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PubMed1985

Cerebrospinal fluid magnesium and calcium related to amine metabolites, diagnosis, and suicide attempts.

Magnesium and calcium concentrations were measured in the cerebrospinal fluid (CSF) of 15 neurological controls and 41 psychiatric patients suffering from major depression (n = 16), schizophrenic disorder (n = 15), or adjustment disorder (n = 10). All subjects were women 19-67 years of age and free from drugs at the time of the study. CSF was evaluated for 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid (HVA), and cortisol (CS) levels, and all patients received a dexamethasone suppression test (DST) following lumbar puncture. CSF calcium levels did not differ among groups, although we found a trend toward higher mean levels in both depression and schizophrenia. By contrast, CSF magnesium was found to be significantly lower in both depression and adjustment disorder; if, however, patients who had made suicide attempts were excluded, the difference became insignificant. Patients who had made suicide attempts (by using either violent or nonviolent means) had significantly lower mean CSF magnesium level irrespective of the diagnosis. CSF calcium did not correlate with magnesium, 5-HIAA, HVA, CS, global severity, therapeutic response, or DST, but CSF magnesium correlated significantly with CSF 5-HIAA, especially after correcting for age and body height. Both variables seemed to be primarily related to recorded suicide attempts, but decreased magnesium was not limited to violent cases.

Adjustment Disorders↗
PubMed1995

Psychiatric illness and psychosocial concerns of patients with newly diagnosed lung cancer.

OBJECTIVE: To determine the nature and incidence of psychiatric illness, symptoms of potential psychiatric significance, substance abuse and psychosocial concerns among patients with newly diagnosed lung cancer. DESIGN: Case series. SETTING: Kingston Regional Cancer Centre, a tertiary care facility for ambulatory cancer patients. PATIENTS: Seventy-one consecutive English-speaking patients with recently diagnosed lung cancer undergoing radiotherapy or chemotherapy were asked to participate; 52 of the 57 patients who agreed were available for evaluation. OUTCOME MEASURES: Current and previous psychiatric diagnoses of affective, anxiety and adjustment disorders, and alcohol and tobacco abuse; symptoms of sadness, fear, shock, anger, denial, acceptance, guilt, suicidal ideation, thoughts of death, insomnia, loss of libido, impaired concentration and reduced level of work or interest; psychosocial concerns about family, work and finances; and an impression of coping. RESULTS: At the time of the interview two (4%) of the patients were found to have an affective disorder, none had an anxiety disorder, and six (12%) had an adjustment disorder. Previously, 16 patients (31%) had had an affective or anxiety disorder or both. Two (4%) had had an adjustment disorder following the diagnosis of their lung cancer that had resolved before the interview. At some point in their lives 24 patients (46%) had abused alcohol, and 7 (13%) were currently abusing alcohol. All had smoked, 33 (63%) having been tobacco dependent. Feelings of sadness were expressed by 23 (44%), fear by 15 (29%), anger by 2 (4%), shock by 9 (17%) and guilt by 4 (8%). Seven (13%) had considered suicide, and thoughts of death were reported by 16 (31%). Twenty (38%) were accepting of their diagnosis, and 5 (10%) expressed optimism. Twenty-seven (52%) had insomnia, which was reported to be severe by 15 (29%). Loss of libido was reported by 25 (48%) and was severe in 14 (27%). Difficulty concentrating was reported by 10 (19%) and a reduced ability to work or loss of interest by 17 (33%). Fifteen patients (29%) were concerned about their families and 4 (8%) about work or finances. Most (41 [79%]) had good family support, and 23 (44%) found support in religion. Seven patients (13%) seemed to be coping poorly. CONCLUSIONS: Although psychiatric illness was infrequent, symptoms of potential psychiatric significance and psychosocial concerns were common in this patient population. Attention to these symptoms and concerns should be addressed in a systematic and effective way by all health care professionals and agencies planning the care of patients with lung cancer.

Adenocarcinoma↗
PubMedDate not supplied

Effects of a modified group intervention with early-stage breast cancer patients.

The aim of this study was to investigate the clinical effectiveness of a psychiatric intervention program consisting of 5 weekly structured interventions and 3 additional group meetings every two months. Previous studies revealed that a 5 weekly structured intervention program was effective for alleviating psychological discomforts in Japanese breast cancer patients, and that the effectiveness persisted for 6 months for patients without lymph node metastasis or adjustment disorders. Since this 5-session intervention did not have persistent effects in patients with lymph node metastasis and/or adjustment disorders, 3 additional group meetings every two months were added after completion of the 5 weekly structured interventions. A total of 43 breast cancer patients completed the full program. The Profile of Mood States (POMS) scores were compared before, immediately after 5 sessions, immediately after the 3 additional interventions, and 6 months after all programs. As analyzed by POMS scores, the clinical effectiveness of a structured group intervention program persisted for 6 months for patients even with nodal metastases and/or adjustment disorders. These findings of the present study suggested that the 5 weekly intervention program was sufficient for patients without lymph node metastasis or adjustment disorders. In contrast, this intervention program alone was insufficient for patients with nodal metastases and/or adjustment disorders. For them, a new psychiatric intervention program consisting of 5 weekly structured interventions and 3 additional group meetings every two months were effective and sufficient.

Adjustment Disorders↗
PubMed2002

Psychiatric morbidity and impact on hospital length of stay among hematologic cancer patients receiving stem-cell transplantation.

PURPOSE: To determine the prevalence of psychiatric disorders during hospitalization for hematopoietic stem-cell transplantation (SCT) and to estimate their impact on hospital length of stay (LOS). PATIENTS AND METHODS: In a prospective inpatient study conducted from July 1994 to August 1997, 220 patients aged 16 to 65 years received SCT for hematologic cancer at a single institution. Patients received a psychiatric assessment at hospital admission and weekly during hospitalization until discharge or death, yielding a total of 1,062 psychiatric interviews performed. Psychiatric disorders were determined on the basis of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Univariate and multivariate linear regression analyses were used to identify variables associated with LOS. RESULTS: Overall psychiatric disorder prevalence was 44.1%; an adjustment disorder was diagnosed in 22.7% of patients, a mood disorder in 14.1%, an anxiety disorder in 8.2%, and delirium in 7.3%. After adjusting for admission and in-hospital risk factors, diagnosis of any mood, anxiety, or adjustment disorder (P =.022), chronic myelogenous leukemia (P =.003), Karnofsky performance score less than 90 at hospital admission (P =.025), and higher regimen-related toxicity (P <.001) were associated with a longer LOS. Acute lymphoblastic leukemia (P =.009), non-Hodgkin's lymphoma (P =.04), use of peripheral-blood stem cells (P <.001), second year of study (P <.001), and third year of study (P <.001) were associated with a shorter LOS. CONCLUSION: Our data indicate high psychiatric morbidity and an association with longer LOS, underscoring the need for early recognition and effective treatment.

Adjustment Disorders↗
PubMed1995

International study of expert judgment on therapeutic use of benzodiazepines and other psychotherapeutic medications: III. Clinical features affecting experts' therapeutic recommendations in anxiety disorders.

Our objective was to assemble expert clinical experience and judgment in the treatment of anxiety and related disorders in a systematic, quantitative manner. This article reports on some clinical features apart from diagnosis that may affect choice of strategy in the pharmacotherapy of anxiety disorders. A panel of internationally recognized experts in treating anxiety and depression was constituted by multistage peer nomination. Ninety percent (66 of 73) completed an extensive questionnaire. This report focuses on the expert panel's responses to questions on therapeutic options, based on multi-part case vignettes of several anxiety disorders presenting clinical variations within the same diagnosis. In the presence of higher levels of functional impairment, the experts more often recommended formal psychosocial procedures for adjustment disorder; medication for agoraphobia, social phobia, obsessive-compulsive disorder, and adjustment disorder; and polypharmacy for agoraphobia. Their therapeutic recommendations were not materially affected by chronicity in the case of panic disorder. Under the condition of heavy use of alcohol in the case of generalized anxiety disorder, the experts avoided benzodiazepines in favor of various other medications. In the presence of a serious cardiac conduction defect in the case of obsessive-compulsive disorder, they less often recommended medication. Those who did recommend medication changed their preference from tricyclic antidepressants (clomipramine) to selective serotonin reuptake inhibitors. Under the condition of a more severe precipitating event in the case of adjustment disorder, the experts were more likely to recommend both formal psychosocial intervention and medication.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2007

[Pharmacological therapy for psychiatric issues among cancer patients].

It is reported that the common psychiatric disorders among cancer patients are adjustment disorder, major depression, and delirium. Pharmacotherapy is often provided for management of these distressing symptoms. Antianxiety drugs, especially benzodiazepines, are often used for ameliorating adjustment disorder. Among them, shorter-acting benzodiazepines are usually preferred. Several randomized clinical trials indicate the efficacy of antidepressants for management of major depression experienced by cancer patients. Because there are no significant differences of effectiveness among available antidepressants, it is recommended that selection of antidepressant should depend on its adverse event profiles. Although the principal management strategies of delirium are detection and treatment of underlying causes of delirium, concurrent pharmacotherapy as symptomatic treatment is often needed. Neuroleptics, especially haloperidol, are most widely used for management of delirium.

Adjustment Disorders↗
PubMedDate not supplied

Posttraumatic embitterment disorder.

BACKGROUND: Adjustment and reactive disorders are a heterogeneous group of mental disorders. Diagnostic criteria are vague and scientific research is limited despite the fact that these disorders play a major role in clinical practice. METHODS: The 'posttraumatic embitterment disorder' (PTED) is introduced as a new concept for a subgroup of adjustment disorders. A case vignette and diagnostic criteria are presented. RESULTS: Core criteria of PTED are: (1) a single exceptional negative life event precipitates the onset of the illness; (2) the present negative state developped in the direct context of this event; (3) the emotional response is embitterment and feelings of injustice; (4) repeated intrusive memories of the event; (5) emotional modulation is unimpaired, patients can even smile when engaged in thoughts of revenge, and (6) no obvious other mental disorder that can explain the reaction. Additional symptoms are feelings of helplessness, self-blame, rejection of help, suicidal ideation, dysphoria, aggression, down-heartedness, seemingly melancholic depression, unspecific somatic complaints, loss of appetite, sleep disturbances, pain, phobic symptoms in respect to the place or to persons related to the event, reduced drive. Duration is longer than 3 months. Performance in daily activities and roles is impaired. CONCLUSIONS: PTED is a frequent disorder. The diagnosis of PTED can lead to specific therapeutic interventions. PTED can be discriminated from PTSD, depression, anxiety disorders, and other adjustment disorders.

Adjustment Disorders↗
PubMed2006

Relationship between mood related disorders and quality of life in a population of Dutch adult psychiatric outpatients.

Our objective was to investigate explicitly the relationship between mood-related disorders (MRDs) and quality of life (QOL), while trying to overcome the limitations of earlier research. QOL scores of psychiatric outpatients with MRDs were compared with QOL scores of outpatients without MRD and a sample of the general Dutch population (GDP). QOL was assessed with the World Health Organization Quality of Life assessment instrument, long version (WHOQOL-100), and depressive symptoms were assessed with the Symptom Checklist-90 (SCL-90). Outpatients with MRD had lower scores on all aspects of the WHOQOL-100 compared with the GDP. Compared with outpatients without MRD, the outpatients with MRD scored lower on most aspects of the WHOQOL-100. Within the group with MRDs, patients with major depressive disorder (MDD) had lower QOL scores compared with patients with dysthymic disorder or adjustment disorder with depressed mood. Severity of MRD and MDD was negatively related to QOL. Comorbid personality disorders worsened QOL. Within the group with MRDs, common variance between depressive symptoms and QOL did not exceed 25%. MRDs are negatively related with QOL. Severity of MRD and comorbidity of personality disorders decrease QOL further. MRDs affect all domains and facets of QOL. The relationship found between MRDs and QOL was not caused by an overlap between the concepts depressive symptoms and QOL, shown by the relative small common variance between (depressive) symptoms and QOL.

Adult↗
PubMed2004

Deliberate self-harm as seen in Kampala, Uganda - a case-control study.

OBJECTIVES: A study to investigate deliberate self-harm (DSH) in an African context was undertaken in Uganda. METHODS: A case-control study in which 100 cases of DSH and 300 controls matched on age and sex were recruited from three general hospitals in Kampala and subjected to a structured interview using a modified version of the European Parasuicide Study Interview Schedule I. RESULTS: Among the cases, 63% were males, with a male to female ratio of 1.7:1 and a peak age range of 20-24 years. Higher educational attainment, higher socio-economic class and poor housing were significantly associated with DSH. District of current residence, district of birth, religion, ethnicity, marital status, number of children, current living arrangement, area of usual residence, employment status of respondent and partner were not significantly associated with DSH. Pesticides and medications, mainly antimalarials and diazepam, were the main methods of DSH used. The most commonly reported psychiatric disorders were adjustment disorder, acute stress reactions and depression. CONCLUSION: DSH in Uganda appears to predominantly afflict the young. Disturbed interpersonal relationships, poverty and loneliness were important factors in the immediate precipitation of this behaviour. The fact that pesticide poisoning is still the predominantly used method in DSH in this area calls for a review of the legislation that controls the sale and availability of these agricultural chemicals.

Adolescent↗
PubMed2006

Emergency department visits for behavioral and mental health care after a terrorist attack.

STUDY OBJECTIVE: We assess emergency department (ED) utilization by a population whose health care encounters can be tracked and quantified for behavioral and mental health conditions in the aftermath of the terrorist attacks of September 11, 2001. METHODS: We assessed presentations to EDs by using Medicaid analytic extract files for adult New York State residents for 2000 and 2001. We created 4 mutually exclusive geographic areas that were progressively more distant from the World Trade Center and divided data into 4 periods. All persons in the files were categorized by their zip code of residence. We coded primary ED diagnoses for posttraumatic stress disorder, substance abuse, psychogenic illness, severe psychiatric illness, depression, sleep disorders, eating disorders, stress-related disorders, and adjustment disorders. RESULTS: There was a 10.1% relative temporal increase in the rate of ED behavioral and mental health diagnoses after the September 11, 2001, terrorist attacks for adult Medicaid enrollees residing within a 3-mile radius of the World Trade Center site. Other geographic areas experienced relative declines. In population-based comparisons, Medicaid recipients who lived within 3 miles of the World Trade Center after the September 11, 2001, terrorist attacks had a 20% increased risk of an ED mental health diagnosis (prevalence density ratio 1.2; 95% confidence interval 1.1 to 1.3) compared to those who were non-New York City residents. CONCLUSION: The complex role that EDs may play in responding to terrorism and disasters is becoming increasingly apparent. To the best of our knowledge, this is the first report of a quantifiable increase in ED utilization for mental health services by persons exposed to a terrorist attack in the United States.

Adult↗
PubMedDate not supplied

[Repeat suicide attempts: characteristics of repeaters versus first-time attempters admitted in the emergency of a Tunisian general hospital].

UNLABELLED: Repeat suicide attempts constitute a special problem in suicidology. It seems that the excess mortality by suicide is even higher among the suicide repeaters. The objectives of this study were to estimate repeat suicide attempts frequency among a sample of suicide attempters admitted in the University Hospital Emergency of Monastir (Tunisia), to compare their features to those of first-time attempters and to determine factors associated with repeat suicide. METHOD: A transversal survey involves a review of all patients committing suicide attempt and who are admitted in the emergency service during the second semester of 1999. Study variables included: demographic parameters, family and personal psychiatric history, axis I psychiatric disorder and circumstances of the present suicide attempt. Also, subjects were evaluated with the following scales: Montgomery and Asberg Depression Rating Scale (MADRS) and The Social Readjustment Rating Scale of Holms and Rahe. RESULT: Among the 90 suicide attempters, 42.2% (n = 38) had made at least one previous suicide attempt. More repeaters than first-time attempters were divorced or separated: 21.1% versus 5.8% (p = 0.05). Belonging to a numerous family (n > or = 4) was more frequent in the repeaters group: 73.7% versus 46.2% (p = 0.01). The two groups did not differ as to level of education but were significantly different with regard to their professional activity: 60.5% of repeaters were unemployed versus 34.6% of first-time attempters (p = 0.01). Repeaters had more loaded family psychiatric disorders: 26.3% versus 7.7% (p = 0.03). However there were practically no differences between repeaters and first-time attempters in regard of suicide in their families. Personal previous history of repeaters was characterized by frequency of psychiatric hospitalization: 50% versus 11.5% (p = 0.00005). Sexual abuse was more frequent in repeaters group but this difference was not significant. Alcohol and drug abuse were not frequent in the two groups. Concerning the actual suicide attempt, the most frequently diagnosed disorder was adjustment disorders. However depressive and psychotic disorders were significantly more frequent in the repeaters group: 34.2% versus 13.4% (p = 0.05). Repeaters had more frequently elevated scores (> 14) in MADRS: 71.1% versus 48.1% (p = 0.01), and raised intensity of stress factors lived during the six months preceding actual suicide attempt: 68.4% versus 42.3% (p = 0.04). Nevertheless we hadn't noticed any differences between the two groups regarding the methods used or the motives. CONCLUSION: Differences in the characteristics of repeaters and first-time attempters are therefore of interest when discussing future suicidal risk and should clear on preventive actions in order to face the increase of suicidal recidivism. A broad based, multidisciplinary intervention approach is recommended.

Adult↗
PubMed1998

Demographic/socioeconomic factors in mental disorders associated with tuberculosis in southwest Nigeria.

In spite of the high prevalence of tuberculosis worldwide, there are few studies on its psychiatric complications. The mental state of 53 patients with pulmonary tuberculosis seen in a Nigerian chest clinic was examined using the 30-item General Health Questionnaire (GHQ-30), the Present State Examination (PSE), and a clinical evaluation based on the International Classification of Disease, tenth edition (ICD-10). Results were compared with two comparison groups: (1) a group of 20 long-stay orthopedic patients with lower limb fractures; and (2) a group of 20 apparently healthy controls. The sociodemographic characteristics of the groups were also compared. A significantly higher prevalence of psychiatric disorders was found in the tuberculosis group (30.2%) than in the orthopedic group (15%) and the apparently healthy controls (5%). The types of psychiatric disorders encountered included mild depressive episode, generalized anxiety disorder, and adjustment disorder (ICD-10). Psychiatric morbidity was higher in tuberculosis patients with low educational attainment, and did not show a statistically significant relationship with other sociodemographic parameters. Ways of improving the mental health of tuberculosis patients are discussed.

Adolescent↗
PubMed1997

The utility of the ten-point clock test as a screen for cognitive impairment in general hospital patients.

The object of this work was to illustrate the utility of the ten-point clock test as a screen for cognitive impairment in the general hospital by examining a range of diagnoses and estimating sensitivity for each. A total of 195 consecutive medical and surgical inpatients were examined who were referred for psychiatric consultation and histories from patient, family, nurses, physicians, and hospital records were obtained. Seventy-six percent of these patients were administered the ten-point clock test at the initial evaluation. The percentages of patients scoring less than 8 points on the ten-point clock test for the following primary diagnoses were delirium (92%), dementia (90%), and adjustment disorder (5%). Thirty-nine to seventy percent of patients with a delirium, dementia, opioid intoxication, or a cognitive disorder n. o. s. scored lower than 5 points but none of the patients with a major depressive disorder, alcohol dependence, or adjustment disorder did so. The sensitivities of the ten-point clock test and minimental state examinations appeared similar in a subset of patients. The ten-point clock test is a useful screen for cognitive impairment in general hospital patients.

Adult↗
PubMedDate not supplied

The disclosure of information to cancer patients and its relationship to their mental state in a consultation-liaison psychiatry setting in Japan.

In Japan, as in some other countries, not all cancer patients are informed of their diagnosis and expected prognosis. However, we do not know enough about the relationship between the kind of information given to cancer patients and their mental state. The following is a study that examines this relationship. The subjects were 81 adult cancer inpatients referred to psychiatrists. Those with mental disorders before admission or with delirium were excluded. The subjects were classified into three groups according to the kind of information given to them: 28 were not informed of a diagnosis of cancer, 36 were informed of a diagnosis of cancer, and 17 were informed of both a diagnosis of cancer and a poor prognosis. The distributions of DSM-IV Axis I diagnoses were nearly equal among the three groups of patients. In each group, more than 90% of patients were diagnosed as having either major depressive disorder or adjustment disorders. In the results of HAM-D, HAM-A, and a question about irritability, the mean total HAM-A scores and mean scores for the factors of Suicide, Behavior at Interview, and Irritability, differed significantly among the three groups. They were highest in patients who were not informed of a diagnosis of cancer. The authors discuss the nature of relationship between the disclosure of information and the mental state in cancer patients.

Adaptation, Psychological↗
PubMed1990

Geriatric psychiatry consultations in a university hospital.

A review was conducted of the records of 147 patients above the age of 60 in a 350-bed general university hospital for whom a request for consultations was made over a two-year period by a geriatric psychiatry division in a department of psychiatry. Findings were compared with those obtained by Mainprize and Rodin and by Ruskin. Most referrals in the present study were from internal medicine as they were in the other two studies. The principal reason for referrals in this and in Mainprize and Rodin's study was depression (48% and 37%, respectively) but not in Ruskin's study (10%). The primary DSM-III-R diagnoses of the referred patients in this study were affective disorder (27%), adjustment disorders (26%), and dementia (22%). Affective disorder was also the most frequent diagnosis in Ruskin's study. Psychotropic medication was the most frequently cited recommendation in all three studies.

Aged↗
PubMed2000

A longitudinal study of prisoners on remand: psychiatric prevalence, incidence and psychopathology in solitary vs. non-solitary confinement.

OBJECTIVE: To compare two levels of stress (solitary confinement (SC) and non-SC) among remand prisoners as to incidence of psychiatric disorders in relation to prevalent disorders. METHOD: Longitudinal repeated assessments were carried out from the start and during the remand phase of imprisonment. Both interview-based and self-reported measures were applied to 133 remand prisoners in SC and 95 remand prisoners in non-SC randomly selected in a parallel study design. RESULTS: Incidence of psychiatric disorders developed in the prison was significantly higher in SC prisoners (28%) than in non-SC prisoners (15%). Most disorders were adjustment disorders, with depressive disorders coming next. Incident psychotic disorders were rare. The difference regarding incidence was primarily explained by level of stress (i.e. prison form) rather than confounding factors. Quantitative measures of psychopathology (Hamilton Scales and General Health Questionnaire) were significantly higher in subjects with prevalent and incident disorders compared to non-disordered subjects. CONCLUSION: Different levels of stress give rise to different incidence of psychiatric morbidity among remand prisoners. The surplus of incident disorders among SC prisoners is related to SC, which may act as a mental health hazard.

Adult↗
PubMed1993

Adolescent psychopathology: I. Prevalence and incidence of depression and other DSM-III-R disorders in high school students.

Data were collected on the point and lifetime prevalences, 1-year incidence, and comorbidity of depression with other disorders (Diagnostic and Statistical Manual of Mental Disorders [3rd ed., rev.]) in a randomly selected sample (n = 1,710) of high school students at point of entry and at 1-year follow-up (n = 1,508). The Schedule for Affective Disorders and Schizophrenia for School-Age Children was used to collect diagnostic information; 9.6% met criteria for a current disorder, more than 33% had experienced a disorder over their lifetimes, and 31.7% of the latter had experienced a second disorder. High relapse rates were found for all disorders, especially for unipolar depression (18.4%) and substance use (15.0%). Female subjects had significantly higher rates at all age levels for unipolar depression, anxiety disorders, eating disorders, and adjustment disorders; male subjects had higher rates of disruptive behavior disorders.

Adolescent↗
PubMedDate not supplied

The prevalence of atypical features across mood, anxiety, and personality disorders.

This study examines and compares the prevalence rates of the atypical features subtype across each of the major mood, anxiety, and personality disorders (PDs). It also evaluates the impact that comorbid anxiety and PDs have on the likelihood that depressed patients will present with atypical symptoms. Eleven hundred thirty psychiatric outpatients were evaluated for the presence of atypical symptoms. All axis I diagnoses were made using the Structured Clinical Interview for DSM-IV (SCID). PDs were assessed in a subset of 530 patients using the Structured Interview for DSM-IV Personality Disorders (SIDP-IV). From a sample of 579 patients diagnosed with a current major depressive disorder, 22.5% met criteria for the atypical subtype. Prevalence rates were similar in bipolar and unipolar patients, although the pattern of symptoms was distinct. Prevalence rates were lower in patients with dysthymic disorder (12.5%), adjustment disorder with depressed mood (9.4%), and depression not otherwise specified (NOS) (7.9%). When major depression existed in the presence of a comorbid anxiety disorder, the likelihood of presenting with atypical features doubled. Nine percent of the patients diagnosed with an anxiety disorder (without a comorbid depressive disorder) met criteria for atypical features. Two of the four atypical symptoms, leaden paralysis and rejection sensitivity, were found to be especially prominent in nondepressed anxiety disorder patients. Of the 10 PDs listed in DSM-IV, only avoidant PD was associated with the atypical features subtype. In large part, this was accounted for by the high rate of rejection sensitivity in these patients. In conclusion, as many as one quarter of depressed patients who present for outpatient psychiatric treatment meet criteria for the atypical features subtype. There appears to be a strong association between anxiety and atypical depression, but the exact nature of this relationship needs to be further elucidated. It is unclear whether personality pathology is independently associated with the atypical features subtype.

Adolescent↗