Role of Comorbid Depression and Co-occurring Depressive Symptoms in Outcomes for Anxiety-Disordered Youth Treated with Cognitive-Behavioral Therapy

This study examined the role of comorbid depressive disorders (major depressive disorder or dysthymic disorder) and co-occurring depressive symptoms in treatment outcome and maintenance for youth (N = 72, aged 7–14) treated with cognitive-behavioral therapy for a principal anxiety disorder (generalized anxiety disorder, separation anxiety disorder, or social phobia). Hierarchical linear modeling examined treatment outcome and maintenance in terms of severity of the principal anxiety disorder. Results indicated that higher levels of child-reported depressive symptoms predicted less favorable treatment outcome. Higher levels of mother-reported depressive symptoms predicted less favorable treatment maintenance at a 1-year follow-up. Results suggest that co-occurring depressive symptoms play a role in effective treatment for anxiety-disordered youth and support the merits of treatment adaptations for these youth.     

Prenatal dysthymia versus major depression effects on the neonate

Depressed pregnant women were classified as dysthymic or major depression disorder based on the Structured Clinical Interview for Depression and followed to the newborn period. The newborns of dysthymic versus major depression disorder mothers had a significantly shorter gestational age, a lower birthweight, shorter birth length and less optimal obstetric complications scores. The neonates of dysthymic mothers also had lower orientation and motor scores and more depressive symptoms on the Brazelton Neonatal Behavioral Assessment Scale. These findings were not surprising given the elevated cortisol levels and the inferior fetal measures including lower fetal weight, fetal length, femur length and abdominal circumference noted in our earlier study on fetuses of dysthymic pregnant women.     

Managing antidepressants in primary care: physicians' treatment modifications

To examine antidepressant management practices in primary care, patients (N = 148) given an antidepressant for at least one month completed the Beck Depression Inventory (BDI-II), the Patient Health Questionnaire-9 (PHQ-9), and a demographic survey. Participants' mean age was 50.7 yr. and 80% were women. Patients' charts indicated whether physicians had made changes to prescribed antidepressants or dose either 6 wk. before or 6 wk. after study entry. For the 87% of participants whose depression status could be determined, 10% met dysthymic disorder criteria and only 33% had had a medication change in the previous month. Major depressive disorder occurred in 37% but only 18% had had a medication change. Co-existing dysthymic disorder and major depressive disorder were diagnosed in 34%, with 24% receiving a medication change. Participants not receiving a medication change had mean BDI-II scores indicating moderate depression. Lack of antidepressant adjustment suggests physicians may need to monitor depressive symptoms closely using protocols and prompts.     

Assessing Interpersonal Subtypes in Depression

The context-free diagnoses outlined by the Diagnostic and Statistical Manual of Mental Disorders might not provide enough information to represent the heterogeneity observed in depressed patients. Interpersonal factors have been linked to depression in a mutually influencing pathoplastic relationship where certain problems, like submissiveness, are related to symptom chronicity. This study evaluated interpersonal pathoplasticity in a range of depressive presentations. We examined archival data collected from 407 participants who met criteria for major depressive disorder (MDD), dysthymic disorder (DD), or subthreshold depression (sD). Latent profile analysis (LPA) identified 5 interpersonal subtypes (vindictive, intrusive, socially avoidant, exploitable, and cold). Apart from gender, the subtypes did not differ significantly on demographic characteristics, psychiatric comorbidity, or self-report depression severity. Socially avoidant participants were more likely to meet criteria for a clinical depression diagnosis (MDD or DD), whereas vindictive participants were more likely to have sD. Our results indicate that interpersonal problems could account for heterogeneity observed in depression.     

Self-image of emotionally disturbed adolescents

This study examined the ways in which normal, depressed, and conduct-disordered adolescents differ with regard to self-image. Normal and psychiatrically hospitalized adolescents completed the Offer Self Image Questionnaire for Adolescents (OSIQ). Patients were grouped on the basis of their DSM-III diagnoses, and their OSIQ scores were compared. Major depressive disorder, particularly the first episode, was associated with poor self-evaluation in multiple areas, while conduct disorder was associated with almost no specific self-image deficits. For younger (12- to 15-year-old) adolescents, a repeated episode of depression was associated with a poorer selfimage than was a diagnosis of dysthymic disorder or a typical depression, but a better self-image than a single episode of depression, suggesting that at this age, repeated episodes are met with internal adaptation rather than continued self-devaluation. Adolescents who received a diagnosis of both conduct disorder and major depression reported an overall level of self-image disturbance between those with either of these disorders alone, suggesting that acting-out behaviors may attenuate the self-devaluing experience of depression. Results are discussed in terms of current issues in adolescent development and developmental psychopathology.Portions of this article were presented at the annual meeting of the Midwestern Psychological Association, Chicago, 1986, and the annual meeting of the Association for the Advancement of Behavior Therapy, Chicago, 1986. The author wishes to express her appreciation to Kenneth I. Howard for his continued guidance throughout this project; to Lauren B. Alloy, Richard R. Bootzin, G. Daniel Lassiter, William Revelle, and two anonymous reviewers for helpful comments on an earlier draft; to Daniel Offer and Eric Ostrov for allowing use of their normative data; and to the staff of Charter Barclay and Riveredge Hospitals for their assistance in the data collection.     

Screening and assessment of psychosocial dysfunction in a private pediatric practice

Fifty-one mother-infant pairs were screened at birth and at one month of age using the Neonatal Perception Inventories (NPI). This instrument identified 20 infants who were judged at high risk for the development of subsequent emotional disorder. Evaluation of the study group at 14–17 months of age, using the Infant Mental Health Profile, documented impairment in the areas of attachment, confidence and coping in 80–95% of those infants with high risk NPI ratings. The use of the NPI as a screening instrument in a primary care private pediatric setting is discussed.     

The Szondi Test in a Psychological Battery: Two Case Studies

This study investigated MMPI Characteristics of male and female adolescent inpatients with diagnoses of borderline personality disorder (n = 28) in contrast to adolescent inpatients receiving principal diagnoses of conduct disorder (n = 21), dysthymic disorder (n = 50), other personality disorders (n = 17), and other diagnoses (n = 30). The borderline group has significantly higher elevations than comparison groups on MMPI Scales F, Hs, D, Pd, Pa, Pt, Sc, and Ma. A stepwise discriminant analysis resulted in 82.1%. accuracy in correctly classifying borderline patients and 78.0% accuracy in identifying, nonborderline patients. Findings are discussed in terms of potential uses and limitations in identifying borderline personality disorder with the MMPI.     

Do Childhood Externalizing Disorders Predict Adult Depression? A Meta-Analysis

Childhood externalizing disorders have been linked to adult affective disorders, although some studies fail to substantiate this finding. Multiple longitudinal cohort studies identifying childhood psychopathology and their association with adult psychiatric illness have been published. To examine the association between childhood externalizing symptoms or disorders and the development of adult depression across cohorts, a meta-analysis was performed. Potential studies were identified using a PubMed search through November 2013. All published, prospective, longitudinal, community-sampled cohort studies of children (≤ 13 years) with externalizing symptoms or disorders (aggression, conduct problems, oppositional defiant disorder, conduct disorder), reassessed in adulthood (≥ 18 years) for depressive disorders (major depressive disorder, depressive disorder NOS, or dysthymic disorder) were included. A random effects model was used to summarize the pooled effect sizes. Ancillary analyses considered covariates that could account for variance among studies. Ten studies representing eight cohorts of children initially assessed at age 13 or younger (N?=?17,712) were included in the meta-analysis. Childhood externalizing behavior was associated with adult depressive disorders (OR?=?1.52, 95 % confidence interval?=?1.27–1.80, p?相似文献   

A Rorschach study of attachment and anxiety in inpatient conduct-disordered and dysthymic adolescents.

We investigated the constructs of attachment and anxiety in inpatient conduct-disordered and dysthymic adolescents. Texture, diffuse shading, and pure human content (Exner, 1986) Rorschach indices were compared between 48 subjects who met the criteria for conduct disorder and 30 subjects who met the criteria for dysthymia, according to the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-III-R]; American Psychiatric Association, 1987). We also compared mild, moderate, and severe conduct-disorder groups on the three selected Rorschach variables and investigated certain family characteristics for the two groups. We found a lower frequency of texture and pure human content responses in conduct-disordered subjects and a greater frequency of diffuse shading responses in the dysthymic subjects. The conduct-disordered subjects also came from homes in which the mother figure was significantly less present. Our psychometric findings of lessened attachment and diminished anxiety in the conduct-disordered adolescents are similar to adult psychopaths. We urge that an attachment or socialization disturbance criterion be reintroduced into the forthcoming DSM-IV conduct-disorder diagnosis.     

Rethinking the mood and anxiety disorders: a quantitative hierarchical model for DSM-V

The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) groups disorders into diagnostic classes on the basis of the subjective criterion of "shared phenomenological features." There are now sufficient data to eliminate this rational system and replace it with an empirically based structure that reflects the actual similarities among disorders. The existing structural evidence establishes that the mood and anxiety disorders should be collapsed together into an overarching class of emotional disorders, which can be decomposed into 3 subclasses: the bipolar disorders (bipolar I, bipolar II, cyclothymia), the distress disorders (major depression, dysthymic disorder, generalized anxiety disorder, posttraumatic stress disorder), and the fear disorders (panic disorder, agoraphobia, social phobia, specific phobia). The optimal placement of other syndromes (e.g., obsessive-compulsive disorder) needs to be clarified in future research.     

Categorical versus dimensional status of borderline personality disorder

One of the many controversies concerning the borderline personality disorder (BPD) diagnosis is whether the construct refers to a categorical or dimensional variable. The current study used Meehl's (1973) maximum covariance analysis to investigate this issue. The charts of 409 psychiatric inpatients were systematically reviewed for the presence of BPD and dysthymic symptoms. Charts of 244 inpatients were also reviewed to assess the presence of indicators of male sex, a categorical variable. The results for BPD and dysthymia were consistent with a dimensional model, whereas those for male sex were consistent with a categorical model. A dimensional model of classification of BPD is recommended, and suggestions for future research are provided.     

The Development and Validation of the Multicomponent AIDS Phobia Scale

The development, reliability, and validity of a new instrument, the Multicomponent AIDS Phobia Scale (MAPS), is described. Based on a sample of 181 university students, the results indicate that the MAPS has strong internal consistency and moderate test-retest reliability. In addition, an assessment of concurrent and discriminant validity indicates statistically significant correlations with other self-report measures of anxiety, hypochondriasis, obsessive-compulsive disorder, and fear of AIDS. The results of a factor analysis indicate that the scale consists of two factors: Fear of Infection and Fear of Others/Avoidance. Although further research with the MAPS in a clinical population is warranted to investigate the generalizability of this study's results, the instrument appears to be a reliable and valid measure of AIDS Phobia and may prove useful for improving clinical assessment and documenting treatment outcome.     

Psychoanalytic contributions to psychiatric nosology: forms of masochistic behavior

This paper summarizes the major strengths and weaknesses of current psychiatric nosology, and then discusses various forms of masochistic behavior as one illustration of how psychoanalysis can contribute to the continuing evolution of psychiatric nosology. Masochistic behavior is separated into behavior in which there is a predominantly conscious link between pleasure and pain, and behavior in which that link is predominantly unconscious. Both categories are further separated into normal and pathological forms. The current diagnostic category of dysthymic disorder is then discussed, with consideration given to the contribution that psychoanalysis can make toward the clarification and delineation of this heterogeneous diagnostic category.     

An Empirical Evaluation of the Diagnostic Criteria for Premenstrual Dysphoric Disorder: Problems with Sex Specificity and Validity

Premenstrual dysphoric disorder is a psychiatric disorder that reportedly affects between 3 to 8% of women. Although not an official diagnosis in the current Diagnostic and Statistical Manual of Mental Disorders, premenstrual dysphoric disorder has received increasing attention in the clinical literature, and considerable debate exists regarding the validity of this proposed condition. This study examined the prevalence of premenstrual dysphoric disorder in a sample of women and men and assessed the construct validity of the disorder. Twenty percent of women met the criteria for provisional diagnosis of premenstrual dysphoric disorder using Diagnostic and Statistical Manual criteria. In addition, 4% of men met these criteria when given sex-neutral assessment forms. Self-reported psychological distress and impaired interpersonal functioning did not predict women's likelihood of meeting the criteria for premenstrual dysphoric disorder. Results cast doubt on the sex-specificity of the diagnostic criteria of premenstrual dysphoric disorder and the construct validity of the disorder. Limitations of this study are discussed.     

The core elements of neurosis: mixed anxiety-depression (cothymia) and personality disorder

Although there has been great diagnostic activity within the conditions formally included under the general rubric of neurosis in the last 20 years, there is little evidence that the many new diagnoses (i.e., generalized anxiety disorder, panic disorder, social anxiety disorder, and dysthymic disorder) have helped clinicians and improved the health of those diagnosed. This is largely because of the extensive comorbidity between these disorders negates much of their attempted separation and it is argued that the core of neurosis is a mixed anxiety-depressive disorder, or cothymia, combined with significant personality disorder of any type. The specific association of the anxious-fearful personality cluster (cluster C) and neurosis, called the general neurotic syndrome, is also relevant but appears to have lesser significance as the personality elements are not stable. Data are presented that justify these conclusions from a long-term follow-up study of anxiety and depressive disorders.     

The Charcot Effect: The Invention of Mental Illnesses

This article proposes the Charcot effect, in which clinicians describe what they themselves prescribe. It is argued that the Charcot effect can be a critical instrument for exposing how mental illnesses are invented in the process of developing diagnostic systems and conducting psychopharmacological research. We argue that the Charcot effect helps explain the expansion of depression to epidemic proportions, the promotion of social phobia as a pharmaceutical marketing strategy, the profile of panic disorder according to the available medication, and the worse prognosis of schizophrenia in developed countries than in developing countries. Having undertaken this review, we situate the Charcot effect in relation to constructivist psychology.     

Maternal borderline personality disorder symptoms and adolescent psychosocial functioning

Borderline personality disorder (BPD) is characterized by severe disruption of interpersonal relationships, yet very little research has examined the relationship between maternal BPD and offspring psychosocial functioning. The present study examined 815 mothers and their 15-year-old children from a community-based sample to determine (1) if there is an association between mothers' BPD symptoms and the interpersonal functioning, attachment cognitions, and depressive symptoms of their offspring, and (2) if the association of maternal BPD and youth outcomes is independent of maternal and youth depression. Measures of youth psychosocial functioning included self, mother, interviewer rated, and teacher reports. Results indicated that there was a significant association between maternal BPD symptoms and youth outcomes, and that this association remained even after controlling for maternal lifetime history of major depression, maternal history of dysthymic disorder, and youth depressive symptoms. This study provides some of the first empirical evidence for a link between mother's BPD symptoms and youth psychosocial outcomes.     

Dimensions and Latent Classes of Episodic Mania-Like Symptoms in Youth: An Empirical Enquiry

The dramatic increase in diagnostic rates of bipolar disorder in children and adolescents in the USA has led to an intense interest in the phenomenology of the disorder. Here we present data from a newly-developed instrument to assess episodic mania-like symptoms in youth in a large population-based sample (N = 5326) using parent- and self-report. We found that a substantial proportion of children screened positive for having episodes of “going high” and were at an increased risk for morbidity and impairment. Using factor analysis, we identified that episodic mania-like symptoms comprised two dimensions: An under-controlled dimension that was associated with significant impairment, and a low-risk exuberant dimension. Using latent class analysis, we identified a small group of children scoring high on a range of manic symptoms and suffering from severe psychosocial impairment and morbidity. Our results carry implications for the nosology and psychosocial impairment associated with episodic mood changes in young people.     

Peer Nomination Inventory of Depression: Characteristics in a Spanish sample

The Peer Nomination Inventory of Depression (PNID) was answered by 1,121 children from Barcelona in the fourth year of grammar school and by their teachers (n=36) to analyze this questionnaire in a Spanish sample. The results indicated (1) high internal consistency; (2) discriminative power between depressed and nondepressed; (3) low concurrent validity; (4) convergent and discriminant validity; (5) a two-factor structure; and (6) that two discriminant functions could differentiate between depressed, dysthymic, and nondepressed subjects. The teacher's responses showed (1) moderate internal consistency; (2) discriminative power between depressed and nondepressed groups; (3) moderate concurrent validity; (4) and that two discriminant functions could differentiate between the diagnostic groups. The importance of the information given by the teacher to help detect severe depressive problems was pointed out.     

Chronic, low-grade depression in a nonclinical sample: depressive personality or dysthymia?

Depressive personality disorder (DPD) is being considered for inclusion in future editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM). However, there is substantial conceptual and empirical overlap between DPD and dysthymic disorder (Dysthymia) criteria, suggesting that these two constructs may not be distinct. Confirmatory factor analysis of the DPD traits and dysthymia symptoms in a large, nonclinical sample (N = 368) indicated that a two-factor model was a better fit than a one-factor model. However, binary diagnostic analysis revealed that over half of the individuals meeting criteria for DPD also met criteria for dysthymia and that the best-fitting model allowed the psychological symptoms of dysthymia to load on both DPD and dysthymia latent factors. All of the individuals with DPD alone failed to meet criteria for dysthymia because they did not report chronic depressed mood. Our results suggest that although DPD is not synonymous with Dysthymia, it may be a milder subtype.