as a common psychiatric disorder. The lifetime prevalence of 2% to 3% found in the United States has also been found in epidemiologic studies in several other countries with diverse cultures. This disorder has previously been underestimated due to a number of factors that include patients' reluctance to spontaneously admit to obsessions and compulsions and the omission of screening questions about obsessive compulsive disorder on routine mental status examinations. Depression and other anxiety disorders frequently co-occur with obsessive compulsive disorder, which may contribute to misdiagnosis. Patients with eating disorders, Gilles de la Tourette's syndrome, and schizophrenia have a greater comorbid risk compared with the general population. Differential diagnosis of obsessive compulsive disorder includes generalized anxiety disorder, panic disorder, phobias, compulsive personality disorder, and hypochondriasis. While many of these syndromes are characterized by intrusive thoughts, few have associated rituals. The complex tics seen in some patients with Tourette's syndrome may be difficult to distinguish from the compulsions seen in obsessive compulsive disorder, and, in fact, there is significant overlap in symptoms between the two disorders. Currently, the impulse control disorders, such as compulsive gambling and the paraphilias, are not considered to be part of obsessive compulsive disorder. Although the phenomenology of obsessive compulsive disorder appears to be quite diverse, with many distinct kinds of obsessions and compulsions, there are three important core features: abnormal risk assessment, pathologic doubt, and incompleteness. These features cut across phenomenological subtypes and may be useful in defining homogeneous subgroups with distinct treatment outcomes.
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PMID:The epidemiology and differential diagnosis of obsessive compulsive disorder. 156 54

This study measured the prevalence of chronic medical conditions in 4,549 middle aged persons attending three large general practices in Dublin over the course of a calender year. The prevalence of the following conditions were measured: coronary heart disease, hypertension, stroke, diabetes, asthma, chronic bronchitis, rheumatic disorders, dyspepsia, depression, anxiety disorders, psychoses, and cancer. In order to obtain a valid denominator for the study a second community based study was carried out in the same areas to determine what proportion of persons visit their general practitioner over the course of a year. Overall 40.5% of males and 44% of females suffered from a least one of the twelve conditions, with rheumatic disorders having the highest prevalence (14.5%) and psychotic disorders the lowest (0.75%).
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PMID:General practice estimates of the prevalence of common chronic conditions. 147 57

The Lifetime and 6 month DSM-III prevalence rates of mental disorders from an adult general population sample of former West Germany are reported. The most frequent mental disorders (lifetime) from the Munich Follow-up Study were anxiety disorders (13.87%), followed by substance (13.51%) and affective (12.90%) disorders. Within anxiety disorders, simple and social phobia (8.01%) were the most common, followed by agoraphobia (5.47%) and panic disorder (2.39%). Females had about twice the rates of males for affective (18.68% versus 6.42%), anxiety (18.13% versus 9.07%), and somatization disorders (1.60% versus 0.00%); males had about three times the rates of substance disorders (21.23% versus 6.11%) of females. Being widowed and separated/divorced was associated with high rates of major depression. Most disordered subjects had at least two diagnoses (69%). The most frequent comorbidity pattern was anxiety and affective disorders. Simple and social phobia began mostly in childhood or early adolescence, whereas agoraphobia and panic disorder had a later average age of onset. The majority of the cases with both anxiety and depression had depression clearly after the occurrence of anxiety. The DIS-DSM-III findings of our study have been compared with both ICD-9 diagnoses assigned by clinicians independently as well as other epidemiological studies conducted with a comparable methodology.
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PMID:Lifetime and six-month prevalence of mental disorders in the Munich Follow-Up Study. 157 82

A discrete-time survival analysis of recovery from major depressive episodes for a sample of married subjects (N = 119) identified several significant predictors of recovery including comorbidity for anxiety disorders or substance abuse, social support, age, and education. Furthermore, the analysis distinguished between different sources and types of social support, documenting that spouses' positive responses to the depression predict rapid recovery whereas the perception that friendships are conflictual predicts slow recovery. Finally, the analysis documented changes in the importance of predictor variables over the course of the episode. Specifically, spouse's negative reactions to the depression and subject's education level became more important predictors of recovery as the episode became longer, and the recovery advantage experienced by younger respondents lessened over time.
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PMID:Speed of recovery from major depressive episodes in a community sample of married men and women. 158 20

To clarify the relationship between dissociative symptoms and obsessive-compulsive disorder (OCD), 100 patients with OCD were assessed with standardized instruments measuring symptoms of OCD, dissociation, and depression. Diagnoses of personality disorders and dissociative disorders were made using structured interviews. Compared with a previous study, OCD patients had dissociation scores slightly higher than normal controls and comparable to patients with other anxiety disorders. Patients with elevated dissociation scores had more severe OCD symptoms, were more depressed, and were more likely to have a personality disorder than patients with low dissociation scores. Although dissociative symptoms were frequently reported by OCD patients, symptoms of OCD may also mimic dissociation in some patients.
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PMID:Dissociative symptoms in patients with obsessive-compulsive disorder. 158 77

In serious mental illness (SMI) even good community care does not usually make a major impact on clinical or social function, but patients and relatives prefer community to hospital care, and it tends to be cheaper. Any gains are lost if the required community services are not resourced, coordinated, and maintained indefinitely. A few SMI patients continue to need asylum under one roof. CPNs see more anxiety/depression than SMI. Their patients come increasingly from GPs, and they tend to work in practices with less need. Their cost-effectiveness is uncertain, although nurse behaviour therapists are cost-effective in anxiety disorders in primary care. Such research is also needed into the work of other mental health professionals. Despite their effectiveness, there is a dearth of behaviour therapists among nurses and psychiatrists. Problem-orientated training is lacking for most professionals with most patients. Behavioural self-treatments have improved phobic disorders and non-severe depression in controlled studies. Gains were as great when self-treatment was guided by a computer or by a manual as by a clinician. Self-help can extend care delivery, with therapists acting as consultants. Computers can also aid clinical audit.
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PMID:Innovations in mental health care delivery. 159 70

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.
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PMID:Generalized anxiety disorder vs. panic disorder. Distinguishing characteristics and patterns of comorbidity. 143 31


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