Lifetime comorbidity among anxiety disorders and between anxiety disorders and other mental disorders in adolescents

We examine the lifetime comorbidity among anxiety disorders, and between anxiety disorders and other mental disorders, in a large (n = 1,507) community sample of high school students on whom extensive diagnostic data were available. Three diagnostic groups were formed: those with a lifetime anxiety disorder (n = 134); those with a nonanxiety disorder (n = 510); and those who had never met criteria for a mental disorder (n = 863). The intra-anxiety comorbidity rate was relatively low (18.7%), and was strongly associated with being female (92%). The lifetime comorbidity between anxiety and other mental disorders (primarily MDD) was substantial (73.1%) and was not associated with being female.     

Intellectual ability and achievement in psychiatrically hospitalized children with conduct, anxiety, and affective disorders.

The IQ and academic achievement of psychiatrically hospitalized children were studied. The sample consisted of 76 children, with a mean age of 10 years, who received diagnoses of conduct, oppositional, anxiety, and affective disorders on the basis of a structured diagnostic interview. A relative deficit in verbal abilities was observed for conduct-disordered children, extending to preadolescents the findings previously obtained for adolescent delinquents. Depressed children were characterized by underachievement, which is consistent with the learned helplessness literature. Contrary to expectations, children with an anxiety disorder had a lower IQ than children without the disorder. No cognitive deficits were observed for children diagnosed as oppositional. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Separation and comorbidity of hyperactivity and conduct disturbance in Chinese schoolboys

In a two-stage community study of 3069 Chinese schoolboys in Hong Kong, those entering stage 2 were classified by scores on Rutter's teacher and parent questionnaires into: (1) a mixed hyperactive/conduct-disturbed (HA-CD) group; (2) a pure hyperactive (HA) group; (3) a pure conduct-disturbed (CD) group; and (4) a normal control group. The four groups of children were compared on a series of psychosocial, cognitive and neurodevelopmental measures. This was followed by a regression analysis to examine the specificity of the differential patterns of associations between HA and CD. There was a mix of negative and positive findings defying a simple, definitive conclusion. However, the positive findings that did emerge supported a growing body of recent literature which favoured a separation of HA from CD and their cross-cultural validity: the former was associated with neurodevelopmental impairments, the latter with family disharmony. The mixed condition, HA-CD, was a hybrid of its two constituent conditions, displaying the attributes of both.     

Seasonal affective disorders

Seasonal affective disorder is a pattern of major depressive episodes that occur and remit with changes in seasons. It may be seen in major depressive or bipolar disorders, as described in the Diagnostic and Statistical. Manual of Mental Disorders (DSM-IV). The most recognized form of seasonal affective disorder, "winter depression," is characterized by recurrent episodes of depression, hypersomnia, augmented appetite with carbohydrate craving, and weight gain that begin in the autumn and continue through the winter months. Physicians have many options for treating seasonal affective disorder. While questions regarding the validity of seasonal affective disorder as a syndrome and the mechanism of action of light therapy continue to be investigated, the established effectiveness of light therapy in patients with winter depression supports the usefulness of assessment for this seasonal pattern and consideration of light therapy as an option in addition to existing treatment choices.     

Social status and the comorbidity of child depression and conduct disorder.

This study examined the overlap between child depression (DEP) and conduct disorder (CD) as a function of peer social status (i.e., popular, rejected, neglected, controversial, average) in a sample of 1,464 nonreferred 4th graders. Both DEP and CD were measured by self-report, peer nomination, and teacher ratings. Social status was assessed by peer nomination. A strong correlation (.73) was found between DEP and CD, even after accounting for shared method variance by confirmatory factor analysis. Furthermore, the number of Ss who scored high on both DEP and CD was greater than would be expected by chance alone. Multivariate tests revealed that rejected Ss scored higher than average Ss on measures of DEP and CD. Controversial boys also scored higher on measures of CD. However, analyses also revealed that the association between depression and rejected social status might be due to a subgroup of depressed children who also manifested symptoms of CD. Implications for assessment and treatment of child disorders are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Diagnosis and treatment of affective disorders

The rates of major depression (5-12%) are considerably higher than for bipolar disorder (ca. 1%). Depressive disorder is most frequent in general practice. Although general practitioners recognise and manage efficiently a large number of depressed patients, at any consultation about half the patients are not diagnosed. Recognising depression is made difficult by the frequency in general practice of presentations with somatic symptoms (masked depression) and of depression related to physical disorder. The best method for the general practitioner to overcome these problems is by using a relatively direct interview for the main specific symptoms of depression. The general practitioner has a key role in the management of depression and as a gatekeeper with a prime responsibility to make appropriate referrals to specialists. Counselling members of the family or friends and recommending self-help groups are important to improve the therapeutic compliance of the patients.     

Prevalence of anxiety disorders and their comorbidity with mood and addictive disorders

BACKGROUND: The co-occurrence of anxiety disorders with other mental, addictive, and physical disorders has important implications for treatment and for prediction of clinical course and associated morbidity. METHOD: Cross-sectional and prospective data on 20,291 individuals from the Epidemiologic Catchment Area (ECA) study were analysed to determine one-month, current disorders, one-year incidence, and one-year and lifetime prevalence of anxiety, mood, and addictive disorders, and to identify the onset and offset of disorders within the one-year prospective period. RESULTS: Nearly half (47.2%) of those meeting lifetime criteria for major depression also have met criteria for a comorbid anxiety disorder. The average age of onset of any lifetime anxiety disorder (16.4 years) and social phobia (11.6 years) among those with major depression was much younger than the onset age for major depression (23.2 years) and panic disorder. CONCLUSIONS: Anxiety disorders, especially social and simple phobias, appear to have an early onset in adolescence with potentially severe consequences, predisposing those affected to greater vulnerability to major depression and addictive disorders.     

Relationship between prophylactic effect of lithium therapy and family history of affective disorders

Lithium therapy response and age of onset (AOO) were studied in 98 patients with bipolar affective disorder (BPAD) who were divided into subgroups depending on type of family history of affective disorders. The highest (33.0 years) and lowest (25.5 years) age of onset were found in nonfamilial patients and in familial patients with a first-degree relative of BPAD, respectively. Nonfamilial patients showed the best response to lithium. There were 0.9 episodes/year off lithium compared to 0.3 episodes/year on lithium (an 88% decrease). A poorer response (a 71% decrease; a reduction from 1.39 episodes per year off lithium to 0.65 on lithium) was found in familial patients with a first-degree relative of BPAD. Differences in serum lithium values between the groups could not explain the observed differences. Thus, familial patients showed a more severe manifestation of the disease with an earlier AOO and a lower prophylactic effect of lithium.     

Clinical judgment and affective disorders.

Addresses 3 limitations of previous work on counselor clinical judgment by the 1st author et al (see record 1983-11141-001) and R. F. Haase et al (see record 1983-26503-001). Results of the study of 20 practicing counselors suggest that the judgment process used by experienced counselors to make diagnoses of affective disorders differs depending on the type of diagnostic judgment and that attributions may play a role in at least certain types of judgments. (8 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pathways linking affective disturbances and physical disorders.

Comorbidity of psychological and physical disorders is substantial. This article presents a broad theoretical framework for identifying factors that contribute to and maintain comorbid conditions. The authors propose heuristic models of how co-occurrences of psychological and physical disorders are developed and maintained. The models specify biological, behavioral, cognitive, and social pathways that may account for comorbidity. Although the authors' discussion of psychological disorders is limited to the role of affective disturbances (subclinical negative moods as well as mood and affective disorders), the pathways they identify are thought to contribute to co-occurrences of other psychological disorders and physical disease as well. The authors emphasize that pathways linking comorbid states are bi-directional and that operative pathways differ depending on the specific affective response, illness behavior, disease, or disease stage. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The use of carbamazepine in affective disorders

The normothymic effect of carbamazepine administered alone or in combination with lithium in patients with affective disorders was studied. The incidence and time-course of carbamazepine-induced side effects was analyzed.     

Residential behavior therapy for children with conduct disorders

Children with conduct disorders are often referred to residential treatment centers (RTCs). RTCs shorten the length of treatment and thus feel they need to reconceptualize the purpose and process of treatment. Two intervention strategies have been found to affect conduct disorder in outpatient settings: parent training programs that are based on operant learning principles and cognitive-behavioral programs that focus on the relation between cognition and behavior. These strategies should not be transferred to the RTC but adapted to the characteristics of residentially treated conduct disordered children and their parents. These methods should be used together to integrate and strengthen the various learning processes that residential treatment can foster. An outline is given of a comprehensive and integrated residential treatment program based on behavioral methods that have been proven to affect conduct disorder.     

Associative disturbance in schizophrenia, schizoaffective disorders, and major affective disorders: Comparisons between hospitalization and 1-year follow-up.

Word-association performance of 71 Research Diagnostic Criteria-diagnosed schizophrenic, schizoaffective, and affective disorder patients was assessed shortly after hospital admission to evaluate the diagnostic specificity of associative disturbance. The same Ss were assessed again 1 yr after discharge to investigate the longitudinal course of word-association behavior. Data regarding rehospitalization were included in the analyses of 4 primary word-association indices. Results indicate that thought disorder was not distinctively schizophrenic and that associative thought disorder was more characteristically associated with rehospitalization for affective disorder patients than for other diagnostic groups. Arousal and cognitive control mechanisms are discussed. (3 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Co-occurrence and contransmission of affective disorders and alcoholism in families

The analysis of patterns of co-occurrence and cotransmission of affective disorders and alcoholism in families may provide clues for understanding the excess comorbidity between these conditions in clinical settings and in the general population. This paper reports the results of a family study of the relatives of patients with bipolar disorder, unipolar depression and alcoholism, and combinations thereof. Excess comorbidity between affective disorders and alcoholism was observed in all groups of relatives. However, the sharing of familial aetiological components was not a major contributor to the excess comorbidity between affective disorders and alcoholism. Unipolar depression and alcoholism segregated independently in families, whereas a modest correlation between familial components of alcoholism and bipolar disorder was observed.     

Prospective analysis of comorbidity: Tobacco and alcohol use disorders.

Alcohol use disorders (AUD) and tobacco use disorders (TD) frequently co-occur. The authors examined AUD–TD comorbidity over time using a state–trait (ST) model. The ST model represents variance in AUD/TD as a traitlike factor that spans measurement occasion and identifies distinct sources of variance in AUD/TD comorbidity. The ST model was evaluated on 450 young adults (baseline age?=?18.5 yrs; 51% with family history of alcoholism) assessed 5 times over 7 yrs. The ST model demonstrated superior fit over a first-order autoregressive model. The tendency to diagnose with AUD and TD was partially explained by family history of alcoholism; this relationship was mediated by childhood stressors, alcohol expectancies, and behavioral undercontrol. Results supported a common third-variable influence (vs. directional) model of comorbidity. The ST model is an important conceptual and methodological approach to the prospective study of comorbidity in general. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depression and axis II disorders: comorbidity and relationship to cooperativeness

The diagnosis of depression and Axis II personality disorders have been found to co-occur in people, and the purpose of this paper is to examine the relationships between chronicity of depression and Axis II diagnosis. We assessed for the prevalence of two Axis II disorders, Antisocial Personality Disorder (APD) and Borderline Personality Disorder (BPD). Patients who were evaluated in a tertiary care center were diagnosed as having Chronic Major Depressive Disorder (CMDD), Dysthymic disorder (DD), or Acute Major Depressive Disorder (AMDD). We expected the prevalence of Axis II disorders to increase with increasing depression chronicity. Cloninger et al. (1993, Arch Gen Psychiatry 50:975-988; 1994) have proposed that temperament and character factors may be predictors of personality disorders. The instrument originally developed to measure these factors was the Tri-dimensional Personality Questionnaire (TPQ), which was later revised to produce the Temperament and Character Inventory (TCI). There is evidence that TCI scores help predict the presence of Axis II disorders. We hypothesized that one component of the TCI, cooperativeness, would be lower in CMDD than DD or AMDD, reflecting a relationship between Axis II disorders and chronicity of depression. From our sample, no patients had APD and there was not a significant difference between the number of patients with BPD in each of the depression groups. Furthermore, there was not a significant difference between cooperativeness scores among each of the groups. The implications of these findings are discussed.     

Neuropsychobiology of affective disorders. Some methodological considerations

Amine hypothesis is neither an adequate nor a sufficient postulate in understanding the neuropsychobiology of affective disorders. Interactions and balance between various mechanisms and factors may be important. Better techniques and methodology need to be used and a more comprehensive approach seems to be necessary in formulating meaningful research strategies. The present paper reexamines someaspects of the available data and suggests a few approaches in the sutdy and elucidation of neruophychobiology of affective disorders.     

Phototherapy. An alternative for seasonal affective disorders or sleep disorders

Although clinicians have observed for centuries that som depressed patients become worse in the winter, it was first in 1984 that Norman Rosenthal and co-workers described a syndrome which they called seasonal affective disorder (SAD), characterised by winter depression, lethargy and a craving for carbohydrate. Phototherapy was proved to be an effective treatment right from the start. Recently it has been reported that not only depression, but also panic disorder and obsessive compulsive disorders may exhibit a seasonal pattern and thus benefit from phototherapy. Phototherapy may also benefit patients suffering from "sun-downing", a syndrome of confusion and agitation in the evening in persons with Alzheimer's disease. Based on the observation that bright light may both elevate brain serotonin and ameliorate sleep abnormalities, the authors report the results of phototherapy for treatment of non-seasonal depressions, either alone or in combination with antidepressants or sleep deprivation.     

Occurrence and clinical correlates of psychiatric comorbidity in patients with psychotic disorders

BACKGROUND: The aim of this study was to explore patterns and clinical correlates of psychiatric comorbidity in patients with schizophrenia spectrum disorders and mood spectrum disorders with psychotic features. METHOD: Ninety-six consecutively hospitalized patients with current psychotic symptoms were recruited and included in this study. Index episode psychotic diagnosis and psychiatric comorbidity were assessed using the Structured Clinical Interview for DSM-III-R-Patient Version (SCID-P). Psychopathology was assessed by the SCID-P, Brief Psychiatric Rating Scale, Scale for the Assessment of Negative Symptoms, and Hopkins Symptom Checklist. Awareness of illness was assessed with the Scale to Assess Unawareness of Mental Disorders. RESULTS: The total lifetime prevalence of psychiatric comorbidity in the entire cohort was 57.3% (58.1% in schizophrenia spectrum disorders and 56.9% in mood spectrum psychoses). Overall, panic disorder (24%), obsessive-compulsive disorder (24%), social phobia (17.7%), substance abuse (11.5%), alcohol abuse (10.4%), and simple phobia (7.3%) were the most frequent comorbidities. Within the group of mood spectrum disorders, negative symptoms were found to be more frequent among patients with psychiatric comorbidity than among those without comorbidity, while such a difference was not detected within the group of schizophrenia spectrum disorders. Social phobia, substance abuse disorder, and panic disorder comorbidity showed the greatest association with psychotic features. An association between earlier age at first hospitalization and comorbidity was found only in patients with unipolar psychotic depression. Patient self-reported psychopathology was more severe in schizophrenia spectrum patients with comorbidity than in those without, while such a difference was less pronounced in mood spectrum psychoses. CONCLUSION: These findings suggest that psychiatric comorbidity is a relevant phenomenon in psychoses and is likely to negatively affect the phenomenology of psychotic illness. Further studies in larger psychotic populations are needed to gain more insight into the clinical and therapeutic implications of psychiatric comorbidity in psychoses.     

Differential diagnosis of attention deficit and conduct disorders using conditional probabilities.

Attention deficit and conduct disorders require an important yet often difficult differential diagnosis. Prior efforts to determine which symptoms are optimal for making this differential diagnosis have been limited by a reliance on statistics that do not supply the probability of the disorders given a symptom's presence (positive predictive power) or the probability that the disorder is not present given the absence of the symptom (negative predictive power). This investigation examined the utility of these latter statistics in the differential diagnosis of childhood attention deficit and conduct disorders. The data consisted of symptoms from a standardized maternal psychiatric interview collected for a sample of 76 clinic-referred boys. Results indicated that some symptoms are optimal as inclusion criteria, some as exclusion criteria, some as neither, and some as both. Furthermore, some symptoms that have been traditionally associated with the diagnosis of one disorder were actually found to be more useful in the diagnosis of the other disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)