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Clinical correlates and symptom patterns of anxious depression among patients with major depressive disorder in STAR*D
- MAURIZIO FAVA, JONATHAN E. ALPERT, CHERYL N. CARMIN, STEPHEN R. WISNIEWSKI, MADHUKAR H. TRIVEDI, MELANIE M. BIGGS, KATHY SHORES-WILSON, DON MORGAN, TERRY SCHWARTZ, G. K. BALASUBRAMANI, A. JOHN RUSH
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- Journal:
- Psychological Medicine / Volume 34 / Issue 7 / October 2004
- Published online by Cambridge University Press:
- 21 October 2004, pp. 1299-1308
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- Article
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Background. Anxious depression, defined as Major Depressive Disorder (MDD) with high levels of anxiety symptoms, may represent a relatively common depressive subtype, with distinctive features.
Objective. The objective of this study was to determine the prevalence of anxious depression and to define its clinical correlates and symptom patterns.
Method. Baseline clinical and sociodemographic data were collected on 1450 subjects participating in the STAR*D study. A baseline Hamilton Rating Scale for Depression (HAM-D) Anxiety/Somatization factor score of [ges ]7 was considered indicative of anxious depression. The types and degree of concurrent psychiatric symptoms were measured using the Psychiatric Diagnostic Screening Questionnaire (PDSQ), by recording the number of items endorsed by study participants for each diagnostic category. MDD symptoms were assessed by clinical telephone interview with the 30-item Inventory of Depressive Symptomatology (IDS-C30).
Results. The prevalence of anxious depression in this population was 46%. Patients with anxious MDD were significantly more likely to be older, unemployed, less educated, more severely depressed, and to have suicidal ideation before and after adjustment for severity of depression. As far as concurrent psychiatric symptoms are concerned, patients with anxious depression were significantly more likely to endorse symptoms related to generalized anxiety, obsessive compulsive, panic, post-traumatic stress, agoraphobia, hypochondriasis, and somatoform disorders before and after adjustment for severity of depression. Anxious-depression individuals were also significantly less likely to endorse IDS-C30 items concerning atypical features, and were significantly more likely to endorse items concerning melancholic/endogenous depression features.
Conclusion. This study supports specific clinical and sociodemographic correlates of MDD associated with high levels of anxiety (anxious depression).
4 - Regulation of emotion in generalized anxiety disorder
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- By Douglas S. Mennin, Yale University, Cynthia L. Turk, LaSalle University, Richard G. Heimberg, Temple University, Cheryl N. Carmin, University of Illinois-Chicago
- Edited by Mark A. Reinecke, Northwestern University Medical School, Illinois, David A. Clark, University of New Brunswick
- Foreword by Aaron T. Beck
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- Book:
- Cognitive Therapy across the Lifespan
- Published online:
- 05 July 2014
- Print publication:
- 25 September 2003, pp 60-89
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- Chapter
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Summary
Introduction
Interest in the study of anxiety disorders has increased dramatically since the publication of the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III; American Psychological Association (APA), 1980). In fact, the 1980s witnessed a 10-fold increase in the number of published articles devoted to the study of anxiety disorders (Norton et al., 1995), and anxiety disorders were the topic of 14% of the articles published in clinical psychology and psychiatry journals between 1990 and 1992 (Cox et al., 1995). The large majority of these studies focused on panic disorder (McNally, 1994) and social phobia (Heimberg et al., 1995). However, investigations of generalized anxiety disorder (GAD) have recently begun to appear with increasing frequency (Borkovec et al., 1991; Brownand Barlow, 1992; Wittchen et al., 1994).
Compared to other anxiety disorders, GAD remains poorly understood. Advances in understanding have been slowed by the evolving definition of the disorder. In DSM-III, GAD was a residual category that could not be diagnosed in the presence of any other anxiety or affective disorder (APA, 1980). Attempts to diagnose GAD according to DSM-III criteria were also characterized by low inter-rater reliability (Barlow, 1987). However, the diagnostic criteria for GAD changed substantially from DSM-III to DSM-IV (APA, 1994). GAD is no longer considered to be a residual category, but a disorder specifically characterized by excessive and uncontrollable worry and somatic symptoms suggestive of central nervous system hyperarousal (e.g., muscle tension).