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Objective The study focused on the relationship between mixed depression and borderline personality disorder (BPD). Method The sample comprised 2811 patients with a major depressive episode (MDE). Clinical characteristics were compared in patients with (BPD+) and without (BPD−) comorbid BPD and in BPD+ with (MXS+) and without (MXS−) mixed features according to DSM-5 criteria. Results A total of 187 patients (6.7%) met the criteria for BPD. A DSM-IV-TR diagnosis of bipolar disorder (BD) was significantly more frequent in patients with BPD+ than in patients with BPD. Patients with BPD+ were significantly younger and reported lower age at onset than BPD−. Patients with BPD+ also showed more hypomania/mania in first-degree relatives in comparison with patients with BPD−, as well as more psychiatric comorbidity, mixed features, atypical features, suicide attempts, prior mood episodes and antidepressant-induced hypo/manic switches. Mixed features according to DSM-5 criteria were observed in 52 (27.8%) BPD+. In comparison with MXS−, MXS+ were significantly younger at age of onset and at prior mood episode and had experienced more mood episodes and hypo/manic switches with antidepressant treatments. Conclusion Major depressive episode patients with comorbid BPD reported a high prevalence of mixed features and BD. The presence of DSM-5 mixed features in MDE patients with BPD may be associated with complex course and reduced treatment response.

Objective Self-reports such as Hypomania Checklist (HCL-32) can be used to enhance recognition of bipolar disorders, but they are often too long and only validated in clinical samples. The objectives of this study are therefore to test whether (i) the HCL-32 can be used for screening in the community and (ii) whether two previously suggested shorter versions would do as well. Method Data stemmed from the CoLaus|PsyColaus, a prospective cohort study which included randomly selected residents aged 35–66 years from an urban area. Participants underwent semistructured interviews to assess DSM-IV disorders and 1712 of them completed the HCL-32. Results Forty individuals (2.3%) were diagnosed as having BD. Compared to others, participants with BD scored significantly higher on the HCL-32. The HCL-32 had a sensitivity of 0.78 and specificity of 0.68. Very similar figures were found for two previously proposed shorter versions with 16 and 20 items. The results of confirmatory factor analysis and item response theory (IRT) models supported the postulated two-factor structure for the three HCL versions. Conclusion Despite the low base rate of BD in this sample, the screening properties of the HCL-32 remained almost as good. Importantly, two previously proposed shorter versions performed as well, suggesting that those could be used without losing essential information.

Angst J, Gamma A, Clarke D, Ajdacic-Gross V, Rossler W, Regier D. Subjective distress predicts treatment seeking for depression, bipolar, anxiety, panic, neurasthenia and insomnia severity spectra. Objective: To examine correlates of mental health treatment seeking such as gender, diagnosis, impairment, distress and mastery. Method: Longitudinal epidemiological data from the Zurich Study of common psychiatric syndromes, including unipolar and bipolar depression, panic, anxiety, neurasthenia and insomnia, were utilized. In longitudinal Generalized Estimating Equations, treatment seeking was regressed on measures of subjective distress and impairment, childhood family problems, mastery and number of comorbid diagnoses. Results: Approximately half of all treated participants across all six syndromes suffered from subthreshold disorders. Meeting full or subthreshold diagnostic criteria was associated with treatment seeking for insomnia. Being female was associated with treatment seeking for depression. The only variable highly and consistently associated with treatment seeking, across all syndromes, was subjective distress. Treated participants reported high levels of distress, work and social impairment in both diagnostic and subthreshold groups. Conclusion: Subjective distress may be a better indicator of treatment seeking than symptom count.

OBJECTIVE: To expand the concept of recurrent brief depression (RBD) to brief depression (BD) and to test its clinical relevance. METHOD: Subjects (N = 591) were studied prospectively six times from ages 20/21 to 40/41 years. RBD was defined according to DSM-IV as episodes under 2 weeks with about monthly recurrence and work impairment. BD embraces RBD and brief depressive episodes with a frequency of 1-11 per year. RESULTS: Pure BD and pure major depressive episodes (MDE) did not differ in treatment rates, family history of mood and anxiety disorders or comorbidity with bipolar spectrum and anxiety disorders but they differed in work impairment, suicide attempt rates and distress self-ratings. The combination of BD + MDE identified a very severe group of MDE, comparable with combined depression (MDE + RBD) and double depression (MDE + dysthymia). CONCLUSION: Our data argue for the use of BD as a diagnostic specifier for severe MDE. RBD remains an important independent subgroup.

Objective: It is generally accepted that one of the most important predictors of recurrence in depressive and bipolar disorders is the number of previous episodes. However, very few studies have considered the individual tendency toward recurrence in analyses of the effect of the number of episodes on the risk of subsequent recurrence in affective disorder. Method: Frailty models were used to estimate the effect of the number of episodes on the rate of recurrence taking into account the individual frailty toward recurrence. The study base consisted of 406 patients, 186 patients with depressive disorder and 220 patients with bipolar disorder, who were admitted between 1959 and 1963 to the Psychiatric Hospital University of Zurich with an affective episode and followed up to 1997. Results: The individual rate of subsequent recurrence was found to increase with the number of episodes even when the effect was adjusted for the individual frailty toward recurrence. The effect of episodes was the same in depressive and bipolar disorders and for men and women. Conclusion: It seems increasingly valid that in depressive and bipolar disorders, the risk of subsequent recurrence increases with the number of episodes.

Objective: To identify risk factors for mood disorders in a community sample studied from the ages of 20 to 35 years. Method: Social characteristics, a family history of mood disorders and some personality features were analysed as risk factors for bipolar and depressive disorders by means of logistic regression. Results: Frequent 'ups and downs' of mood were the strongest risk factor for both bipolar and depressive disorders; a weaker risk factor for both was emotional/vegetative lability (neuroticism). An additional risk factor for bipolar disorders was a positive family history of mania, whereas for depression it was a positive family history of depression/fatigue. As a risk factor for bipolar disorders, 'ups and downs' were much stronger than a positive family history of mania. Frequent ups and downs were independent of the family history of mood disorders. Conclusion: The results suggest that mood regulation should be investigated as a new, very important independent risk factor for mood disorders.

Objective: The Zurich study is a longitudinal study in psychiatric epidemiology that started in the late 1970s. The sixth interview in 1999 provides the basis to investigate and update the participation and drop-out patterns of the Zurich subjects. Method: Aside from descriptive analyses, particular attention was paid to the Symptom Checklist 90-R (SCL-90-R), used initially to stratify the Zurich sample. Results: The initial proportions of high-scorers vs. low-scorers (two-thirds vs. one-third) have not changed significantly in the 367 subjects who participated in the 1999 interview. More detailed analyses indicate a selective and changing dependence of participation/drop-out on health status as measured by the SCL-90R. In recent interviews drop-out has become more likely in subjects with extremely high SCL scores and in subjects with low SCL scores. Conclusion: Drop-out in the Zurich Study is associated with extreme SCL scores.

Objective: This report examines: 1) the magnitude of co-occurrence of threshold and subthreshold-level depression and anxiety in the community, and 2) the relationship between comorbidity and the diagnostic level of depression and anxiety and their clinical correlates. Method: A community sample of 591 subjects was interviewed prospectively five times across 15 years from the ages of 20-35, The diagnostic interview allowed the assignment of diagnoses according to DSM-III criteria and operational definitions of subthreshold syndromes. Results: I ) Comorbidity between depression and anxiety was more frequent when one syndrome reached threshold level; 2) comorbidity at both the threshold and subthreshold diagnostic levels was associated with symptom severity, disability and treatment, whereas the diagnostic level was associated with disability and suicidal attempts. Conclusion: The systematic association between comorbidity across diagnostic threshold levels of anxiety and depression with clinical correlates suggests the importance of a more dimensional approach to their classification.

Objective: The purpose of this paper is to examine the prevalence, clinical significance and comorbidity of perimenstrual symptoms/ syndrome (PERI-MS) in a community sample of women. Method: Premenstrual and menstrual physical and psychological symptoms were assessed in a prospective longitudinal study of a representative community cohort of women (N=299) who were interviewed five times between the ages of 21 and 35 years. Results: When classified according to the severity of distress, the prevalence rates were 8.1% for severe and 13.6% for moderate PERI-MS, respectively. Clinical indicators of severity were all greater among PERI-MS women with than without depressed mood. Conclusion: The results of this study suggest that irritability, nervousness and tension irrespective of the presence of concomitant depressed mood are core elements of the perimenstrual syndrome.

Depression is a serious condition associated with a high rate of recurrence in all populations of depressed patients. Research studies in the past have focused more on the criteria for onset of depressive disorder than on consistent criteria for outcome. However, the issue of concern to the patient is whether their depression is a lifelong condition or a condition from which they can reasonably expect to make a complete recovery. The issues surrounding recovery from depression are reviewed in the following article. The lifetime prognosis of depression is examined with reference to the Zürich follow-up study, and outcome criteria and the importance of assessing recovery in terms of quality of life as well as symptomatic improvement are considered. The relevance of clinical trial results to the clinical management of depression is also addressed.

Objective The study focuses on the controversial relationship between borderline personality disorder (BPD) and bipolar disorder (BD), defined according to different criteria set, in a world-wide sample of patients with a current major depressive episode (MDE). Method A total of 5635 patients with an MDE were enrolled in a multinational study, designed to assess varying definition of hypo/mania and familial and clinical variables associated with bipolarity. Patients with (BPD+) and without (BPD−)comorbid BPD were compared on sociodemographic, familial and clinical characteristics. Results Five hundred and thirty-two patients (9.3%) met criteria for BPD. A diagnosis of BD was more frequent in BPD+ than in BPD− using either DSM-IVTR-modified criteria or the bipolar specifier. BPD+ were younger than BPD− depressives with regard to age and age at onset. They also showed more hypomania/mania in first-degree relatives in comparison to BPD− as well as more psychiatric comorbidity, psychotic symptoms, mixed states, atypical features, seasonality of mood episodes, suicide attempts, prior mood episodes and antidepressants-induced hypo/manic switches. Conclusion In our sample, selected on the basis of the presence of a mood disorder, the BD-BPD connection is confirmed by the high prevalence of bipolarity in depressive patients with BPD and by the significant association with familial and clinical features classically considered as external validators of bipolarity.

The article reviews research and presents our results on the natural history of 2 forms of anxiety disorder, panic disorder and generalized anxiety disorder. Data from our epidemiological cohort study give evidence of premorbid anxiousness and overadaptation already in childhood. Distressing conditions in the family are more prevalent among subjects with anxiety disorders or major depression than among controls. Anxiety disorders frequently begin between age 20-30 and can be triggered by life events. The course is often characterized by a certain chronicity that manifests itself in residual symptoms and mild impairment in social roles even after many years and is frequently complicated with depression. The best predictors are severity and duration of symptoms, as well as comorbidity with depression. Future studies of the natural history should take into account these factors in multivariate approaches.

In this study, the association and outcome of panic and depression were investigated in an epidemiological cohort of young adults interviewed at age 21, 23, and 28. The prevalence rates of sporadic panic, panic disorder, major depression, and recurrent brief depression were very stable. There was a clear preponderance of females in all diagnoses. Panic and depression overlapped to a large extent cross-sectionally at all 3 interviews, and this overlap increased in a longitudinal perspective. For the analysis of outcome, the subjects were divided into 4 groups according to their diagnosis at the first interview: pure panic, pure depression, mixed panic and depression, and controls. Irrespective of the first diagnosis, the 7-year outcome showed a strong tendency to develop into pure depression or mixed panic and depression at follow-up interviews. In a longitudinal perspective, cases that suffered from both panic and depression appeared more severely ill, as expressed in very high treatment rates and a high rate of lifetime suicide attempts.