J. Pössl

Anxiety and depression: comorbidity, psychopathology, and social functioning.

A sample of 48 former nonpsychotic inpatients was studied with respect to the overlap of depression and anxiety. Particular emphasis was placed on social dysfunctions associated with anxiety disorder as both a pure and a mixed condition. Furthermore, another question examined was whether social dysfunctions represent a risk factor for the development of a severe depression. Almost 40% of patients with a DSM-III anxiety disorder (during the last 4 weeks before follow-up) simultaneously fulfilled the criteria of a depressive disorder, mainly those of a major depression. While the course of symptomatology for both the pure anxiety and the mixed group had been rather similar over a long period of time, social dysfunctions before index admission had been generally more pronounced in patients who later developed a severe secondary depression. Social dysfunctions of patients with both disorders are not exclusively explainable by a higher severity of symptoms or the presence of particular personality features.

A case history analysis of the “manic type” and the “melancholic type” of premorbid personality in affectively ill patients

SummaryThe use of case histories in examining the premorbid personality of affectively ill patients is especially useful in the case of patients with a predominantly manic course of the disorder, because this kind of affective illness is very rare. The concept of the “manic type” of premorbid personality is described in detail and contrasted with the concept of the “melancholic type” often found in patients with a purely depressive course of the illness.

An operationalized procedure for the recognition of premorbid personality types in biographical case notes on psychiatric patients

SummaryA method for the assessment of six premorbid personality types from biographical data in psychiatric case histories is described. Trained raters have to fill in a list comprising 106 items as descriptors of a patients premorbid behavioural development. The assignment to the types in question (the “manic type” and its rare variant, the “happy-go-lucky type”, the “melancholic type”, the “anxious insecure type” and its rare variant, the “unrealistic dreamy type”, and finally, the “nervous tense type”) is computed on the basis of the item scores by forming type scores and comparing their height intraindividually. The subject under study is assigned to the type reaching the comparatively highest value. Two raters independently analyzed 261 records from which all information on mental disorders in family members and the patient himself/herself as well as all biographical data from the first manifestation of a symptom disorder onwards had been erased by technical assistants. In 106 of the records, a global assignment to the types of premorbid personality had already been performed by one of the authors of the typology. The scores for the same type assessed by the two ratings correlated highly with each other (0.77 to 0.80), the concordance of types reached a kappa-value of 0.55 (P<0.001), and the results of the operationalized typing agreed in the same order with the result of global typing in the subsample ofn=106. The distributionof types over clinical groups (affective, schizoaffective, and schizophrenic psychoses, neurotic and personality disorders) deviated significantly from chance expectancy, well in accord with clinical expectancy and, as far as available, with results of prospective studies on premorbid personality. This points to the clinical validity of the procedure which can therefore be recommended as an adjunct to the questionnaire approach with its limitations regarding diagnostic and prognostic (predictive) validity.