Erika Szádóczky

Anxiety disorders comorbidity in bipolar I, bipolar II and unipolar major depression: results from a population-based study in Hungary

BACKGROUND The aim of this study was to analyze the lifetime comorbidity between DSM-III-R anxiety disorders in separate subgroups of patients with major depression, bipolar II and bipolar I disorder in a community sample of a Hungarian population. METHODS Randomly selected subjects (aged between 18 and 64 years, N=2953) were interviewed by the Diagnostic Interview Schedule (DIS) which generated DSM-III-R diagnoses. RESULTS The prevalence of generalized anxiety disorder, agoraphobia and simple phobia was the highest among bipolar II patients (20.8, 37.5 and 16.7%, respectively), social phobia was most prevalent in (nonbipolar) major depression (17.6%), while the rate of panic disorder was the same in the (nonbipolar) major depressive and bipolar II subgroups (12.4 and 12.5%, respectively). Bipolar I patients showed a relatively low rate of comorbidity. CONCLUSIONS The findings support previous results on the particularly high rate of lifetime comorbidity between anxiety disorders and unipolar major depression and particularly bipolar II illness. LIMITATIONS Underestimation of the prevalence of bipolar II disorder by the diagnostic methodology used, resulting in a small number of bipolar II cases, lack of analysis of data by gender, no data on obsessive-compulsive disorder.

Suicide attempts in the Hungarian adult population. Their relation with DIS/DSM-III-R affective and anxiety disorders

Prevalence of suicide attempts and their relationship with DIS anxiety and affective disorder diagnoses were investigated in a Hungarian adult community sample. Despite the high suicide mortality rate, the rate of suicide attempts was similar to that reported in other studies using similar methods. Suicide attempts occurred more frequently among women and previously married persons. Although the presence of any lifetime anxiety and/or affective disorder increased the rate of reported suicide attempts, the effect of co-morbidity, recurrence and chronicity might be considered significant predictors. The highest odds of an attempt were related to the diagnoses of dysthymic or bipolar disorders. Agitation was the only depressive symptom, which increased the odds of a suicide attempt.

The role of psychosocial and biological variables in separating chronic and non-chronic major depression and early-late-onset dysthymia

Psychosocial (sociodemographic characteristics, loss and separation and family atmosphere in childhood, recent life events) and biological (family history, DST, TRH-test) variables were investigated in 180 patients with Major Depression (MD) and Dysthymic Disorder (DD). The aim of the study was to reveal certain differences between the chronic and non-chronic course of MD and the early- and late-onset subtypes of dysthymia. When comparing the two course patterns of MD, a higher rate of malignant tumours among first-degree relatives, a greater number of long-lasting stress situations before the index depressive episode, longer duration of the previous episodes, less frequent DST nonsuppression, and a blunted TSH response to TRH were found in patients with a chronic course of MD. Several factors seem to influence the course pattern of MD, or else the chronic form represents a subgroup within MD. The late-onset dysthymics were mainly women with a low level of education, a lower suicidal tendency, normal suppression in DST, and a lack of blunted TSH responses to TRH administration during the period of double depression. The early-onset dysthymics showed a higher number of persons who had never married, who presented a more traumatic and frustrating childhood background, and who had a higher rate of DST non-suppressors and blunted TSH responses after TRH administration during the period of their double depression. Our data suggest that late-onset dysthymia might be a biologically distinct subgroup of chronic depression.

Phototherapy increases platelet 3H-imipramine binding in patients with winter depression

The density of platelet 3H-imipramine binding sites (Bmax) was investigated in seven inpatients with winter depression before and after incandescent light treatment and in seven healthy volunteers within a 7-day interval without light exposure. A significantly lower mean Bmax value was found in the depressed patients compared to the controls. After light treatment, parallel to a marked clinical improvement, Bmax increased in each patient and reached or even exceeded the mean values of the controls. These results indicate that in patients with winter depression the decreased Bmax value is state-dependent. The incandescent light treatment has beneficial effect in winter depressives and can influence Bmax values.

Anxiety and mood disorders in primary care practice.

Anxiety and mood disorders are common conditions in primary health care service. Primary care physicians (PCPs) have a privileged role in the early recognition of these conditions. In this study, the prevalence rates of threshold and subthreshold mood and anxiety disorders were surveyed among 1815 primary care attendees in 12 PCPs’ offices in Budapest, using the Diagnostic Interview Schedule (DIS). The 1-year prevalence of DIS/DSM-III-R anxiety and/or mood disorders was 16.8%, and the 1-month prevalence was 12.5%. The occurrence rates of subthreshold anxiety and/or depression were 25.7 and 13.1%, respectively. The impact of threshold anxiety and mood disorders on work performance was considerably higher than the impact of subthreshold symptoms. At the time of the interview, 6.7% of the patients received mood and/or anxiety disorder diagnoses by their PCPs. The measure of agreement between the diagnoses generated by the DIS and the ones given by the PCPs was low. The presence of an acute or chronic physical illness made it more difficult for the PCPs to recognize a psychiatric disorder. Conversely, patients’ psychological complaints significantly improved the recognition of anxiety and/or mood disorders. The use of the Beck Depression Inventory (BDI) brief version would help the patients to reveal their psychological symptoms, and the physicians to recognize an underlying psychiatric disorder.

Dexamethasone suppression test and TRH-TSH test in subaffective dysthymia and character-spectrum disorder

Based on Akiskals criteria of subaffective dysthymia (SDT) and character-spectrum disorder (CSD) as the two, etiologically distinct forms of early-onset primary dysthymia, the authors investigated the dexamethasone suppression test (DST) in 18 patients with SDT and in 30 patients with CSD. TRH-TSH test was also investigated in smaller subsamples of the patients (n = 8, and n = 7, respectively). Fifty percent of the patients with SDT showed abnormal DST and TRH-TSH test results respectively, while the figures in the CSD patients were 7% and 0%. These findings suggest that SDT is a clinically diagnosable and biologically distinct subgroup within the broader category of early-onset primary dysthymia, which represents a symptomatically milder version of primary affective disorder.

Lifetime patterns of depressive symptoms in the community and among primary care attenders: an application of grade of membership analysis

The objective of this study was to describe empirical and natural lifetime patterns of depressive and anxiety symptoms reported by community respondents and primary care attenders. The Grade of Membership model was used to analyze data collected from 716 subjects between 18 and 64 years of age with a lifetime diagnosis of DIS/DSM-III-R Major Depressive Episode. Symptoms of depression, mania, and anxiety (GAD, panic attack, and phobias) were processed. Six prototype categories (pure types) provided the best description of the structure of symptoms included in the analysis. Type I: bipolar depression with marked suicidal behaviour, comorbidity and early onset. Type II: non-melancholic-somatisation depression with late onset. Type III: non-melancholic, non-severe bipolar depression with male preponderance. Type IV: depression secondary to anxiety with marked female preponderance. Type V: melancholic depression with suicide ideation. Type VI: melancholic depression with panic attacks and female preponderance. The results support the heterogeneity of the longitudinal symptom pattern of depression and the existence of two time-trend types of comorbid anxiety disorders.

Effect of phototherapy on 3H-imipramine binding sites in patients with SAD, non-SAD and in healthy controls

The effect of incandescent light treatment on the density of 3H-imipramine binding sites (Bmax) was investigated in 17 patients with seasonal affective disorder, in eight patients with non-seasonal depression and in six healthy volunteers. A significant increase in mean Bmax value parallel to a marked improvement of the depressive symptoms was found only in patients with SAD. No effect was observed either on mean Bmax value or on clinical symptoms in patients with non-SAD and on mean Bmax value in healthy volunteers.

Influyen el sexo y la ansiedad en el resultado del tratamiento de la Depresión

We managed a follow-up study to reveal the effect of gender and coexisting anxiety on treatment outcome in depression. The state of our 150 consecutive inpatients with unipolar major depression were followed up. We used Hamilton Depression Rating Scale, Zung Self Rating Depression Scale and Spielberger Stait-Trait Anxiety Inventory. Ninety-three patients (62%) completed the trial, the mean follow-up duration was 2.95 years. On admission, we found gender difference neither in the severity of depression nor in coexisting anxiety. Females presented more anxiety traits and responded better to antidepressive medication till week six (65% vs. 50% response rate). The severity of coexisting anxiety did not modify the response rate. Although depression decreased significantly in both genders, 36.6% of the total population (with a relative overrepresentation of males) were depressed at closer visit. In summary, female gender was associated with better outcome, while coexisting anxiety had no effect on therapy-response.