Generalized anxiety disorder in patients with major depression: is DSM-IV's hierarchy correct?
Generalized anxiety disorder in patients with major depression: is DSM-IV's hierarchy correct?
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DOI：
10.1176/appi.ajp.160.3.504
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发表时间：
2003-03
期刊：
影响因子：
--
通讯作者：
M. Zimmerman;I. Chelminski
中科院分区：
文献类型：
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作者：
M. Zimmerman;I. Chelminski
目的DSM-III在抑郁症患者焦虑障碍的诊断中规定了等级关系，规定如果焦虑障碍的发生仅限于心境障碍的过程，则不能诊断为焦虑障碍。在DSM的后续版本中，除了广泛性焦虑症之外，所有焦虑症的这种等级都被取消了。作者检验了情绪和焦虑症之间这种剩余的等级关系的有效性。方法对332例抑郁症门诊患者进行半结构化诊断访谈和填写纸笔问卷调查。为研究DSM-IV广泛性焦虑障碍与心境障碍等级关系的效度，对除排除标准外符合广泛性焦虑障碍所有诊断标准的重性抑郁障碍患者进行改良广泛性焦虑障碍诊断。分析比较了三组不重叠的DSM-IV重度抑郁症患者的特征：1）合并DSM-IV广泛性焦虑症的患者，2）合并改良广泛性焦虑症的患者，3）既没有DSM-IV也没有改良广泛性焦虑症的患者。结果与无广泛性焦虑障碍的抑郁症患者相比，有DSM-IV和改良广泛性焦虑障碍的抑郁症患者有更高水平的自杀意念，更差的社会功能，更高频率的其他焦虑障碍、进食障碍和躯体形式障碍，更高的DSM-IV轴I障碍的多维度自我报告测量的大多数分量表得分，更高水平的病理性担忧，更高水平的抑郁症患者有更高水平的抑郁症。一级亲属中广泛性焦虑症的发病风险较高。两组广泛性焦虑症患者之间没有差异。结论：研究结果质疑DSM-IV重性抑郁障碍和广泛性焦虑障碍之间的等级关系的有效性，并建议排除标准应予以取消。
OBJECTIVE DSM-III imposed a hierarchical relationship in the diagnosis of anxiety disorders in depressed patients, stipulating that anxiety disorders could not be diagnosed if their occurrence was limited to the course of a mood disorder. In the subsequent versions of the DSM this hierarchy was eliminated for all anxiety disorders except generalized anxiety disorder. The authors examined the validity of this remaining hierarchical relationship between mood and anxiety disorders. METHOD Psychiatric outpatients with major depressive disorder (N=332) were evaluated with a semistructured diagnostic interview and completed paper-and-pencil questionnaires on presentation for treatment. To study the validity of the DSM-IV hierarchical relationship between generalized anxiety disorder and mood disorders, the authors made a diagnosis of modified generalized anxiety disorder for patients with major depressive disorder who met all the criteria for generalized anxiety disorder except for the exclusion criterion. The analyses compared the characteristics of three nonoverlapping groups of patients with DSM-IV major depressive disorder: 1) those with coexisting DSM-IV generalized anxiety disorder, 2) those with coexisting modified generalized anxiety disorder, and 3) those with neither DSM-IV nor modified generalized anxiety disorder. RESULTS Compared to the depressed patients without generalized anxiety disorder, the depressed patients with DSM-IV and modified generalized anxiety disorder had higher levels of suicidal ideation; poorer social functioning; a greater frequency of other anxiety disorders, eating disorders, and somatoform disorders; higher scores on most subscales of a multidimensional self-report measure of DSM-IV axis I disorders; a greater level of pathological worry; and a higher morbid risk for generalized anxiety disorder in first-degree family members. The two generalized anxiety disorder groups did not differ from each other. CONCLUSIONS The findings question the validity of the DSM-IV hierarchical relationship between major depressive disorder and generalized anxiety disorder and suggest that the exclusion criterion should be eliminated.