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The highly prevalent psychiatric disorders dysthymia and panic disorder have often a chronic or recurrent course with superimposed major depression. The prominent comorbidity between these diagnoses constitutes a confounding factor in the study of long-term outcome. We performed a 9-year follow-up of 38 patients with "pure" diagnoses, i.e. without comorbid dysthymia and panic disorder, selected from two 2-year naturalistic treatment studies with psychotherapy and antidepressant medication. The aims of the present study were to investigate 1) the stability of change, and 2) the impact of comorbid personality disorders (PDs) on long-term outcome. Patients were reassessed with SCID-I and SCID-II interviews, SCL-90/BSI and a detailed, modified life-charting interview, investigating course and treatment over time. About 50% of patients showed substantial improvement, of whom about half were in remission. Comorbid PD was a negative prognostic factor independently of Axis I diagnosis. Although patients with panic disorder had a lower frequency of comorbid PD, later onset, shorter duration of illness and better outcome after the original studies, there was no difference in the long-term outcome. The less stable outcome among panic patients suggests that standard treatments are not resulting in enduring remission. In order to achieve remission, it is necessary to 1) address comorbid PDs, 2) perform careful assessments of all comorbid diagnoses, and 3) build routines for the follow-up and augmentation of treatments.

The objective of the study was to describe changes in self-reported personality in anxiety patients undergoing capsulotomy. Sixteen patients with anxiety diagnoses undergoing capsulotomy were included. Ratings of personality characteristics with the Karolinska Scales of Personality (KSP), anxiety symptoms and adverse effects such as apathy and dysexecution were performed at baseline, at 1 year and 8-18 years post-operatively. Twelve patients had an anxiety reduction of at least 50%. Patients were significantly less anxiety prone at long-term follow-up as measured by KSP. Four patients suffered from adverse effects indicating frontal lobe dysfunction. There was no significant correlation between the reduction in BSA score and the KSP change from pre-operatively to long term in any of the KSP scales. In line with previous studies, high anxiety proneness normalizes after capsulotomy in anxiety patients. Adverse effects were more frequent than expected. The conclusion based on previous KSP findings that the incidence of adverse personality changes following capsulotomy is low and does not increase with time is challenged by the present study.

The Depression Self-Rating Scale (DSRS) is a self-report inventory based on the DSM-IV criteria for major depression. This study aimed to investigate diagnostic concordance of a major depressive disorder (MDD) using the DSRS and the Structured Clinical Interview for DSM-IV, axis I disorders (SCID-I). An additional aim was to investigate whether concordance could be improved by adding different cut-off scores for the Beck Depression Inventory (BDI) or the self-report version of the Montgomery-Asberg Depression Rating Scale (MADRS-S). MDD was determined by means of the SCID-I interview and the DSRS in 83 psychiatric in- and outpatients. Depressive severity was assessed using the BDI and the MADRS-S. A DSRS-version including the A- and C-criteria for an MDD had a sensitivity and a specificity for an expert-rated diagnosis of 86% and 75%, respectively. By using cut-off scores for the BDI or the MADRS-S, specificity could be raised to 85% without loss of sensitivity. The DSRS appears to be a useful instrument in the diagnostic process involving MDD, particularly when used in combination with the BDI or the MADRS-S. The DSRS is thought to be of value in psychiatric outpatient departments, where treatment of patients is often delegated to paramedical staff or nurses. The scale might also be used as an independent diagnostic tool in epidemiological studies in order to achieve an estimate of the prevalence of MDD in different population settings.