Twenty-eight percent of 32 panic disordered patients had a prodrome of generalized anxiety symptoms lasting a median of 5 years before the occurrence of their first panic attack. Patients with a generalized anxiety prodrome were similar to the nonprodrome patients for 55 tested clinical variables, including individual anxiety symptoms, response to treatment, severity of illness, and most aspects of family history. It appears that a prodrome of generalized anxiety symptoms is a variation of the presentation of panic disorder. Initially, these patients may be misdiagnosed as having generalized anxiety disorder (GAD) and contribute to the heterogeneity of GAD.

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Examination of comorbid anxiety in psychiatric inpatients.

Seventy-three percent of 90 psychiatric inpatients had a coexisting anxiety disorder. There were few differences between patients with or without coexisting anxiety on more than 100 clinical and demographic variables that were tested. Patients who had an anxiety syndrome before the onset of their major psychiatric disorder also showed few differences when compared with patients whose anxiety started coincident to or after another DSM-III axis I disorder. The concept of primary/secondary anxiety disorder may not be useful when applied to a cross-section of psychiatric inpatients.

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Proposed delusional depression subtypes: preliminary evidence from a retrospective study of phenomenology and treatment course.

An analysis of the phenomenology and treatment course of 52 subjects with delusional depression suggests that there may be various subtypes: bipolar, early-onset unipolar and possibly a late-onset unipolar. The bipolar subgroup tended to relapse in different but always psychotic directions, and was resistant to lithium carbonate treatment alone. Treatment refractoriness, delusional depressive recurrences, and a dementia-like presentation were associated with a small late-onset subgroup. A high rate of delusionally depressive relapses also characterized the early-onset unipolar group, however, patients with single episodes were found only in this subgroup.

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Comparison of major depressive patients with a predominantly sad versus anxious mood.

One hundred and seventy-seven patients with major depressive disorder (MDD) experienced a mood disturbance that could be characterized as predominantly sad (55%), anxious (31%) or mixed (14%). Patients that had a predominantly sad mood were more likely to be hypersomnic, anhedonic, younger and seen in an outpatient setting. Predominantly anxious MDD patients were more likely to have been hospitalized, agitated, psychotic, incapacitated, insomnic, and to have had higher post-dexamethasone cortisol levels.

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Failure to differentiate bipolar disorder from schizophrenia on measures of neuropsychological function.

30 inpatients diagnosed with schizophrenia were compared to 35 inpatients with bipolar affective disorder, manic type, on a large group of neuropsychological measures. Separate factor analyses were performed on measures of verbal, spatial, and speed variables in order to generate summary scales. Controlling for the effects of age, education, sex, duration of illness, number of previous hospitalizations, and medications at time of testing, there were no significant differences between diagnostic groups on the three factors or on individual test variables. Patients on medication performed more poorly on speed variables than those off medication. These findings call into question the notion of differential patterns of cognitive deficit among psychotic diagnoses.

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