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Am J Psychiatry 1994; 151:1153-1162
Copyright © 1994 by American Psychiatric Association
The DSM-IV field trial for mixed anxiety-depression
RE Zinbarg, DH Barlow, M Liebowitz, L Street, E Broadhead, W Katon, P Roy-Byrne, JP Lepine, M Teherani and J Richards
Phobia and Anxiety Disorders Clinic, University at Albany, State University of New York, NY.
OBJECTIVE: This field trial was designed to answer four questions. First,
are patients presenting with anxious or depressed symptoms that are
associated with significant impairment but do not meet DSM-III-R
definitional thresholds for axis I anxiety or mood disorders? Second, is
the impairment experienced by these patients simply the consequence of the
severity of their medical conditions? Third, what percent of these patients
present with depressive symptoms only, anxious symptoms only, and a mixture
of both? Fourth, how should the operational criteria for the syndrome(s)
presented by these patients be defined? METHOD: A total of 666 patients
from five primary care medical sites and two outpatient mental health sites
were administered a semistructured psychiatric interview. RESULTS: Patients
presenting with affective symptoms that did not meet definitional
thresholds for DSM- III-R axis I disorders were at least as common as
patients with several of the already established anxiety and mood disorders
in each of the seven sites, and their disorders were associated with
significant distress or impairment. A nonspecific pattern of anxious and
depressed symptoms was the modal presentation among these patients with
currently subdefinitional threshold disorders, and they could be
significantly differentiated in terms of current symptoms from patients
presenting with a principal diagnosis of generalized anxiety disorder,
major depressive episode, or panic disorder with agoraphobia. CONCLUSIONS:
The authors recommend that a mixed anxiety-depression category be included
in the DSM-IV appendix for proposed diagnostic categories that need further
study. A criteria set is proposed.
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