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Letter to the Editor   |    
Dr. MacKinnon Replies
DEAN F. MacKINNON, M.D.
Am J Psychiatry 2002;159:2116-2116. doi:10.1176/appi.ajp.159.12.2116

To the Editor: The purportedly "simpler" explanation of our findings offered in the letter by Drs. Parvin and Swartz actually rests on an unsupported assumption. We found that the co-occurrence of panic disorder with bipolar disorder in families ascertained for a high prevalence of bipolar disorder was predicted to a significant degree by one’s membership in a family in which the bipolar proband had comorbid panic disorder. This, we concluded, implies the existence of an inherited risk factor for panic in a subset of families. Drs. Parvin and Swartz argue that the relationship between panic and what we called "bipolar disorder" was really between panic and anxiety disorder symptoms that overlap with manic symptoms. To accept this argument, one has to assume that our diagnosticians systematically overdiagnosed bipolar disorder. This is unlikely since we based our diagnoses on the work of trained interviewers and research psychiatrists using a reliable diagnostic instrument (1) and state-of-the-art diagnostic methods (2). Therefore, it would seem to be "simpler and more ordinary" to assume that we did not confuse anxiety with mania. It is also surprising that Drs. Parvin and Swartz prefer the explanation that panic disorder is associated with generalized anxiety disorder rather than bipolar disorder, since the validity of generalized anxiety disorder syndrome remains open to debate (3) and, at any rate, is apparently a syndrome distinct from panic disorder (4).

On the other hand, I agree with Drs. Parvin and Swartz that the boundaries between anxiety and mood disorders may not be as clear as the current diagnostic nomenclature makes them seem. This is the problem we hope further investigation can address.

Faraone SV, Blehar M, Pepple J, Moldin SO, Norton J, Nurnberger JI, Malaspina D, Kaufmann CA, Reich T, Cloninger CR, DePaulo JR, Berg K, Gershon ES, Kirch DG, Tsuang MT: Diagnostic accuracy and confusability analyses: an application to the Diagnostic Interview for Genetic Studies. Psychol Med  1996; 26:401-410
[PubMed]
[CrossRef]
 
Maziade M, Roy MA, Fournier J-P, Cliche D, Mérette C, Caron C, Garneau Y, Montgrain N, Shriqui C, Dion C, Nicole L, Potvin A, Lavallée J-C, Pirès A, Raymond V: Reliability of best-estimate diagnosis in genetic linkage studies of major psychoses: results from the Quebec pedigree studies. Am J Psychiatry  1992; 149:1674-1686
[PubMed]
 
Brown TA, Barlow DH, Liebowitz MR: The empirical basis of generalized anxiety disorder. Am J Psychiatry  1994; 151:1272-1280
[PubMed]
 
Weissman MM: Panic and generalized anxiety: are they separate disorders? J Psychiatr Res 1990; 24(suppl 2):157-162
 
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References

Faraone SV, Blehar M, Pepple J, Moldin SO, Norton J, Nurnberger JI, Malaspina D, Kaufmann CA, Reich T, Cloninger CR, DePaulo JR, Berg K, Gershon ES, Kirch DG, Tsuang MT: Diagnostic accuracy and confusability analyses: an application to the Diagnostic Interview for Genetic Studies. Psychol Med  1996; 26:401-410
[PubMed]
[CrossRef]
 
Maziade M, Roy MA, Fournier J-P, Cliche D, Mérette C, Caron C, Garneau Y, Montgrain N, Shriqui C, Dion C, Nicole L, Potvin A, Lavallée J-C, Pirès A, Raymond V: Reliability of best-estimate diagnosis in genetic linkage studies of major psychoses: results from the Quebec pedigree studies. Am J Psychiatry  1992; 149:1674-1686
[PubMed]
 
Brown TA, Barlow DH, Liebowitz MR: The empirical basis of generalized anxiety disorder. Am J Psychiatry  1994; 151:1272-1280
[PubMed]
 
Weissman MM: Panic and generalized anxiety: are they separate disorders? J Psychiatr Res 1990; 24(suppl 2):157-162
 
+
+

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