Recognition of personality disorder and anxiety disorder comorbidity in patients treated for depression in secondary psychiatric care

Abstract

ObjectivesDepression is a common illness with substantial economic consequences for society and a great burden for affected individuals. About 30% of patients with depression do not respond to repeated treatments. Psychiatric comorbidity is known to affect duration, recurrence and treatment outcome of depression. However, there is a lack of knowledge on the extent to which psychiatric comorbidity is identified in the clinical setting for depressed patients in secondary psychiatric care. Therefore, the aim of this study was to compare the agreement between traditional diagnostic assessment (TDA) and a structured and comprehensive diagnostic procedure (SCDP) for identification of personality and anxiety disorder comorbidity in depressed patients in secondary psychiatric care. Methods274 patients aged 18-77 were referred from four secondary psychiatric care clinics in Sweden during 2012-2017. ICD-10 diagnoses according to TDA (mostly unstructured by psychiatric specialist and residents in psychiatry), were retrieved from medical records and compared to diagnoses resulting from the SCDP in the study. This included the Mini International Neuropsychiatric Interview, the Structured Interview for DSM Axis II Personality Disorders and semi-structured questions on psychosocial circumstances, life-events, psychiatric symptoms, psychiatric treatments, substance use, and suicidal and self-harm behaviour.The assessment was carried out by psychiatric specialists or by residents in psychiatry with at least three years of psychiatric training.

Investigation of early and lifetime clinical features and comorbidities for the risk of developing treatment-resistant depression in a 13-year nationwide cohort study

“…Physical comorbidities, including diabetes [ 15 , 16 ], heart diseases [ 17 ], functional gastrointestinal disorders (FGIDs) [ 18 ], thyroid disease [ 19 ], systemic lupus erythematosus (SLE) [ 20 ], and rheumatoid arthritis [ 21 ], have been implicated in the development and prognosis of common mental disorders, especially mood disorders. In addition, a group of anxiety disorders (including panic disorder, generalized anxiety disorder, social anxiety disorder, and obsessive-compulsive disorder), attention deficit hyperactivity disorder (ADHD), substance use disorders (SUDs), and personality disorders were found to be more prevalent in patients with MDD [ 22 – 25 ], or predictive of worse outcomes or slower remission [ 24 ]. This emergent evidence has indicated that both physical and psychiatric comorbidities might prolong the course of depression and worsen clinical outcomes.…”

Recognition of anxiety disorders in children: a cross-sectional vignette-based survey among general practitioners

“…This low recognition rate might be a consequence of similar number of cues for anxiety (8) and depression (7) in this vignette, the large conceptual overlap between anxiety and depression and that MHPs might also be more attuned towards depression. 49 GPs could not indicate watchful waiting for the vignettes in this study overestimating the likelihood that GPs take any action when presented with children similar to the vignettes. In conversations with GPs.…”

Schema therapy versus cognitive behavioral therapy versus individual supportive therapy for depression in an inpatient and day clinic setting: study protocol of the OPTIMA-RCT

“…Besides its high rates of recurrence and nonresponders to therapy, MDD is characterized by its heterogeneity of symptoms [16] and comorbidities on axis I and II [17][18][19]. Especially personality disorders are highly prevalent in inpatient settings [20], they increase the time for remission [21], and lower positive outcome in the treatment of MDD [22].…”