Syndrome comorbidity in patients with major depression or dysthymia: prevalence and temporal relationships

Article Abstract:

Patients who receive official diagnoses of major depression or dysthymia (chronic mild to moderate depressive symptoms) often manifest other nondepressive psychiatric symptoms as well. Most frequently these symptoms are anxiety-related, such as panic attacks. Psychiatrists have typically ignored these comorbid (referring to an association between two disease states) symptoms, failing to diagnose them as an independent, concurrent disorder, and instead have assumed they were part of the primary diagnosis, depression. This tradition is changing as the DSM-III-R (revised third edition of the Diagnostic and Statistical Manual of Mental Disorders) no longer ignores comorbid syndromes; this allows clinicians to make multiple diagnoses when they occur. When several disorders coexist, the principal diagnosis is the one that is most severe and interferes most with the patient's functioning. Understanding comorbidity is important in deciding upon treatment and outcome, and in understanding the underlying cause of the illness. Research on comorbidity is showing consistency in these relationships, proving the importance of such an understanding. To further clarify the understanding of comorbidity among patients with major depression or dysthymia, the DSM-III-R was used to evaluate 260 patients at an outpatient clinic who had these primary diagnoses. Of the 197 patients with a primary diagnosis of major depression, 116 (59 percent) were given at least one additional diagnosis, and of the 63 patients with a primary dysthymia diagnosis, 41 (65 percent) were given at least one additional diagnosis. These additional diagnoses were most often anxiety disorders, the most common being social phobia and generalized anxiety disorder. The onset of the depressive disorder most commonly preceded the onset of the anxiety disorder. Over 10 percent of the dysthymia patients and over 15 percent of the major depression patients were given an additional diagnosis related to substance abuse or dependence. These results support the belief that assigning one diagnosis is inadequate to convey a typical patient's overall psychopathology. These authors suggest that the term 'primary diagnosis' be used to define the earliest manifestation of illness, while 'principal diagnosis' be used to define the illness which is currently most severe, which initiated the current evaluation, and which will be the focus of treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Practice, Mental illness, Anxiety, Psychiatry, Psychiatric diagnosis

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Panic disorder and suicidal ideation and behavior: discrepant findings in psychiatric outpatients

Article Abstract:

Suicidal ideation and behavior are most commonly associated with mood disorders (such as depression) and schizophrenia, but more than one study has found that persons who currently or previously met the criteria for panic attacks were at even greater risk for suicide than people with other psychiatric disorders. The present study sought to replicate these findings by evaluating patients who currently had a panic disorder. A total of 900 patients were interviewed; of which, 73 had panic attacks without agoraphobia, 78 had panic attacks with agoraphobia, 485 had mood disorders, and 264 had other psychiatric disorders. All patients completed the Scale for Suicide Ideation and the Beck Hopelessness Scale and were interviewed regarding their past and present suicide ideation and attempts. None of the patients that had panic disorder without agoraphobia reported suicide attempts, and only one (1.3 percent) of the patients that had panic disorder with agoraphobia reported a suicide attempt. In contrast, 34 (7 percent) of the patients with mood disorders reported at least one suicide attempt. Patients with mood disorders also scored higher on the Scale of Suicidal Ideation and the Beck Hopelessness Scale than other patients. These results do not support the earlier findings of higher rates of suicide behavior among patients with past or present panic disorder. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Complications and side effects, Risk factors, Suicide, Panic disorders, Panic disorder

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Differences between patient and family assessments of depression in Alzheimer's disease

Article Abstract:

Alzheimer's disease is a neurological condition in which cognitive function gradually deteriorates, resulting in a loss of memory and the ability to reason. These effects in turn have psychological consequences, leading to a sense of loss, social withdrawal and depression. The coexistence of dementia (disintegration of the personality and cognitive function) and depression causes difficulties in diagnosis because the symptoms of the two disorders often overlap. In addition, cognitive dysfunction makes the patient incapable of providing an adequate description of his psychic condition: he may actually forget events and circumstances in his recent history. An interview designed to cover criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) for major depression was conducted with both 36 Alzheimer's patients and members of their families. Data from the patients revealed a depression rate around 14 percent, while family members assessed the patients' depression at 50 percent. This disparity is attributable to greater family endorsement of the patients' lack of interest, irritability, fatigue, and sense of worthlessness. When revised criteria (DSM-III-R) were applied the discrepancy narrowed somewhat, but the authors point to the need to develop better guidelines for the diagnostic interpretation of information from multiple sources regarding depression in demented patients.

Dementia, Alzheimer's disease

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