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Am J Psychiatry 1992; 149:100-107
Copyright © 1992 by American Psychiatric Association
Anxiety syndromes as epiphenomena of primary major depression: outcome and familial psychopathology
W Coryell, J Endicott and G Winokur
Department of Psychiatry, University of Iowa College of Medicine, Iowa City 52242.
OBJECTIVE: Anxiety symptoms often appear within depressive episodes, but
their significance is uncertain. This study sought to determine whether
they indicate the coexistence of a separate disease process and whether
they have prognostic significance. METHOD: A series of patients with
primary depression who entered a follow-up and family study included 37 who
also had obsessions or compulsions, 93 who had panic attacks, 101 who had
phobias, and 196 who had none of these anxiety syndromes. Each of the
overlapping groups defined by the presence of a specific anxiety syndrome
was compared to the group that had none of these syndromes with respect to
baseline demographic, phenomenological, and historical features, illness
rates among directly interviewed relatives, and diagnostic stability and
clinical outcome at semiannual follow-ups over a period of 5 years.
RESULTS: Depressive symptoms at intake were more longstanding and severe
among patients with specific anxiety symptoms, and these patients went on
to experience more depressive morbidity during the ensuing 5 years. The
development of autonomous anxiety disorders was rare, however, and specific
anxiety syndromes in the probands did not increase risks for the
corresponding disorders among relatives. CONCLUSIONS: When restricted to
episodes of major depression, anxiety syndromes appear to be prognostically
significant epiphenomena rather than indicators of an additional disorder.
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