Identifying Depressed Patients With a High Risk of Comorbid Anxiety in Primary Care

Felker, Bradford; Hedrick, Susan C.; Chaney, Edmund F.; Liu, Chuan‐Fen; Heagerty, Patrick J.; Caples, Heather; Lin, Patricia; Katon, Wayne

doi:10.4088/pcc.v05n0301

Cited by 11 publications

(7 citation statements)

References 32 publications

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“…When considering our results' specificity to PTSD, our participants with panic evidenced higher depressive severity than those without. Coupled with previous work, 48 this finding suggests that comorbid panic might also complicate primary care-based depression treatment. Notwithstanding this possibility, MDD-PTSD+ patients who reported panic did not experience worse depression than those who did not.…”

Section: Discussionmentioning

confidence: 70%

Prevalence of Depression–PTSD Comorbidity: Implications for Clinical Practice Guidelines and Primary Care-based Interventions

et al. 2007

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Section: Discussionmentioning

confidence: 70%

Prevalence of Depression–PTSD Comorbidity: Implications for Clinical Practice Guidelines and Primary Care-based Interventions

et al. 2007

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“…Brewin et al (2010) mentioned that patients with posttraumatic stress disorder, other anxiety disorders, depression, eating disorders, and psychosis frequently report repeated visual intrusions corresponding to a small number of real or imaginary events, which are usually extremely vivid, detailed, and with highly distressing content. These studies (Liebowitz and Klein, 1979;Hackmann et al, 2000;Felker et al, 2003;Brewin et al, 2010) may provide further evidence for the existence of ADAs in western countries. Self-damage, which is often observed in ADA, is said to be closely related to borderline personality disorder (Evren et al, 2012).…”

Section: Discussionmentioning

confidence: 99%

“…Intrusive thoughts in the ruminations were often linked to adverse interpersonal events, both in their study (Hackmann et al, 2000) and ours. Felker et al (2003) reported that 21.9 of the patients with depression suffer from comorbid flashbacks and panic attacks. Brewin et al (2010) mentioned that patients with posttraumatic stress disorder, other anxiety disorders, depression, eating disorders, and psychosis frequently report repeated visual intrusions corresponding to a small number of real or imaginary events, which are usually extremely vivid, detailed, and with highly distressing content.…”

Section: Discussionmentioning

confidence: 99%

Anxious-Depressive Attack: An Overlooked Condition A Case Report

Kaiya

2016

Anxiety Disord Res

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Patients with anxiety and/or depressive disorders often experience sudden intense feelings of distressing emotions, including sadness, anxiety, loneliness, gloom and so on, without any apparent psychological reason. Tearfulness often precedes or accompanies such emotional outburst. In addition to these emotional symptoms, mild physiological symptoms similar to those seen in a panic attack, such as palpitations, dizziness, trembling and so on, may appear. Immediately after this emotional outburst, distressing trains of thought or images related to recent or past unpleasant events are experienced and ruminated on repeatedly. They are often manifested as flashbacks with or without visual images. Since these conditions are the bitterest experiences for most patients, they may cope with them in various ways such as deliberate self-harm. These patients generally have a more or less depressive mood. These conditions are considerably different from a panic attack, in that the emotional and cognitive storm dominates the physical one. The author named this condition as an Anxious-Depressive Attack (ADA). In this study, we present five cases of ADA and discuss their psychopathology and differential diagnoses. To the author's knowledge, this is the first report proposing the term ADA, which is a unique but common syndrome. Awareness regarding ADA may help improve understanding and treatment of the patient.

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“…Moreover, the high health care costs associated with depression [Mulrow et al, 1995] could probably be decreased if identification, and thus also initiation of treatment, could be facilitated. Because there is evidence that patients with depression and comorbid anxiety are more severely impaired than patients with depression alone [Felker et al, 2003] and effective treatments exist for both disorders (e.g., serotonin reuptake inhibitors or newer antidepressants, such as venlafaxine, and psychotherapeutic interventions such as cognitive-behavioral therapy), identification would even be more important. Most previous screening studies did not account for comorbid conditions.…”

Section: Impact Of Comorbidity On Screening Resultsmentioning

confidence: 99%

Depressive, anxiety, and somatoform disorders in primary care: prevalence and recognition

et al. 2007

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Recent studies emphasize the negative impact of comorbidity on the course of depression. If undiagnosed, depression and comorbidity contribute to high medical utilization. We aimed to assess (1) prevalences of depression alone and with comorbidity (anxiety/somatoform disorders) in primary care, (2) coexistence of anxiety/somatoform disorders in depressive patients, and (3) diagnostic validity of two screeners regarding depression with versus without comorbidity. We examined 394 primary care outpatients using the Composite International Diagnostic Interview (CIDI), the General Health Questionnaire (GHQ-12), and the Well-Being Index (WHO-5). We conducted configurational frequency analyses to identify nonrandom configurations of the disorders and receiver operating characteristic (ROC)-analyses to assess diagnostic validity of the screeners. Point prevalence of any depressive disorder was 22.8%; with at least one comorbid disorder, 15%; and with two comorbid conditions, 6.1%, which significantly exceeded expected percentage (0.9%, P< or =.0001). Depression without comorbidity occurred significantly less often than expected by chance (P< or =.0007). Comorbidity of depressive and anxiety or somatoform disorders was associated with a high odds ratio (6.25). The screeners were comparable regarding their diagnostic validity for depression with [GHQ-12: area under the curve (AUC)=0.86; WHO-5: AUC=0.88] and without comorbidity (GHQ-12: AUC=0.84; WHO-5: AUC=0.86). It can be concluded that comorbidity between depression and anxiety/somatoform disorders in primary care may occur much more frequently than expected. These results confirm assumptions that the current division between depression and anxiety might be debatable. Validity of screeners tested in our study was not affected by comorbid conditions (e.g., anxiety or somatoform disorders).

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Identifying Depressed Patients With a High Risk of Comorbid Anxiety in Primary Care

Cited by 11 publications

References 32 publications

Prevalence of Depression–PTSD Comorbidity: Implications for Clinical Practice Guidelines and Primary Care-based Interventions

Prevalence of Depression–PTSD Comorbidity: Implications for Clinical Practice Guidelines and Primary Care-based Interventions

Anxious-Depressive Attack: An Overlooked Condition A Case Report

Depressive, anxiety, and somatoform disorders in primary care: prevalence and recognition

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