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

Humans are social animals attuned to reactions of others; however, some are exquisitely sensitive to--and often misperceive--perceptions of those they encounter. The core feature of social phobia is marked and persistent fear of embarrassment or humiliation in social situations where the individual worries that others may judge his or her performance as too much or too little. Anticipatory anxiety and avoidance occur when the individual is under scrutiny while speaking or performing publicly, eating with others, writing in public, or using public bathrooms. Diagnosis of social phobia is based largely on history obtained from the patient. Onset is usually around puberty; its course is chronic with comorbid depression common and alcohol and other substances routinely abused in misguided attempts to minimize anxiety and depressive symptoms. At examination, patients often have a moist hand, averted gaze, blushing, and other manifest signs of anxiety. Slight shyness is familiar to most, but a substantial number suffer dysfunctional and distressing social anxiety to the point that they become phobic. A few patients satisfy criteria for avoidant personality disorder, which can be socially incapacitating.
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PMID:The diagnosis of social phobia. 778 74

The coexistence of anxiety and depression is common and frequently poses diagnostic and treatment challenges in the clinical setting. Although precise diagnosis is important for treatment selection, it is often complicated by the shortcomings of the current classification system. Whereas some patients present with symptoms that meet the diagnostic criteria for both an anxiety disorder and major depression, others may present with "subsyndromal" symptoms of depression and/or anxiety. Epidemiologic data and a rational treatment approach to the patient with mixed anxiety and depression, depressive symptoms coexistent with "syndromal" and "subsyndromal" symptoms of generalized anxiety disorder, panic disorder, obsessive compulsive disorder, and social phobia are discussed, as well as areas of future research to examine coexisting anxiety and depression.
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PMID:Management of comorbid anxiety and depression. 784 1

Originally considered a rare disorder, obsessive compulsive disorder (OCD) has been shown to be quite common with a 1% point prevalence in many cultures. Comorbidity with other psychiatric disorders is common, with a lifetime history of major depression present in two thirds of OCD patients. This disorder also coexists with a number of other Axis I disorders including panic disorder, social phobia, eating disorders, and Tourette's disorder. Data collected on phenomenological subtypes have shown that most OC patients have multiple obsessions and compulsions. Another model for subtyping OC symptoms categorizes core features that underlie obsessions and compulsions. These core features such as abnormal risk assessment or incompleteness may be useful in identifying homogeneous subgroups that have distinct treatment responses. The presence of compulsions is helpful in distinguishing this disorder from other anxiety disorders as well as depression. The differential diagnosis of OCD is presented.
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PMID:The epidemiology and differential diagnosis of obsessive compulsive disorder. 796 32

The purpose of this study was to assess the prevalence of mental illness and to evaluate the quality of life of patients with neurocirculatory asthenia. A consecutive series of 80 patients who satisfied the diagnostic criteria developed by Kannel et al. for neurocirculatory asthenia was included in this study. Patients underwent a psychiatric diagnostic research interview and extensive psychometric evaluation, with both observer and self-rated scales for depression, anxiety, phobic symptoms, quality of life and abnormal illness behavior. In 47 patients (59%), a psychiatric diagnosis (mainly an anxiety disorder) antedated the onset of neurocirculatory asthenia, which was thus defined as secondary, also because cardiorespiratory symptoms were part of the mental symptoms. In the remaining 33 patients (41%) neurocirculatory asthenia was the primary disorder. Patients with secondary neurocirculatory asthenia reported significantly higher levels of anxiety, depression, social phobia, abnormal illness behavior and an impaired quality of life compared with patients with primary neurocirculatory asthenia. This latter did not significantly differ in these variables (except for depression) from healthy control subjects matched for sociodemographic variables. At a 1-year follow-up, patients with primary neurocirculatory asthenia had a much better prognosis than those with secondary neurocirculatory asthenia. The results indicate the feasibility of the primary/secondary distinction based on the time of onset of mental and cardiorespiratory symptoms in neurocirculatory asthenia. Since only about one quarter of the patients were found to suffer from decreased energy and fatigue according to specified criteria, the terms neurocirculatory asthenia and effort syndrome should probably be discarded.
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PMID:Neurocirculatory asthenia: a reassessment using modern psychosomatic criteria. 806 69

Twenty-two patients meeting a primary DSM-III-R diagnosis of Social Phobia, entered a 12 week open trial of sertraline. Twenty patients completed at least 8 weeks of treatment. Sixteen patients (80%) were considered responders and 4 (20%) were considered non-responders. All measures of social anxiety and avoidance, depression and social functioning showed a statistically significant change from baseline to end point.
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PMID:Sertraline in social phobia. 807 77

In a cohort of young Swiss adults, sexual disturbances and dysfunctions were assessed by interview four times between ages 20 and 30 years. Over 10 years almost every second female and every third male subject reported disturbances. In females at age 30 years, the prevalence of orgasmic difficulties and of dyspareunia corresponded to non-clinical samples of other studies. Also, in accordance with the literature, impaired interest was much more prevalent in females. In males and females, sexual disturbances were to some extent associated with anxiety and depression; in addition, in women, they were also associated with social phobia and eating disorders. With regard to neuroticism, negative affect and reports of an unsatisfactory childhood, subjects with temporary disturbances resembled more strongly those with chronic problems than controls. Compared with the controls, women's sexual disturbances were more chronic and more strongly associated with minor psychiatric symptoms and personality deviance; this finding was less pronounced in men.
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PMID:The Zurich Study: XXI. Sexual dysfunctions and disturbances in young adults. Data of a longitudinal epidemiological study. 811 62

This article delineates the conceptual models used when medications are prescribed for patients with personality disorders and reviews the data on the efficacy of these medications. Studies before 1980 are difficult to interpret because of changes in diagnostic criteria. Nonetheless, early studies on non-DSM-III disorders such as pseudoneurotic schizophrenia, emotionally unstable character disorder, hysteroid dysphoria, and subaffective disorders indicated the potential utility of pharmacotherapy for treating personality disorders. Models to consider in evaluating the possible use of medications for treating personality disorders are: (1) treating the disorder itself; (2) treating symptom clusters within and across disorders; and (3) treating associated axis I disorders. Among the current personality disorders, borderline personality disorder has been the most extensively studied, with antipsychotic agents being the most well-documented treatment. Monoamine oxidase inhibitors, fluoxetine, and carbamazepine show promise. Schizotypal disorders may respond to low-dose antipsychotic drugs. Although heuristically valuable, the symptom cluster approach to treatment has not yet been validated. Axis I disorders, especially depression, are frequently associated with all personality disorders. Dependent personality disorder is linked to panic disorder with agoraphobia, whereas avoidant personality disorder is associated with social phobia and panic. In general, pharmacotherapy for axis I disorders is less effective in the presence of a comorbid personality disorder. Despite the modest benefits seen in many studies, pharmacotherapy can add significantly to the overall treatment of those with personality disorders. Future research must carefully assess the effect of comorbid axis I disorders on responses. The symptom cluster/psychobiologic dimension approach should be investigated in clinical studies.
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PMID:Pharmacotherapy of personality disorders: conceptual framework and clinical strategies. 822 92

Both epidemiological and clinical studies have demonstrated a high prevalence of panic disorder among alcoholic patients. In contrast, little attention has been given to studying alcohol abuse and/or dependence in patients suffering from panic disorder. One hundred and fifty-five consecutive referrals for treatment for panic disorder were interviewed using a modified version of the Schedule for Affective Disorders and Schizophrenia--Lifetime Version, modified for the study of anxiety disorders. Thirty-two patients (20.7%) had a lifetime history of alcohol abuse and/or dependence. Although the lifetime comorbidity rate of either agoraphobia and/or social phobia seems without any influence on the risk of alcohol-related disorder, alcoholic patients suffering from panic disorder appear to be more likely to have a history of depression and other addictive disorders. The majority of patients with primary alcoholism were male, and those who became alcoholics after they developed panic disorder were more likely to be female. The comparison between patients with primary and secondary alcoholism did not indicate any difference in the comorbidity rate with other psychiatric disorders nor the severity of panic disorder.
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PMID:[Panic disorder and alcoholism: effects of comorbidity]. 824 21

The longitudinal association of several syndromal diagnoses is very frequently a direct consequence of modern descriptive diagnosis. Comorbidity in this sense is clinically relevant. Comorbid cases are more severe, are more amenable to treatment and are more frequently suicidal. The level of association between psychiatric syndromes can lead to nosologic hypotheses that can be further examined by independent investigations, and especially by means of family studies. Generalized anxiety disorders are very closely associated with the affective disorders, particularly with depressions and suicide attempts, but also with hypomania. There is no close relationship with panic disorder. Social phobias are highly associated with agoraphobia, but also with simple phobia; also with panic, obsessive-compulsive syndromes and substance abuse. The prevalence of obsessive-compulsive syndromes depends to an exceptional degree on the definition. Syndromes below the diagnostic threshold of DSM-III are extremely frequent, and longitudinally a fluctuation about this threshold is apparent. OCS are especially found to be associated with social phobia and agoraphobia as well as with dysthymia and recurrent brief depression, but less with major depression.
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PMID:Comorbidity of anxiety, phobia, compulsion and depression. 825 49

In a population based sample of 2163 personally interviewed female twins, substantial comorbidity was observed between DSM-III-R defined major depression (MD) and 4 subtypes of phobia: agoraphobia, social phobia, animal phobia and situational phobia. However, the level of comorbidity of MD with agoraphobia was much greater than that found with the other phobic subtypes. We concluded bivariate twin analyses to decompose the genetic and environmental sources of comorbidity between MD and the phobias. Our results suggest that a modest proportion of the genetic vulnerability to MD also influences the risk for all phobic subtypes, with the possible exception of situational phobias. Furthermore, the magnitude of comorbidity resulting from this shared genetic vulnerability is similar across the phobic subtypes. By contrast, the non-familial environmental experiences which predispose to depression substantially increase the vulnerability to agoraphobia, have a modest impact on the risk for social and situational phobias and no effect on the risk for animal phobias. The increased comorbidity between MD and agoraphobia results, nearly entirely, from individual-specific environmental risk factors for MD which also increase the risk for agoraphobia but not for other phobias.
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PMID:Major depression and phobias: the genetic and environmental sources of comorbidity. 833 53


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