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Key biological factors that influence the development of depression are modified by diet. This study examined the extent to which the high-prevalence mental disorders are related to habitual diet in 1,046 women ages 20-93 years randomly selected from the population.A diet quality score was derived from answers to a food frequency questionnaire, and a factor analysis identified habitual dietary patterns. The 12-item General Health Questionnaire (GHQ-12) was used to measure psychological symptoms, and a structured clinical interview was used to assess current depressive and anxiety disorders.After adjustments for age, socioeconomic status, education, and health behaviors, a "traditional" dietary pattern characterized by vegetables, fruit, meat, fish, and whole grains was associated with lower odds for major depression or dysthymia and for anxiety disorders. A "western" diet of processed or fried foods, refined grains, sugary products, and beer was associated with a higher GHQ-12 score. There was also an inverse association between diet quality score and GHQ-12 score that was not confounded by age, socioeconomic status, education, or other health behaviors.These results demonstrate an association between habitual diet quality and the high-prevalence mental disorders, although reverse causality and confounding cannot be ruled out as explanations. Further prospective studies are warranted.

Objective: To improve interventions for depressed older adults, data are needed on the comparative effects of pharmacotherapy versus psychotherapy. Given that most older adults with clinically significant depressive symptoms do not have major depression, data on treatments for minor depression and dysthymia are especially needed. Method: Meta-analysis was used to integrate the results of 89 controlled studies of treatments focused on acute major depression (37 studies) and other depressive disorders (52 studies conducted with mixed diagnostic groups, including patients with major depression, minor depression, and dysthymia). A total of 5,328 older adults received pharmacotherapy or psychotherapy in these studies. Results: Clinician-rated depression scores improved, on average, by 0.80 standard deviation (SD) units; self-rated depression scores improved by 0.76 SD units. Clinician-rated depression improved by 0.69 SD units in pharmacotherapeutic studies and by 1.09 SD units in psychotherapeutic studies. Self-rated depression improved by 0.62 SD units and 0.83 SD units, respectively. An interesting finding was the stronger improvements in clinician-rated depression among control subjects participating in medication studies, compared to those in psychotherapeutic studies. Conclusions: Available treatments for depression work, with effect sizes that are moderate to large. Comparisons of psychotherapy and pharmacotherapy must be interpreted with caution, in part because medication studies are more likely to use a credible active placebo, which may lead to smaller adjusted effect sizes in medication studies. Given that psychotherapy and pharmacotherapy did not show strong differences in effect sizes, treatment choice should be based on other criteria, such as contraindications, treatment access, or patient preferences.

A 35-year-old woman was referred by her therapist for an evaluation of her sadness, irritability, fatigue, and poor concentration over a period of two and a half years, which did not improve significantly during the course of cognitive behavior therapy. She was taking hydrochlorothiazide, which was prescribed by her primary care physician for “a mild hypertension.” She had no other medical problems and no history of substance abuse, and she denied smoking tobacco. She reported that she was happily married and had a fulfilling, enjoyable sex life, having sexual intercourse with her husband once or twice a week. She was diagnosed as suffering from dysthymia, and treatment with 10 mg/day of fluoxetine was started. On follow-up 3 weeks later, she reported that she was still mildly depressed but was tolerating fluoxetine well, and the dose was increased to 20 mg/day. At the next 3-week follow-up visit, she reported complete relief of her depression and irritability. However, she complained about marital problems. Detailed questioning revealed a lack of sexual desire and difficulty in achieving orgasm—“if I have one at all,” she said. Although she blamed these problems on a lack of time for intimacy, stress at work, and other issues, it was apparent that the dysfunction was related to the treatment with fluoxetine. How common is lack of sexual desire, delayed orgasm, and anorgasmia associated with serotonergic antidepressants and other medications? What are the management strategies for these side effects?

The purpose of this study was to describe the 10-year course and outcome of dysthymic disorder.The authors conducted a naturalistic, prospective, longitudinal follow-up of 97 adults with early-onset dysthymic disorder and 45 adults with nonchronic major depressive disorder selected from consecutive admissions to several outpatient facilities. Follow-up data were obtained for 90% of the cohort. Assessments were conducted at baseline, 30, 60, 90, and 120 months. Measures included the Longitudinal Interval Follow-Up Evaluation and the Hamilton Depression Rating Scale.The Kaplan-Meier estimated recovery rate from dysthymic disorder was 73.9%, with a median time to recovery of 52 months. Among patients who recovered, the estimated risk of relapse into another period of chronic depression was 71.4%. Chronic depressive relapses took a variety of forms and were not limited to dysthymia. Nonetheless, the distinction between chronic and nonchronic forms of depression was relatively stable over the follow-up period. Mixed-effects models indicated that patients with dysthymic disorder experienced a significantly slower rate of improvement in symptoms over time and exhibited significantly greater depression at the 10-year point, compared to patients with nonchronic major depression.Dysthymic disorder has a protracted course and is associated with a high risk of relapse. The nature of chronic depressive episodes varies over time within individuals, indicating that the various manifestations of chronic depression in DSM-IV do not represent distinct disorders. However, the distinction between chronic and nonchronic forms of depression is relatively stable and may provide a useful basis for subtyping in genetic and neurobiological research.

Subsyndromal major depressive disorder is common among HIV-positive adults. This study was designed to assess the efficacy of dehydroepiandrosterone (DHEA) as a potential treatment.One hundred forty-five patients with subsyndromal depression or dysthymia were randomly assigned to receive either DHEA or placebo; 90% (69 of 77) of the DHEA patients and 94% (64 of 68) of the placebo patients completed the 8-week trial. The primary measure of efficacy was a Clinical Global Impression improvement rating of 1 or 2 (much or very much improved) plus a final Hamilton Depression Rating Scale scoreor=8. Outcome was assessed by using intent-to-treat analysis, followed by completer analysis. Safety was assessed by queries about side effects at every study visit plus measures of CD4 cell count and HIV RNA viral load at baseline and week 8. DHEA dosing was flexible (100-400 mg/day).On the basis of clinicians' ratings, DHEA was superior in the intent-to-treat analysis, where the response rate was 56% (43 of 77) for the DHEA group versus 31% (21 of 68) for the placebo group. In the completer analysis, the response rate was 62% (43 of 69) for the DHEA group, compared to 33% (21 of 64) for the placebo patients. The number needed to treat was 4 on the basis of intent-to-treat data and 3.4 on the basis of completer data. Few adverse events were reported in either treatment group, and no significant changes in CD4 cell count or HIV RNA viral load were observed in either group.Nonmajor but persistent depression is common in patients with HIV/AIDS, and DHEA appears to be a useful treatment that is superior to placebo in reducing depressive symptoms. The low attrition rate in this group of physically ill patients, together with requests for extended open-label treatment, reflect high acceptance of this readily available intervention.

17th Annual Fall Conference of the International-Society-for-the-Study-of-Dissociation -- 36842 -- SAN ANTONIO, TX, WOS: 000225503500019, PubMed ID: 15569899, Objective: The aim of this study was to evaluate dissociative disorder and overall psychiatric comorbidity in patients with conversion disorder. Method: Thirty-eight consecutive patients previously diagnosed with conversion disorder were evaluated in two follow-up interviews. The Structured Clinical Interview for DSM-III-R, the Dissociation Questionnaire, the Somatoform Dissociation Questionnaire, and the Childhood Trauma Questionnaire were administered during the first follow-up interview. The Structured Clinical Interview for DSM-IV Dissociative Disorders was conducted in a separate evaluation. Results: At least one psychiatric diagnosis was found in 89.5% of the patients during the follow-up evaluation. Undifferentiated somatoform disorder, generalized anxiety disorder, dysthymic disorder, simple phobia, obsessive-compulsive disorder, major depression, and dissociative disorder not otherwise specified were the most prevalent psychiatric disorders. A dissociative disorder was seen in 47.4% of the patients. These patients had dysthymic disorder, major depression, somatization disorder, and borderline personality disorder more frequently than the remaining subjects. They also reported childhood emotional and sexual abuse, physical neglect, self-mutilative behavior, and suicide attempts more frequently. Conclusions: Comorbid dissociative disorder should alert clinicians for a more chronic and severe psychopathology among patients with conversion disorder., Int Soc Study Dissociat

Objective: The validity of the distinctions between dysthymic disorder, chronic major depressive disorder, and episodic major depressive disorder was examined in a family study of a large community sample of young adults. Method: First-degree relatives (N=2,615) of 30 probands with dysthymic disorder, 65 probands with chronic major depressive disorder, 313 probands with episodic major depressive disorder, and 392 probands with no history of mood disorder were assessed by using direct interviews and informant reports. Results: The rates of major depressive disorder were significantly greater among the relatives of probands with dysthymic disorder and chronic major depressive disorder than among the relatives of probands with episodic major depressive disorder, who in turn exhibited a higher rate of major depressive disorder than the relatives of probands with no history of mood disorder. The relatives of probands with dysthymic disorder had a significantly higher rate of dysthymic disorder than the relatives of probands with no history of mood disorder, and the relatives of probands with chronic major depressive disorder had a significantly higher rate of chronic major depressive disorder than the relatives of probands with no history of mood disorder. However, the relatives of the three groups of probands with depression did not differ on rates of dysthymic disorder and chronic major depressive disorder. Conclusions: Chronic depression is distinguished from episodic depression by a more severe familial liability. This familial liability may contribute to the more pernicious course of chronic depression.

The authors' goal was to study the importance of different psychiatric disorders in relation to suicide in individuals 65 years old or older.The psychological autopsy approach was used to study 85 cases of suicide among subjects who were 65 years old or older; 153 living comparison subjects from the same age group who were randomly selected from the tax register were interviewed face-to-face. Retrospective axis I diagnoses were made according to DSM-IV on the basis of interview data and medical records.Ninety-seven percent of the suicide victims fulfilled criteria for at least one DSM-IV axis I diagnosis, compared with 18% of the living comparison subjects. Recurrent major depressive disorder was a very strong risk factor for suicide, as was substance use disorder. An elevated risk was also associated with minor depressive disorder, dysthymic disorder, psychotic disorder, single-episode major depressive disorder, and anxiety disorder. Comorbid axis I disorders were observed in 15 (38%) of the 39 elderly subjects with major depressive disorder who had committed suicide.Although recurrent major depressive disorder was the mental disorder most strongly associated with suicide, the findings of this study suggest that elderly individuals who commit suicide represent a heterogeneous group with regard to mental disorders, implying a need for differentiated prevention strategies.

The study examined the usefulness and clinical correlates of specific diagnostic criteria for apathy in Alzheimer's disease. Whereas apathy is a frequent behavioral change in patients with Alzheimer's disease, the lack of standardized diagnostic criteria may explain the wide discrepancies in estimates of the frequency and demographic and clinical correlates of apathy.A consecutive series of 319 patients who met the criteria for probable Alzheimer's disease established by the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association, 117 patients who met the DSM-IV criteria for depression without dementia, and 36 healthy individuals were assessed with a structured psychiatric interview. On the basis of modified Marin's criteria for apathy, they were classified into groups with or without apathy.Apathy was diagnosed in 37% of the 319 Alzheimer's disease patients, compared to none of the healthy comparison subjects. In 24% of the Alzheimer's disease sample, apathy coexisted with either dysthymic disorder or major depressive disorder, whereas 13% had apathy without depression. Apathy was diagnosed in 32% of the depressed nondemented patients, mostly in those with major depressive disorder. Apathy in Alzheimer's disease was significantly associated with severe impairments in activities of daily living and cognitive functions, older age, and poor awareness of behavioral and cognitive changes.This study provides partial validation of specific clinical criteria for apathy in Alzheimer's disease.

The authors sought to determine whether subjects with the sole diagnosis of depressive personality disorder are at higher risk for developing dysthymia and major depression than are healthy comparison subjects.Eighty-five women with depressive personality disorder who had no comorbid axis I or axis II disorders and 85 age-matched healthy comparison women were initially recruited and reinterviewed 3 years later to evaluate the cumulative incidence rate of dysthymia and major depression.At the 3-year follow-up assessment, the women with depressive personality disorder had a significantly greater odds ratio for developing dysthymia than did the healthy comparison women. The difference in odds ratios for the development of major depression between women with and without depressive personality disorder did not reach statistical significance.The present study, the first to determine the subsequent development of dysthymia and major depression in subjects with the sole diagnosis of depressive personality disorder, found that subjects with depressive personality disorder had a greater risk of developing dysthymia than did healthy comparison subjects at 3-year follow-up. Findings of the current study also suggest that depressive personality disorder may mediate the effects of a family history of axis I unipolar mood disorders.

Objective: The authors examined gender differences in treatment response to sertraline, a selective serotonin reuptake inhibitor (SSRI), and to imipramine, a tricyclic antidepressant, in chronic depression. Method: A total of 235 male and 400 female outpatients with DSM-III-R chronic major depression or double depression (i.e., major depression superimposed on dysthymia) were randomly assigned to 12 weeks of double-blind treatment with sertraline or with imipramine after placebo washout. Results: Women were significantly more likely to show a favorable response to sertraline than to imipramine, and men were significantly more likely to show a favorable response to imipramine than to sertraline. Gender and type of medication were also significantly related to dropout rates; women who were taking imipramine and men who were taking sertraline were more likely to withdraw from the study. Gender differences in time to response were seen with imipramine, with women responding significantly more slowly than men. Comparison of treatment response rates by menopausal status showed that premenopausal women responded significantly better to sertraline than to imipramine and that postmenopausal women had similar rates of response to the two medications. Conclusions: Men and women with chronic depression show differential responsivity to and tolerability of SSRIs and tricyclic antidepressants. The differing response rates between the drug classes in women was observed primarily in premenopausal women. Thus, female sex hormones may enhance response to SSRIs or inhibit response to tricyclics. Both gender and menopausal status should be considered when choosing an appropriate antidepressant for a depressed patient.

Suppose you are poor, unemployed, and poorly educated. You cannot afford health insurance. You are depressed, and even if you knew where to go for help and could get there, you are afraid your family and friends will label you crazy or foolish. How would you get help? In this issue, Katon et al. (1) present the results of their research on whether attendance at an obstetrics-gynecology collaborative care clinic can effectively help disadvantaged women with no insurance or with only public coverage who meet criteria for major depression or dysthymia. The study’s comparison group were depressed women with commercial health insurance. Women at two different sites were assessed at intake and then followed up 18 months after initial recruitment. Not only did all of the women in the study show improvement in their depression scores, the disadvantaged group demonstrated a much greater effect size in depression improvement than the group with commercial insurance (0.81 compared with 0.39). The marked difference between the two groups may have occurred because the disadvantaged group started with higher levels of depression as a result of the greater number and variety of personal stressors they have. Nevertheless, the study showed that socially disadvantaged women can obtain and benefit from help received in such a collaborative care setting. Collaborative care models vary. In this case, master’slevel socialworkerswere trainedto act asthe care providers. Depressed women were given initial education about depression, and a semistructured interview was used to obtain a history. Women had choices as to whether they preferred psychotherapy or medication and whether they wished to be followed up in person or by telephone. The social workers helped with barriers to care, such as transportation and housing problems and inability to afford medication. Consulting psychiatrists advised the clinic physicians about medication changes. Collaborative or integrative care appears to function best when case management is involved to provide a strong clinician-patientrelationship(2).Casemanagementisdefined as “a collaborative process of assessment, planning, facilitation, and advocacy for options and services to meet an individual’s health needs through communication and available resources to promote quality cost-effective outcomes” (3). Although research on the benefits of system-level integration is limited (2), the combination of case managers and a psychiatrist consultant to recommend treatment seems to yield the best results. The Katon et al. study therefore used an ideal approach.Itisalso one ofthe fewstudiesofcollaborativecare for depression that have looked at reimbursement issues. The study highlights a number of issues regarding health insurance, stigma, and women’s mental health. Concerning the insurance issue, it may not have been possible to carry out this study in any other major developed country, as most have a health insurance scheme that covers all patients. In Canada, for example, every citizen and anyone legally in the country may apply for health insurance to cover all necessary visits and procedures. Insurance status is not an obstacle to care. The Affordable Care Act may correct some of these obstacles in the United States, providing millions of uninsured people with mental health coverage. Universal health coverage does not, however, eliminate stigma. For many individuals, negative feelings, fears, and misinformationaboutpsychiatric illness interfere with access to care (4, 5). Whilehighlyeducatedin

Objective: The purpose of this study was to determine the treatment history and cost of previous treatment among patients with comorbid substance-related disorder and dysthymia, as compared to patients with substance-related disorder only. Method: Retrospective data were obtained regarding past treatment. Treatment cost was calculated on the basis of the 1996 cost of various treatment modalities. The setting was alcohol-drug programs located within departments of psychiatry in two centers. A total of 642 patients were assessed, of whom 39 had substance-related disorder and dysthymia and 308 had substance-related disorder only (the remaining patients had other comorbid conditions). Data collection instruments included an interview-based questionnaire regarding previous psychiatric and substance abuse treatment. Current cost of treatment in various settings was assessed on the basis of a survey of facilities used by patients in this area. Results: Patients with substance-related disorder and dysthymia had received more substance-related disorder treatment in 18 of 20 measures. Patients with substance-related disorder and dysthymia used 4.7 times more substance-related disorder treatment dollars than patients with substance-related disorder only, although their demographic characteristics were similar. Past self-help activities and pharmacotherapy were remarkably similar for both groups. Although substance-related disorder treatment differed considerably between the two groups of patients, other types of psychiatric treatment (i.e., non-substance-related treatment) did not differ between the two groups. Conclusions: Patients with substance-related disorder and dysthymia are referred to (or seek) substance-related disorder treatment more often than patients with substance-related disorder only but are referred to (or seek) non-substance-related psychiatric treatment no more often than patients with substance-related disorder only. The cost of previous substance-related disorder treatment was several times higher for the patients with substance-related disorder and dysthymia.

Objective: The authors’ goal was to estimate the lifetime and 12-month rates of major depressive episodes and dysthymia for Chinese Americans who reside in Los Angeles. This effort, the Chinese American Psychiatric Epidemiological Study, is the first large-scale community psychiatric epidemiological study on an Asian American ethnic group that used DSM-III-R criteria for major depressive episodes and dysthymia. Method: A multi-stage sampling design was used to select respondents for participation in the survey. The sample included 1,747 adults, 18‐65 years of age, who resided in Los Angeles County and who spoke English, Mandarin, or Cantonese. Results: Approximately 6.9% of the respondents had experienced an episode of major depression and 5.2% had had dysthymia in their lifetime. The 12-month rates of depressive episode and dysthymia were 3.4% and 0.9%, respectively. The most consistent correlate of lifetime and 12-month depressive episode and dysthymia was social stress, measured by past traumatic events and recent negative life events. Conclusions: The Chinese American Psychiatric Epidemiological Study provides a rare opportunity to investigate the heterogeneity within a single Asian American ethnic group, Chinese Americans, and to identify the subgroups among Chinese Americans who may be most at risk for mental health problems. (Am J Psychiatry 1998; 155:1407‐1414)

This study sought to determine psychiatric comorbidity among elderly individuals with bipolar disorder.An epidemiological community survey identified 84 elderly (ages/=65) respondents with bipolar disorder, 1,327 younger adults with bipolar disorder, and 8,121 elderly respondents without bipolar disorder.Elderly respondents with bipolar disorder reported lifetime and 12-month rates of comorbid alcohol use disorders (38.1%, 38.1%, respectively), dysthymia (15.5%, 7.1%), generalized anxiety disorder (20.5%, 9.5%), and panic disorder (19.0%, 11.9%) that were significantly higher than among elderly respondents without bipolar disorder. They had lower lifetime and 12-month rates of alcohol use disorders and lower 12-month rates of dysthymia and panic disorder than younger adults with bipolar disorder. Elderly men with bipolar disorder reported a greater prevalence of alcoholism; women reported a greater prevalence of panic disorder.Comorbid axis I disorders, including panic disorder, are common among elderly individuals with bipolar disorder.

Objective The purpose of this study was to conduct a systematic assessment of psychiatric illness in patients diagnosed with velo-cardio-facial syndrome, a genetic syndrome that involves over 40 somatic anomalies, learning disabilities, and behavioral disorders and is associated with a microdeletion on chromosome 22q11. Method Subjects were referred for psychiatric diagnostic evaluation without regard to age or previous psychiatric history. In order to establish DSM-III-R consensus clinical diagnoses for patients who ranged in age from 5 to 34 years, the Diagnostic Interview for Children and Adolescents--Revised or the Structured Clinical Interview for DSM-III-R (SCID) was used. A review of available medical and psychiatric records and a clinical interview performed by two research psychiatrists to validate specific symptoms and syndromes reported in the Diagnostic Interview for Children and Adolescents--Revised and the SCID were used to elucidate the chronological appearance and duration of symptoms. Results Sixty-four percent (N = 16 of 25) of this unselected series of patients with velo-cardio-facial syndrome met DSM-III-R criteria for a spectrum of bipolar disorders with full syndromal onset in late childhood or early adolescence (mean age at onset = 12 years, SD = 3). In addition, 20% (N = 5) met DSM-III-R criteria for attention deficit hyperactivity disorder (ADHD), while 16% (N = 4) met criteria for attention deficit disorder without hyperactivity. In contrast to previous reports of a high prevalence of schizophrenia, none of the patients was diagnosed with schizophrenia, and only four had psychotic symptoms during a phase of their illness, all in their 20s or 30s. Conclusions Given that the prevalence of bipolar disorder in the general population is estimated to be 1.5% and that the average age at onset is 24, these findings support an unusually strong association between velo-cardio-facial syndrome and early-onset bipolar disorder and suggest that a gene deleted at the 22q11 chromosomal locus may be involved in its pathogenesis. If confirmed, these findings may provide a new and fruitful line of investigation into the molecular basis of bipolar spectrum disorders.

Objective: A number of studies have documented significant comorbidity between dysthymia and axis II personality disorders, particularly those grouped in cluster B. However, the nature of this comorbidity is poorly understood. The purpose of this investigation was to use the family study method to test five competing models of the comorbidity between early-onset dysthymia and cluster B personality disorders. Method: Proband groups consisted of subjects with early-onset dysthymia and a co-occurring cluster B personality disorder (N=28), subjects with early-onset dysthymia without a cluster B personality disorder (N=69), and a comparison group of subjects who had never been psychiatrically ill (N=45). The groups were compared on rates of dysthymia with a cluster B personality disorder, dysthymia without a cluster B personality disorder, and cluster B personality disorders without dysthymia in their first-degree relatives (N=675). Results: The relatives of both subgroups of dysthymic probands exhibited higher rates of dysthymia with a cluster B personality disorder, dysthymia without a cluster B personality disorder, and cluster B personality disorders without dysthymia than the relatives of the never ill probands. In addition, the relatives of probands with comorbid dysthymia exhibited higher rates of cluster B personality disorders without dysthymia than the relatives of probands with noncomorbid dysthymia. Conclusions: This pattern of results is consistent with the notion that dysthymia and cluster B personality disorders co-occur because ofshared etiological factors. This was the only one offive models ofthe comorbidity between dysthymia and cluster B personality disorders that was supported by the family data. Departments of Psychology and Psychiatry and Behavioral Sciences, State University of New York at Stony Brook.

Objective Dysthymia is generally believed to be associated with a high rate of DSM-III-R axis II comorbidity. However, it is unclear whether this rate is higher than that for other axis I disorders, how many dysthymic patients have personality disorders, and what the most common co-occurring axis II conditions are. Method Ninety-seven outpatients with early-on-set dysthymia and 45 with episodic major depression were administered structured diagnostic interviews for axis I and II disorders. In addition, knowledgeable informants were independently interviewed about axis II conditions in the patients. Results A significantly greater proportion of dysthymic patients (60%) than patients with episodic major depression (18%) met criteria for a personality disorder. The most common axis II conditions among dysthymic patients were borderline, histrionic, and avoidant personality disorder. Informants' reports yielded similar results. Conclusions These data indicate that early-onset dysthymia is associated with significantly greater axis II comorbidity than episodic major depression. Further work is necessary to elucidate the processes underlying this association.

OBJECTIVE Difficulties in the assessment of personality disorders and the burgeoning interest in axis II have led to increased use of informants when studying these conditions. The present study sought to evaluate the correspondence between patients and their informants on symptoms of personality disorders. METHOD A total of 105 outpatients and knowledgeable informants were independently interviewed by using the Personality Disorder Examination, a widely used instrument for the full range of personality disorders. RESULTS Diagnostic concordance between interviews was low (median kappa = -0.01), while correlations between dimensional scores were somewhat higher (median kappa = 0.36). Overall, patient interviews showed more pathology than interviews with informants. However, many of the symptoms obtained from informants were not reported by patients. CONCLUSIONS These data suggest that patient-informant concordance for axis II disorders is poor for diagnoses but somewhat better for dimensional scores. There was no evidence that low agreement can be explained by patients attempting to present themselves in a favorable light. Further work is necessary to elucidate the reasons for discordance and determine which data source provides the most valid information.

Objective The authors compared symptom features of specific subtypes of depressive and anxiety disorders. Methods Psychiatric outpatients with moderate levels of psychopathology and DSM-III diagnoses of major depression, dysthymia, panic disorder, or generalized anxiety disorder were given five standard measures of symptoms of anxiety and depressive disorders. Most of the outpatients were white, and most were middle-class. Results Principal components analysis revealed 12 orthogonal symptom components. Discriminant function analysis indicated that anxiety was distinguished by specific autonomic arousal symptoms, threat-related cognitions, and subjective anxiety and tension. Discriminant function analysis also indicated that depression was distinguished by anhedonia, cognitions of personal loss and failure, and dysphoric mood. Conclusions As nosological categories, major depression and panic disorder were better differentiated by specific symptom markers than dysthymia and generalized anxiety disorder.

The authors administered the Structured Clinical Interview for DSM-III-R to 260 patients with principal diagnoses of depressive disorders. Approximately two-thirds of these patients were given at least one additional concurrent axis I disorder. The most common comorbid diagnoses were anxiety disorders. The depressive disorders preceded the anxiety disorders in most patients. The authors not only point out the scientific and clinical implications of psychiatric comorbidity in view of the patterns of comorbidity found in this and previous studies but also discuss issues in comorbidity research.

Data from a survey of five U.S. communities showed that dysthymia affected approximately 3% of the adult population. It was more common in women under age 65, unmarried persons, and young persons with low income and was associated with greater use of general health and psychiatric services and psychotropic drugs. Dysthymia had a high comorbidity with other psychiatric disorders, particularly major depression; only about 25%-30% of cases occur over a lifetime in the absence of other psychiatric disorders. The findings suggest that although the onset and highest risk periods of major depression and bipolar disorder are in young adulthood, a residual state of dysthymia occurs in middle and old age.

The authors compared the hypnotizability of 65 Vietnam veteran patients with posttraumatic stress disorder (PTSD) to that of a normal control group and four patient samples using the Hypnotic Induction Profile. The patients with PTSD had significantly higher hypnotizability scores than patients with diagnoses of schizophrenia (N = 23); major depression, bipolar disorder--depressed, and dysthymic disorder (N = 56); and generalized anxiety disorder (N = 18) and the control sample (N = 83). This finding supports the hypothesis that dissociative phenomena are mobilized as defenses both during and after traumatic experiences. The literature suggests that spontaneous dissociation, imagery, and hypnotizability are important components of PTSD symptoms.

In an attempt to characterize a subgroup of depressed patients diagnosed as having dysthymic disorder, the authors gave them two commonly used biological tests for depression and several personality inventories and compared the results with those from age- and sex-matched normal control subjects. There were no significant differences between the 11 early-onset dysthymic disorder patients and the 11 controls on the dexamethasone suppression test or the thyrotropin-releasing hormone test. The personality questionnaires, however, showed that the dysthymic disorder patients were significantly more neurotic, extrapunitive, and intrapunitive and had significantly lower self-esteem than the control subjects.

Using a structured interview, the authors found that the prevalence of major depression and dysthymic disorder was 4.7% and 3.3%, respectively, in a community sample of 150 adolescents. All of the adolescents who met the criteria for major depression and dysthymic disorder had other psychiatric disorders as well; anxiety was the most frequent accompanying DSM-III diagnosis.

On the basis of the observations that chronic nonspecific diarrhea is a precursor of irritable colon syndrome and that chronic nonspecific diarrhea is associated with attention deficit disorder in childhood, the authors conducted a psychiatric diagnostic evaluation of 22 adults with irritable colon syndrome. Six (27%) of the patients received a diagnosis of attention deficit disorder, residual type, six (27%) were diagnosed as having dysthymic disorder, and five (23%) had had episodes of unipolar depression. The relationship between the presence of these disorders and greater severity of irritable colon syndrome was statistically significant.

The relationship between depression and borderline disorder is unclear. Using standardized observer- and subject-rated scales for depression, the authors compared patients satisfying DSM-III criteria for borderline personality disorder and dysthymic disorder. The two groups did not differ on depression as defined by the scales; however, there was a substantial intergroup difference on certain characteristics of the depression spectrum thought empirically to be associated more often with the borderline patient. The depth and quality of the depression of the borderline patient may largely overlap with that of the dysthymic patient, but it also possesses features that make it qualitatively distinct.

The dexamethasone suppression test (DST) was administered to 120 adolescent psychiatric patients at the time of hospitalization, and cortisol levels were measured at 4:00 p.m. and 11:30 p.m. on the day after a 1-mg oral dose of dexamethasone was given. Failure to suppress serum cortisol (i.e., cortisol level less than 5 micrograms/dl) was noted in 25 patients: 7 of 17 patients who met DSM-III criteria for major depressive disorder, 7 of 38 patients with dysthymic disorder, 7 of 47 patients with conduct disorder, and 4 of 15 schizophreniform patients. The predictive value of the DST for major depressive disorder was only 28%. Although adolescent patients with abnormal DSTs may eventually develop affective symptoms consistent with a major depressive disorder, the DST did not discriminate between major depression and other psychiatric diagnoses in these hospitalized adolescents.