Fifty consecutive panic patients had M-mode echocardiographs read independently by two cardiologists with expertise in echocardiography. In this prospective study, there was poor interrater reliability (22 of 50; K = 0.11) for diagnosis of mitral valve prolapse (MVP). On repeat evaluation 10 months later there was also unacceptable intrarater reliability for each reader: 22 of 35 (K = 0.41) and 22 of 35 (K = 0.45). We conclude that M-mode echocardiography is clinically unreliable for establishing the diagnosis of mitral valve prolapse. These findings suggest that the variable reporting of M-mode-determined mitral valve prolapse in psychiatric populations may reflect differences among echocardiologists rather than differences in cardiac pathology. The clinical implications of these findings are discussed.

Agoraphobia↗

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The relationship between anxiety and depression: a clinical comparison of generalized anxiety disorder, dysthymic disorder, panic disorder, and major depressive disorder.

This study examined the relationship between the chronic disorders, generalized anxiety disorder (GAD) and dysthymic disorder (DD), and the more acute disorders, panic disorder (PD) and major depressive disorder (MDD) in 110 psychiatric outpatients with diagnoses of either PD, MDD, GAD, or DD. Pure, mixed, and early-/late-onset forms of the chronic disorders were compared with each other and then with PD and MDD on clinical measures and psychiatric history. Minimal differences were found between pure GAD and mixed GAD or between pure DD and mixed DD. The chronic disorders, DD and GAD, had distinct clinical symptom profiles when compared with each other and appeared more closely related to their parent disorders than to each other. However, despite these similarities, there were significant differences between DD and MDD in contrast to the minimal differences between GAD and PD, providing less support for GAD as a valid diagnostic category separate from PD. Comparisons of early-/late-onset DD and GAD showed more severe symptoms in late-onset DD, in contrast to more severe symptoms in early-onset GAD. These varying patterns of symptom severity may warrant study for further syndromal delineation.

Adult↗

PubMedDate not supplied

A report on three patients with "rapid cycling" unipolar depression.

We report three cases of unipolar depression who meet criteria for "rapid cycling" by having four or more major depressive episodes within a 1-year period. This report describes the clinical characteristics of the three patients and discusses the concept of false unipolar depression, and compares these patients with the "pseudounipolar" group described by Akiskal et al. Our findings support the clinical notion that rapid cycling in unipolar depression is a rarity.

Adult↗

PubMedDate not supplied

Diagnostic reliability of the history of hypomania in bipolar II patients and patients with major depression.

Records of patients who had been systematically evaluated at the Center for Anxiety and Depression were reviewed. Included in this report are records of patients who had a diagnosis of bipolar II or unipolar affective disorder as determined by one of the authors and who also underwent a Structured Clinical Interview for DSM-III (SCID). A second study was undertaken with L.K.T. observing the clinical interview of D.L.D. and both clinicians making a diagnosis for the patient. There was reasonable diagnostic agreement between D.L.D. and the SCID for diagnosis of bipolar II disorder. Twelve of 34 patients clinically diagnosed as bipolar II were diagnosed by the SCID as unipolar. These 12 patients failed to demonstrate clinical factors, which could help explain the diagnostic difference between SCID and the clinical diagnosis. There was excellent agreement on 34 patients as to the presence or absence of hypomania, comparing two clinicians. The SCID interview underestimates the diagnosis of hypomania, a condition that can be diagnosed reliably by clinicians trained to make this diagnosis. This finding has some implications for DSM-IV, where there is a proposal for inclusion of bipolar II disorder as a parallel entity with bipolar disorder.

Adult↗

PubMedDate not supplied

Validity of seasonal pattern as a modifier for recurrent mood disorders for DSM-IV.

Data are reviewed regarding the validity of seasonal pattern (SP), according to DSM-III-R, as a modifier for recurrent mood disorders. The relationship of the DSM-III-R formulation of SP is compared with that of seasonal affective disorder (SAD) as used by the bulk of researchers in the area. Both definitions are evaluated against the criteria for validity suggested by Robins and Guze, by Kendell, and by Spitzer and Williams. While the two definitions are similar and available data support a distinct clinical syndrome of recurrent winter decrements of mood and energy, it is not yet clear whether what is identified as SP or SAD represents a distinct affective syndrome, a subtype of recurrent affective illness, or the most severe form of a widely distributed population trait. Several options for operationalized criteria sets are discussed.

Adult↗

PubMedDate not supplied

Suicide attempt history in depressed patients with and without a history of panic attacks.

This study of 346 depressed outpatients found a significant difference in the frequency of suicide attempts in those with a history of panic attacks (26.9%) compared with those without (16.8%). Further investigation showed that depressed patients with a history of infrequent panic attacks had a higher incidence of suicide attempts (32.3%) than those with panic disorder (21.5%). However, multiple regression analysis including a number of sociodemographic and diagnostic variables revealed that female gender and history of psychosis (but not panic attack history) significantly contributed to the variance in the history of suicide attempts. These data for depressed patients are compared with data from other studies regarding the association of panic attacks and suicidal behavior.

Adolescent↗

PubMedDate not supplied

Clinical and differential diagnostic aspects of treatment-resistant depression.

This study investigated treatment-resistant depressed patients. A sample of 49 patients was selected from a review of 302 patients who had been consecutively evaluated at a tertiary care facility. Clinical records of these 49 patients revealed frequent misdiagnosis of depression subtype, relatively infrequent treatment with electroconvulsive therapy, and pharmacotherapy trials which often were too brief or characterized by inadequate dosing to be effective. A group of non-treatment resistant patients was matched for age, gender, and depressive subtype with 26 treatment-resistant patients. Treatment-resistant patients were less "atypical" and were more likely to have made a suicide attempt than the comparison patients. Although depression rating scales showed similar mean ratings for both groups, the TPQ revealed higher mean ratings for harm avoidance and lower mean ratings for novelty seeking for treatment-resistant patients. The implications of these findings are discussed.

Adult↗

PubMedDate not supplied

The Tridimensional Personality Questionnaire in depression: state versus trait issues.

The goal of our study was to examine the stability over time of the personality measures defined by Cloninger's Tridimensional Personality Questionnaire (TPQ) in patients with major depression. We conducted a retrospective chart review of 63 outpatients who had participated in one of three double-blind antidepressant trials. All subjects had completed the TPQ upon entry and upon termination of the 12-week trials. Statistically significant decrements in harm avoidance scores were observed in those subjects whose depression improved, regardless of gender or duration of presenting depressive episode. No significant changes were observed in the other two dimensions (novelty seeking and reward dependence). Nonresponders as a group had no statistically significant decreases in any TPQ dimension or subscales. While novelty seeking and reward dependence remain relatively independent of mood, harm avoidance appears to be a measure which is elevated during depressive states and which changes with improvement of depression. These findings are consistent with those of other investigators.

Adult↗