Typology of common psychiatric syndromes

1998 ◽  
Vol 173 (4) ◽  
pp. 312-319 ◽  
Author(s):  
Patrick F. Sullivan ◽  
Kenneth S. Kendler
Keyword(s):  
Anxiety Disorder ◽  
Major Depression ◽  
Latent Class ◽  
Monozygotic Twin ◽  
Population Based ◽  
Generalised Anxiety Disorder ◽  
Single Class ◽  
Empirical Typology ◽  
Natural Tendency ◽  
Best Fit

BackgroundDiagnostic comorbidity is prevalent in psychiatry and may be inadequately captured by the DSM-III/III-R nosology.MethodsThe lifetime presence of 11 psychiatric diagnoses was determined by structured personal interviews of a population-based sample of 1898 female twins. We used latent class analysis to derive an empirical typology.ResultsSix classes provided the best fit to the data. Their mnemonics were: minimal disorder (60% of the sample), major depression -generalised anxiety disorder (19%), alcohol–nicotine (7%), highly comorbid major depression (5%) and eating disorders (3%). The validity of this typology was strongly supported by demographic, health, personality and attitudinal validators along with the significant monozygotic twin concordance for class membership. The typology superficially resembled DSM-III-R, but contained many differences. Major depression appeared in three forms (alone, with generalised anxiety disorder and with considerable comorbidity). Alcoholism-nicotine dependence and the various anxiety disorders formed discrete classes, but were also prominent in other classes. Bulimia and anorexia were exceptional in their appearance in a single class.ConclusionsThe DSM-III-R and closely related DSM-IV nosology did not capture the natural tendency of these disorders to co-occur. Fundamental assumptions of the dominant diagnostic schemata may be incorrect.

Major Depression and Generalised Anxiety Disorder

1996 ◽  
Vol 168 (S30) ◽  
pp. 68-75 ◽  
Author(s):  
Kenneth S. Kendler
Keyword(s):  
Risk Factors ◽  
Anxiety Disorder ◽  
Major Depression ◽  
Environmental Risk ◽  
Genetic Factors ◽  
Environmental Risk Factors ◽  
Generalised Anxiety Disorder ◽  
Increase Risk ◽  
Twin Models ◽  
One Year

In both clinical and epidemiological samples, major depression (MD) and generalised anxiety disorder (GAD) display substantial comorbidity. In a prior analysis of lifetime MD and GAD in female twins, the same genetic factors were shown to influence the liability to MD and to GAD. A follow-up interview in the same twin cohort examined one-year prevalence for MD and GAD (diagnosed using a one-month minimum duration of illness). Bivariate twin models were fitted using the program Mx. High levels of comorbidity were observed between MD and GAD. The best-fitting twin models, when GAD was diagnosed with or without a diagnostic hierarchy, found a genetic correlation of unity between the two disorders. The correlation in environmental risk factors was +0.70 when GAD was diagnosed non-hierarchically, but zero when hierarchical diagnoses were used. Our findings provide further support for the hypothesis that in women, MD and GAD are the result of the same genetic factors. Environmental risk factors that predispose to ‘pure’ GAD episodes may be relatively distinct from those that increase risk for MD.

Comorbidity of Mood Disorders: A Longitudinal Prospective Study

1996 ◽  
Vol 168 (S30) ◽  
pp. 31-37 ◽  
Author(s):  
Jules Angst
Keyword(s):  
Anxiety Disorder ◽  
Major Depression ◽  
Panic Disorder ◽  
Generalised Anxiety Disorder ◽  
Major Depressive ◽  
Recurrent Brief Depression ◽  
Cannabis Consumption ◽  
Major Depressive Episodes ◽  
Depressive Episodes

From the Zurich cohort study (n=591), the association of major depressive episodes and recurrent brief depression (RBD) with other psychiatric disorders is presented cross-sectionally at age 28 and 30 years, and over ten years (age 20 to 30 years). Longitudinally, the odds ratios of major depression are highest with dysthymia (4.4), generalised anxiety disorder (4.4), panic disorder (2.7), hypomania and agoraphobia (2.6), and social phobia (2.4). There is a significant association with cannabis consumption and smoking. Follow-up data over nine years are available for 41 patients with a major depressive disorder (MDD) and 62 with RBD: approximately 20% of MDD patients did not receive a diagnosis during follow-up. Major depression reoccurred in 32%, became bipolar in 24%, or developed into RBD in 24%. RBD remitted in 41 %, reoccurred in 35%, turned into major depression in 22%, and became bipolar in only 7%. Longitudinally, MDD and RBD show a symmetrical diagnostic change in a quarter of the cases. There is no substantial development of MDD or RBD into minor depression or generalised anxiety disorder. Thirteen per cent of those with RBD later developed panic disorder.

scholarly journals Generalised anxiety disorder and hospital admissions: findings from a large, population cohort study

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e018539 ◽  
Author(s):  
Olivia Remes ◽  
Nicholas Wainwright ◽  
Paul Surtees ◽  
Louise Lafortune ◽  
Kay-Tee Khaw ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Service Use ◽  
Hospital Admissions ◽  
Late Onset ◽  
Large Population ◽  
Population Based ◽  
Generalised Anxiety Disorder ◽  
Increased Risk ◽  
Using Data ◽  
Administrative Health Databases

ObjectiveGeneralised anxiety disorder (GAD) is the most common anxiety disorder in the general population and has been associated with high economic and human burden. However, it has been neglected in the health services literature. The objective of this study is to assess whether GAD leads to hospital admissions using data from the European Prospective Investigation of Cancer-Norfolk. Other aims include determining whether early-onset or late-onset forms of the disorder, episode chronicity and frequency, and comorbidity with major depressive disorder (MDD) contribute to hospital admissions.DesignLarge, population study.SettingUK population-based cohort.Participants30 445 British participants were recruited through general practice registers in England. Of these, 20 919 completed a structured psychosocial questionnaire used to identify presence of GAD. Anxiety was assessed in 1996–2000, and health service use was captured between 1999/2000 and 2009 through record linkage with large, administrative health databases. 17 939 participants had complete data on covariates.Main outcome measurePast-year GAD defined according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition.ResultsIn this study, there were 2.2% (393/17 939) of respondents with GAD. Anxiety was not independently associated with hospital admissions (incidence rate ratio (IRR)=1.04, 95% CI 0.90 to 1.20) over 9 years. However, those whose anxiety was comorbid with depression showed a statistically significantly increased risk for hospital admissions (IRR=1.23, 95% CI 1.02 to 1.49).ConclusionPeople with GAD and MDD comorbidity were at an increased risk for hospital admissions. Clinicians should consider that meeting criteria for a pure or individual disorder at one point in time, such as past-year GAD, does not necessarily predict deleterious health outcomes; rather different forms of the disorder, such as comorbid cases, might be of greater importance.

scholarly journals Heterogeneity in symptom profiles among older adults diagnosed with major depression

2011 ◽  
Vol 23 (6) ◽  
pp. 906-922 ◽  
Author(s):  
Celia F. Hybels ◽  
Dan G. Blazer ◽  
Lawrence R. Landerman ◽  
David C. Steffens
Keyword(s):  
Social Support ◽  
Older Adults ◽  
Major Depression ◽  
Sex Education ◽  
Latent Class ◽  
Rating Scale ◽  
Functional Limitations ◽  
Depression Scale ◽  
Symptom Profiles ◽  
Best Fit

ABSTRACTBackground: Late-life depression may be undiagnosed due to symptom expression. These analyses explore the structure of depressive symptoms in older patients diagnosed with major depression by identifying clusters of patients based on their symptom profiles.Methods: The sample comprised 366 patients enrolled in a naturalistic treatment study. Symptom profiles were defined using responses to the Center for Epidemiologic Studies Depression Scale (CES-D), the Hamilton Rating Scale for Depression (HAM-D) and the depression section of the Diagnostic Interview Schedule (DIS) administered at enrollment. Latent class analysis (LCA) was used to place patients into homogeneous clusters. As a final step, we identified a risk profile from representative items across instruments selected through variable reduction techniques.Results: A model with four discrete clusters provided the best fit to the data for the CES-D and the DIS depression module, while three clusters best fit the HAM-D. Using LCA to identify clusters of patients based on their endorsement of seventeen representative symptoms, we found three clusters of patients differing in ways other than severity. Age, sex, education, marital status, age of onset, functional limitations, level of perceived stress and subjective social support were differentially distributed across clusters.Conclusions: We found considerable heterogeneity in symptom profiles among older adults with an index episode of major depression. Clinical indicators such as depression history may play less of a role differentiating clusters of patients than variables such as stress, social support, and functional limitations. These findings can help conceptualize depression and potentially reduce misdiagnosis for this age group.

The Clinical Characteristics of Major Depression as Indices of the Familial Risk to Illness

1994 ◽  
Vol 165 (1) ◽  
pp. 66-72 ◽  
Author(s):  
Kenneth S. Kendler ◽  
Michael C. Neale ◽  
Ronald C. Kessler ◽  
Andrew C. Heath ◽  
Lindon J. Eaves
Keyword(s):  
Major Depression ◽  
Clinical Characteristics ◽  
Age At Onset ◽  
Familial Risk ◽  
Population Based ◽  
Treatment Seeking ◽  
Generalised Anxiety Disorder ◽  
Increased Risk ◽  
Co Morbidity ◽  
Familial Vulnerability

BackgroundFrom both a clinical and an aetiological perspective, major depression (MD) is probably a heterogeneous condition. We attempt to relate these two domains.MethodWe examined which of an extensive series of clinical characteristics in 646 female twins from a population-based register with a lifetime diagnosis of MD predicts the risk for MD in co-twins. MD was defined by DSM–III–R criteria.ResultsFour variables uniquely predicted an increased risk for MD in the co-twin: number of episodes, degree of impairment and co-morbidity with panic disorder or bulimia. One variable uniquely predicted decreased risk: co-morbidity with phobia. Variables that did not uniquely predict risk of MD in the co-twin included age at onset, number and kind of depressive symptoms, treatment seeking, duration of the longest episode and co-morbidity with generalised anxiety disorder and alcohol dependence.ConclusionsOur results suggest that the clinical features of MD can be meaningfully related to the familial vulnerability to illness, particularly with respect to recurrence, impairment and patterns of co-morbidity.

scholarly journals Structure of internalising symptoms in early adulthood

2006 ◽  
Vol 189 (6) ◽  
pp. 540-546 ◽  
Author(s):  
David M. Fergusson ◽  
L. John Horwood ◽  
Joseph M. Boden
Keyword(s):  
Anxiety Disorder ◽  
Major Depression ◽  
Structural Equation ◽  
Early Adulthood ◽  
Time Correlation ◽  
Underlying Structure ◽  
Generalised Anxiety Disorder ◽  
Panic Disorders ◽  
Symptom Scores ◽  
Dsm Iv

BackgroundDebate surrounds the underlying structure of internalising disorders including major depression, generalised anxiety disorder, phobias and panic disorders.AimsTo model the within-time and across-time relationships of internalising symptoms, incorporating effects from generalised internalising and disorder-specific components of continuity.MethodData were gathered from a 25-year longitudinal study of a birth cohort of 953 New Zealand children. Outcome measures included DSM–IV symptom scores for major depression, generalised anxiety disorder, phobia and panic disorder at the ages of 18, 21 and 25 years.ResultsStructural equation modelling showed that, within-times, a common underlying measure of generalised internalising explained symptom score comorbidities. Across-time correlation of symptom scores was primarily accounted for by continuity over time in generalised internalising. However, for major depression and phobia there was also evidence of across-time continuity in the disorder-specific components of symptoms.ConclusionsInternalising symptoms can be partitioned into components reflecting both a generalised tendency to internalising and disorder-specific components.

scholarly journals Association between latent toxoplasmosis and major depression, generalised anxiety disorder and panic disorder in human adults

2014 ◽  
Vol 61 (4) ◽  
pp. 285-292 ◽  
Author(s):  
Shawn D. Gale ◽  
Bruce L. Brown ◽  
Andrew Berrett ◽  
Lance D. Erickson ◽  
Dawson W. Hedges
Keyword(s):  
Anxiety Disorder ◽  
Major Depression ◽  
Panic Disorder ◽  
Generalised Anxiety Disorder ◽  
Human Adults

Anxiety disorder in dementia

1994 ◽  
Vol 11 (3) ◽  
pp. 108-109 ◽  
Author(s):  
Clive G Ballard ◽  
Ramalingam NC Mohan ◽  
Abdul Patel ◽  
Candida Graham
Keyword(s):  
Anxiety Disorder ◽  
Major Depression ◽  
Anxiety Disorders ◽  
Close Contact ◽  
Study Group ◽  
Day Hospital ◽  
Generalised Anxiety Disorder ◽  
Degree Relative ◽  
Mild Dementia ◽  
Severity Of Dementia

AbstractObjective: To estimate the prevalence of anxiety disorders and to explore several potential aetiological factors. Method: Ninety two consecutive patients assessed at a day hospital for patients with probable dementia were interviewed using the CAMDEX schedule. Fifty eight patients gave a sufficiently reliable interview and had a first degree relative in close contact as an informant and were hence included in the study group. The prevalence of RDC generalised anxiety disorder in this group was determined. Type of dementia, severity of dementia and insight were explored as possible aetiological factors. Results: The prevalence of RDC generalised anxiety disorder was 31%. Fifty percent of these patients suffered from anxiety symptoms in the context of RDC major depression. Anxiety disorders were most common in those with mild dementia and in those who retained insight, both showing a trend towards a significant association with anxiety. Conclusions: Anxiety disorders are very common in dementia sufferers particularly in those with mild dementia. Further research is needed in this area, particularly with respect to treatment.

Latent class analysis of the feared situations of social anxiety disorder: A population-based study

2016 ◽  
Vol 33 (12) ◽  
pp. 1178-1187 ◽  
Author(s):  
Hugo Peyre ◽  
Nicolas Hoertel ◽  
Fabrice Rivollier ◽  
Benjamin Landman ◽  
Kibby McMahon ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Social Anxiety ◽  
Latent Class Analysis ◽  
Social Anxiety Disorder ◽  
Latent Class ◽  
Population Based ◽  
Class Analysis ◽  
Population Based Study
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