Mixed anxiety and depression

Article Abstract:

There is some controversy over whether anxiety and depression are different illnesses. A significant clinical overlap in the course of illness has been observed between the two disorders, but biological indexes and family history data suggest that there are major differences. The cases of patients with mixed depressive and anxiety symptoms were investigated. A review of reports from community, primary care settings, and psychiatric samples revealed that there is a group of psychiatric patients with symptoms of both anxiety and depression, and that their symptoms are generally below the threshold for diagnosis for either disorder. Despite their lack of diagnosable symptoms, impairment in social and vocational functioning is significant, and requires intervention. It is recommended that those involved in defining diagnostic criteria and clinical guidelines for the identification and treatment of mental disorders consider the following with regard to this group. First, a measure of functional disability or impairment should be added to diagnostic criteria. Second, data suggest that a mixed anxiety-depression presentation should alert clinicians to the likelihood of high risk for the development of a more severe disorder - often major depression or panic disorder. In addition, efforts are needed to determine if it is best to define this mixed anxiety-depression disorder as a new syndrome or adjust the criteria for depression and anxiety diagnoses. Longitudinal studies are needed, along with investigation of associated personality and environmental variables and the development of interventional strategies. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Depression, Mental, Depression (Mood disorder), Anxiety

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Classification in psychopathology: rationale, alternatives, and standards

Article Abstract:

Psychopathology is an outgrowth of both psychology and medicine and as such, efforts to set up a comprehensive classification system must consider both parent fields. Currently, the concepts in the classification of psychopathology are descriptive in nature. That is, current diagnostic criteria are geared toward observable phenomena. However, for a classification system to be truly comprehensive, it must incorporate scientific and philosophic issues as well. A comprehensive system of classification must designate disorders in a way that the features of these disorders can be compared. If feature 'x' is deemed important, the characteristics of feature 'x' must be spelled out for each disorder so that comparison across disorders is possible. There must also be empirical reference, or some way of making diagnostic criteria observable in the real world. For example, defense mechanisms are largely unobservable processes and as such are subject to ambiguity. Empirical references to defense mechanisms, however, minimize ambiguity. Lastly, there is need for quantitative range. Frequency differences and a wide range of intensity need to be defined for clinical symptoms, as they are not always all-or-nothing phenomena. Psychological tests are particularly useful for this purpose. The structure of the classification system must be optimal. That is, the system should be clinically relevant, representative of what it is supposed to classify, and applicable to the range of phenomena. Psychopathologic classification is complicated, but by challenging prevailing frameworks better alternatives will be developed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Standards, Classification, Nosology

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International use and attitudes toward DSM-III and DSM-III-R: growing consensus in psychiatric classification

Article Abstract:

The latest revision of the Diagnostic and Statistical Manual of Mental Disorders may soon be published (as DSM-IV) and discussion continues, as with previous versions of the DSM, about its relative merits and shortcomings. The impact of the DSM in foreign countries is discussed here, with the hope of aiding the designers of DSM-IV. English-speaking foreign nationals from 42 countries were surveyed, including academicians, researchers, and clinicians who were engaged in research or reading on psychopathology. A total of 146 questionnaires were returned. Of the respondents, 79 percent considered the DSM to be useful in their country for diagnosis, 99 percent considered it useful for research, and 93 percent considered it useful for teaching. The DSM was used in more countries for diagnosis than the International Classification of Diseases, Injuries, and Causes of Death (ICD). Respondents particularly liked the multiaxial (Axes I-V) structure of the DSM, its atheoretical approach, its basis on descriptive criteria, and the placement of personality disorders on a separate axis from clinical syndromes, such as schizophrenia. Possibly because of the DSM's reception, new versions of the ICD are adopting a similar structure. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Diagnostic and Statistical Manual of Mental Disorders (Book)

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