Psychopathology
1 Anxious Depression: A Reemerging Subtype of Depression Paula J. Clayton 7 Measurement of Anxiety and Depression James Mullaney 2 1 Affect and Anxiety in Daily Life M. W. deVries, Ph. A. E. G. Delespaul, and С I. M. Dijkman-Caes 33 Symptoms and Syndromes of Anxious Depressive Patients L. Bellodi, O. Gambini, and V. Brancato 43 The Prevalence and Outcome of Anxious Depression in Elderly People Aged 65 and Over Living in the Community /. R. M. Copeland, I. A. Davidson, and M. E. Dewey 49 Life Events and Depression C. Faravelli, S. Pallanti, R. Frassine, B. Guerrini, and G. Albanesi 57 Schizoaffective Disorder, Depressed Type: Clinical, Biological, and Neuropsychological Aspects Mario Maj (more…)

E. S. Paykel
Department of Psychiatry, University of Cambridge, Addenbrooke’s Hospital, Cambridge, CB2 2QQ, England (more…)

71 ‘ subgroups of patients. By means of our operational definition of neurotic-reactive depression, we have been able to delineate a subgroup of patients that at least seems to be different from patients with unipolar and bipolar affective psychoses, furthermore, in long-term follow-up studies, these patients do not seem to de­velop clear-cut unipolar or bipolar affective disorders. In this subgroup of patients with neurotic-reactive depression, there are no supports in family studies, twin studies, or adoption studies for a specific genetic transmission. On the other hand, there seems to be a subgroup of patients with nonpsychotic depressive disorders, characterized by low platelet MAO activity. These subjects seem to be sensitive to stressful life events and seem to have a tendency to react with neurotic-reactive depression and alcohol and drug abuse, and in their relatives, there is an increased frequency of neurotic-reactive depres­sion, alcoholism, and attempted suicides. Because the clinical symptomatology of the patients with affective disorders accompanied by low platelet MAO activity is nonspecific, a variable number of these subjects could be included under any diagnostic category in the field of nonpsychotic depressive disorders. In family studies, this would be reflected as an increased unspecific vulnerability, and an increased frequency of a variety of psychiatric disorders in first-degree relatives. Since low platelet MAO activity has also consistently been found in subgroups of alcoholism (11), a coexistence of neurotic depression and alcoholism would be expected in some families, as suggested by Winokur (21).
REFERENCES
1. Akiskal H. S., Bitar A. H., Puzantian V. R., Rosenthal T. L., and Walker, P. W. (1978): The nosological status of neurotic depression. Arch. Gen. Psychiatry, 35:756-766. 2. American Psychiatric Association. (1980): Diagnostic and Statistical Manual of Mental Disorders, 3rd ed. American Psychiatric Association, Washington, D.C. 3. Angst, J. (1966): Zur Atiologie un Nosologie endogener depressiver Psychosen. Springer Verlag, Berlin. 4. Buchsbaum, M. S., Coursey, R. D., and Murphy, D. L. (1976): The biological highrisk paradigm: Behavioral and familial correlates of low platelet monoamine oxidase activity. Science, 194:339-341. 5. d’Elia, G., von Knorring, L., and Perns, C. (1974): Non-psychotic depressive disorders: A ten year follow up. Acta Psychialr. Scand. (Suppl), 255:173-186. 6.Gershon, E. S., Baron, M., and Leckam, J. F. (1975): Genetic model of the transmission of affective disorders. J. Psychiatr. Res., 12:301-317. 7. von Knorring, A. L. (1983): Adoption Studies on Psychiatric Illness. Umea University Medical Dissertations. New Series No. 101, Umea. 8. von Knorring, L., Oreland, L., and von Knorring, A. L. (1986): Personality traits and psycho-pathology related to platelet MAO activity. In: Biological Psychiatry 1985, edited by С Shagass, R.- С Josiassen, W. H. Bridger, K. J. Weiss, D. Stoff, and G. M. Simpson, pp. 530-532. Elsevier Science Publishing Co., Inc., New York. 9. von Knorring, L., Penis, C, Oreland, L., Eisemann, M., Holgrem, S., and Penis, H. (1985): Morbidity risk for psychiatric disorders in families of probands with affective disorders divided according to levels of platelet MAO activity. Psychiatry Res., 15:271-279. 10. von Knorring, L., Penis, C, Oreland, L., Eisemann, M., and Perris H. (1987): Platelet MAO activity in affective disorders. Relationship to diagnostic subgroup. Biol. Psychiatry, (submitted). 11. Oreland, L., von Knorring, L., von Knorring, A. L., and Bohman, M. (1985): Studies on the connection between alcoholism and low platelet monoamine oxidase activity. In: Progress in Alcohol Research, Vol. 1, edited by Parvez et al., pp. 83-117. VNU Science Press. 12. Perns, С (1966): A study of bipolar (manic-depressive) and unipolar recurrent depressive psychoses. Acta Psychiatr. Scand. (Suppl), 194. 13. Perris, C, Perris, H., Ericsson, U., and von Knorring, L. (1982): The genetics of depression. A family study of unipolar and neurotic-reactive depressed patients. Arch. Psychiatr. Nervenkr 232:137-155. 14. Perris, H., von Knorring, L., Oreland, L., and Perris, С (1984): Life events and biological vul­nerability: A study of life events and platelet MAO activity in depressed patients. Psychiatry Res., 12:111-120. 15. Rasmussen, S., Sorensen, Т ., and Wildshiodtz, G. (1978): Neurosis depressive, en efterundersogelse Nord. Psykiatr. Tidskr., 321-331. 16. Revely, M. A., Revely, A. M., Clifford, R. M., and Murray, R. M. (1983): Genetics of platelet MAO activity in discordant schizophrenic and normal twins. Br. J. Psychiatry, 142:560-565. 17. Smeraldi, E., Negri, F., and Melica, A. M. (1977): A genetic study of affective disorders. Acta Psychiatr. Scand., 56:382-398. 18. Stenstedt, A. (1966): Genetics of neurotic depression. Acta Psychiatr. Scand., 42:392-409. 19. Torgersen, S. (1986): Genetic factors in moderately severe and mild affective disorders. Arch Gen. Psychiatry, 43:222-226. 20. Tzerebietowska. (1976): Unpublished paper. Quoted in: Smeraldi, E., Negri, F., and Melica, A. M. (1977): A genetic study of affective disorders. Acta Psychiatr. Scand., 56:382-398. 21. Winokur, G. (1979): Familial (genetic) subtypes of pure depressive disease. Am. J. Psychiatry, 136:911-913. 22. Winokur, G, Cadoret, R., Dorzab, J., and Baker, M. (1971): Depressive disease: A genetic study. Arch. Gen. Psychiatry, 24:135-144. 23. World Health Organization. (1978): Mental Disorders: Glossary and Guide to the Classification of Mental Disorders in Accordance with the Ninth Revision of the International Classification of Diseases. WHO, Geneva. 24. Zuckerman, M. (1984): Sensation seeking: A comparative approach to a human trait. The Be­havioral and Brain Sciences, 7:413-471. Anxious Depression: Assessment and Treatment, edited by G. Racagni and E. Smeraldi. Raven Press, New York © 1987. (more…)

This study was planned and performed with the aim of monitoring system­atically both patient characteristics and the outcome of different treatment mo­dalities under routine clinical practice conditions. Based on previous reports and personal clinical experiences, a generally accepted standard treatment with IMI and a promising but less widely tried treatment with CLO, both in flexible dosages, were compared. The design allowed for baseline assessment and long-term routine monitoring of treatment response in a large sample of subjects with panic disorder. The advantages over other clinical reports are the random assignment of drugs, the systematic assessment using standardized rating scales and the opportunity to compare this sample of patients with a previously collected sample that was used in a general clinical trial by the same group. The 152 patients selected for the IMI-CLO study to date by a broad interpre­tation and application of DSM-III-R criteria differed surprisingly little from 80 other patients with panic disorder, selected by the same research group, according to more strict diagnostic criteria for a worldwide multicenter study of panic disorder. The demographic and psychopathological characteristics of the two groups widely overlapped. No significant differences were found in age, sex, number of spontaneous and situational panic attacks, percentage of time antic­ipatory anxiety distressed the patients, level of phobic avoidance, depressive mood (HDS) or social disability. In addition, these findings were confirmed by patients’ self-evaluations. The two groups did not differ at baseline on the HSCL factors of anxiety, phobic anxiety, or somatization. The CLO-IMI sample was significantly higher on the obsessive-compulsive factor, and their depression self-ratings were nearly significantly higher. The rank ordering of scores on the HSCL 9-factor profile was practically identical for the two samples, although the general profile level was somewhat higher for the CLO-IMI sample. These observations need further study. Panic disorders appeared to be sharply defined in both groups by profiles with greatest elevations on the anxiety, phobic anxiety, and somatization factors. Even though we included almost the whole spectrum of patients with panic attacks, including multiple diagnoses in axis one, the major clinical features of the CLO-IMI sample did not differ significantly from the typical symptomato-logical picture of panic disorder as presented by the Pisa subsample of what is probably the most carefully selected sample of panic disorder ever undertaken. This evidence supports the homogeneity, reliability, and stability of the panic disorder diagnosis across various patient samples and clinicians, and observa­tion times. The diagnostic subdivision of panic disorder according to DSM-III-R is based essentially on different degrees of phobic avoidance (none, limited, extreme). These diagnostic subtypes did not relate to different rates of drug response to IMI or CLO. This finding supports a more unitarian nosological conceptualiza­tion of panic disorder. Clinical response and side effects have not differed appreciably between the IMI and CLO groups. At similar dosages, both drugs appeared equally effective on the overall symptomatology of panic disorder and agoraphobia. Significant advantages for CLO were found on clinicians’ ratings of the psychic and somatic anxiety items from the HDS. On the former, CLO had faster action with an advantage at 2 weeks, but at 6 and 10 weeks, CLO and IMI were comparable. The CLO advantage on somatic anxiety was apparent at weeks 2 through 10. Since this evidence for treatment differences is relatively limited in view of the number of statistics applied, we prefer not to overinterpret it at this time. An important implication of our findings may be that CLO’s more predominantly serotonin-inhibiting effect does not seem to determine a different spectrum of activity in panic disorder. These data do not clearly support or indicate whether the panic attacks were blocked before the anticipatory anxiety and avoidance behavior decreased. A trend was noticed in favor of a better response of CLO on situational attacks, anticipatory anxiety, and phobic avoidance. Subsequent analyses of all data from the entire sample when the study is completed should better clarify these latter points.

As far as recent life events are concerned, the situation is less intriguing. Table 2 shows the results of the controlled studies in this area. It may be seen that, with the exception of the earlier studies, almost all papers are consistent in finding an excess of stressful life events in the period preceding the onset of a depressive episode. However, since most of the latest studies were carried out in community sam­ples and the diagnoses were made by nopsychiatrists, there is some doubt as to whether such cases correspond to those usually described among psychiatric samples. Moreover, in some cases the results obtained in the community could
pp, patients; ss, subjects. (more…)