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Bartoli F, Bachi B, Callovini T, Palpella D, Piacenti S, Morreale M, Di Lella ME, Crocamo C, Carrà G. Anxious distress in people with major depressive episodes: a cross-sectional analysis of clinical correlates. CNS Spectr 2024; 29:49-53. [PMID: 37489522 DOI: 10.1017/s1092852923002377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
OBJECTIVE Most people with major depressive episodes meet the criteria for the anxious distress (AD) specifier defined by DSM-5 as the presence of symptoms such as feelings of tension, restlessness, difficulty concentrating, and fear that something awful may happen. This cross-sectional study was aimed at identifying clinical correlates of AD in people with unipolar or bipolar depression. METHODS Inpatients with a current major depressive episode were included. Data on socio-demographic and clinical variables were collected. The SCID-5 was used to diagnose depressive episodes and relevant specifiers. The Montgomery-Åsberg Depression Rating Scale (MADRS) and Young Mania Rating Scale (YMRS) were used to assess the severity of depressive and manic (mixed) symptoms, respectively. Multiple logistic regression analyses were carried out to identify clinical correlates of AD. RESULTS We included 206 people (mean age: 48.4 ± 18.6 yrs.; males: 38.8%) admitted for a major depressive episode (155 with major depressive disorder and 51 with bipolar disorder). Around two-thirds of the sample (N = 137; 66.5%) had AD. Multiple logistic regression models showed that AD was associated with mixed features, higher YMRS scores, psychotic features, and a diagnosis of major depressive disorder (p < 0.05). CONCLUSION Despite some limitations, including the cross-sectional design and the inpatient setting, our study shows that AD is likely to be associated with mixed and psychotic features, as well as with unipolar depression. The identification of these clinical domains may help clinicians to better contextualize AD in the context of major depressive episodes.
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Affiliation(s)
- Francesco Bartoli
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Bianca Bachi
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Tommaso Callovini
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Dario Palpella
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Susanna Piacenti
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Marco Morreale
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | | | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Division of Psychiatry, University College London, London, UK
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Jiang X, Ma Z, Li Z, Ou Y, Luo Z, Li Z. Hematochezia caused by tandospirone in a patient with major depressive disorder and anxious distress: a case report. Front Psychiatry 2023; 14:1209354. [PMID: 37529069 PMCID: PMC10387755 DOI: 10.3389/fpsyt.2023.1209354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/26/2023] [Indexed: 08/03/2023] Open
Abstract
Background Major depressive disorder (MDD) with anxious distress is a relatively common condition that is often associated with a poor treatment response. In order to enhance the effectiveness of MDD treatment, 5-HT1A agonists like tandospirone are often prescribed in conjunction with antidepressants. While it is known that antidepressants can increase the risk of bleeding, whether tandospirone poses a similar risk remains uncertain. Case presentation We presented the case of a 55-year-old Chinese woman diagnosed with MDD and anxious distress. After receiving various types of antidepressants, she experienced hematochezia following the administration of tandospirone, sertraline, and agomelatine. The occurrence of hematochezia ceased after tandospirone was discontinued. The patient was subsequently discharged with a treatment regime consisting of sertraline and agomelatine. During the 1-month follow-up, she reported no hematochezia. Conclusion Tandospirone may potentially increase the risk of hematochezia in patients with MDD and anxious distress.
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Affiliation(s)
- Xingmei Jiang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, Sichuan, China
| | - Zhongrui Ma
- Geriatric Diseases Institute of Chengdu, Department of Psychosomatics, Chengdu Fifth People’s Hospital, Chengdu, Sichuan, China
| | - Zhixiong Li
- The Third Department of Clinical Psychology, Karamay Municipal People’s Hospital, Karamay, Xinjiang, China
| | - Ying Ou
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, Sichuan, China
| | - Zhenhua Luo
- The First Affiliated Hospital of Traditional Chinese Medicine, Chengdu Medical College, Chengdu, Sichuan, China
- Xindu Hospital of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Zhe Li
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, Sichuan, China
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Sugawara H, Tsutsumi T, Inada K, Ishigooka J, Hashimoto M, Takebayashi M, Nishimura K. Association between anxious distress in a major depressive episode and bipolarity. Neuropsychiatr Dis Treat 2019; 15:267-270. [PMID: 30697051 PMCID: PMC6339637 DOI: 10.2147/ndt.s188947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Mixed features in a major depressive episode (MDE) predict bipolar disorder (BD). The mixed features specifier included in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) could be restrictive because it excludes the symptoms common to both mania/hypomania and depression, including psychomotor agitation. On the other hand, an anxious distress (ANXD) specifier has also been introduced in the DSM-5, and psychomotor agitation has been defined as a severity of ANXD. In this study, we retrospectively investigated the association between presence of ANXD in an MDE and bipolarity. PATIENTS AND METHODS The subjects were patients admitted with an MDE to the Department of Psychiatry at Tokyo Women's Medical University Hospital from December 2014 to March 2016. Eligible patients were older than 20 years of age and met the DSM-5 criteria for major depressive disorder or BD. All data were extracted from medical records. The subjects were grouped according to whether they did or did not have ANXD. The demographics and clinical features of these groups were compared. Severity of illness was evaluated according to the Hamilton Rating Scale for Depression (HRSD) score on admission. RESULTS ANXD was present in 31 and absent in 33 of 64 patients with MDE. The HRSD score was significantly higher in the group with ANXD than in the group without ANXD (P=0.0041). Mixed features (P=0.0050) and suicide attempts (P=0.0206) were significantly more common in the group with ANXD than in the group without ANXD. CONCLUSION We found that the presence of ANXD in an MDE was associated with greater severity and more mixed features and suicide attempts. It is important to evaluate a patient with an MDE for ANXD so that a diagnosis of mixed depression is not missed. More studies in larger samples are needed to investigate further the association between ANXD in MDE and bipolarity.
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Affiliation(s)
- Hiroko Sugawara
- Department of Neuropsychiatry, Faculty of Life Science, Kumamoto University, Kumamoto, Japan,
| | - Takahiro Tsutsumi
- Department of Psychiatry, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Ken Inada
- Department of Psychiatry, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Jun Ishigooka
- Department of Psychiatry, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Mamoru Hashimoto
- Department of Neuropsychiatry, Faculty of Life Science, Kumamoto University, Kumamoto, Japan,
| | - Minoru Takebayashi
- Department of Neuropsychiatry, Faculty of Life Science, Kumamoto University, Kumamoto, Japan, .,Division of Psychiatry and Neuroscience, Institute for Clinical Research, National Hospital Organization Kure Medical Center, Hiroshima, Japan
| | - Katsuji Nishimura
- Department of Psychiatry, Tokyo Women's Medical University Hospital, Tokyo, Japan
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Maneeton N, Suttajit S, Maneeton B, Likhitsathian S, Eurviyanukul K, Udomratn P, Chan ESY, Si TM, Sulaiman AH, Chen CH, Bautista D, Srisurapanont M. Clinical and socio-demographic correlates of anxious distress in Asian outpatients with major depressive disorder. Nord J Psychiatry 2017. [PMID: 28632428 DOI: 10.1080/08039488.2017.1335344] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Anxious distress in major depressive disorder (MDD) is common and associated with poor outcomes and management difficulties. AIMS This post hoc analysis aimed to examine the socio-demographic and clinical correlates of anxiety distress in Asian outpatients with MDD. METHODS Instead of two out of five specifiers defined by the Diagnostic and Statistical Manual Version-5, anxious distress defined in this study was operationalized as the presence of at least two out of four proxy items drawn from the 90-item Symptom Checklist, Revised (SCL-90-R). Other measures included the Montgomery-Asberg Depression Rating Scale (MADRS), the Fatigue Severity Scale, the Sheehan Disability Scale and the Multidimensional Scale of Perceived Social Support. RESULTS The data of 496 patients with MDD were included. Anxious distress was found in 371 participants (74.8%). The binary logistic regression analysis found that anxious distress was independently and significantly correlated with working status, higher MADRS scores, severe insomnia and functional impairment. CONCLUSIONS Three-fourths of Asian patients with MDD in tertiary care settings may have DSM-5 anxious distress of at least moderate distress. Its prevalence may vary among working groups. The specifier was associated with greater depressive symptom severity, severe insomnia and functional impairment.
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Affiliation(s)
- Narong Maneeton
- a Department of Psychiatry, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand
| | - Sirijit Suttajit
- a Department of Psychiatry, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand
| | - Benchalak Maneeton
- a Department of Psychiatry, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand
| | - Surinporn Likhitsathian
- a Department of Psychiatry, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand
| | - Kanokkwan Eurviyanukul
- a Department of Psychiatry, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand
| | - Pichet Udomratn
- b Department of Psychiatry, Faculty of Medicine , Prince of Songkla University , Songkhla , Thailand
| | | | - Tian-Mei Si
- d National Clinical Research Center for Mental Disorders and the Key Laboratory of Mental Health , Ministry of Health (Peking University) , Beijing , China.,e Peking University Institute of Mental Health (The Sixth Hospital) , Beijing , China
| | - Ahmad Hatim Sulaiman
- f Department of Psychological Medicine, Faculty of Medicine , University of Malaya , Kuala Lumpur , Malaysia
| | - Chia-Hui Chen
- g Department of Psychiatry , Taipei Medical University Shuang-Ho Hospital , Taipei , Taiwan
| | - Dianne Bautista
- c Singapore Clinical Research Institute , Singapore.,h Duke-NUS Medical School , Singapore
| | - Manit Srisurapanont
- a Department of Psychiatry, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand
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Abstract
The DSM-5 process, and the publication of DSM-5 in 2013, have had a considerable impact on the classification of anxiety disorders. Major changes included the reorganization of the chapter structure, individual groupings of disorders within each chapter from a life span viewpoint, and the use of specifiers. The DSM-5 chapter on anxiety disorders does not include obsessive-compulsive disorder or post-traumatic stress disorder. The chapter itself now reflects a developmental approach. The text of each disorder has been enhanced with short sections on development and course, risk and prognostic factors, etc. It is expected that the reformulation of anxiety disorders in DSM-5 will lead to greater precision in a variety of ways, as illustrated in the papers in this issue of Dialogues in Clinical Neuroscience. In summary, these changes in the way we classify anxiety disorders reflect our best view on the clinical empirical data and should prove useful in the assessment of specific anxiety disorders.
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Affiliation(s)
- David J Kupfer
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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