Hu. Wittchen et al., Comorbidity and mixed anxiety-depressive disorder: clinical curiosity or pathophysiological need?, HUM PSYCHOP, 16, 2001, pp. S21-S30
Citations number
29
Categorie Soggetti
Neurosciences & Behavoir
Journal title
HUMAN PSYCHOPHARMACOLOGY-CLINICAL AND EXPERIMENTAL
The paper reviews available epidemiological evidence for the existence of a
nd the implications of comorbidity of anxiety and depressive disorders and
mixed anxiety-depressive (MAD) disorders. Using epidemiolological evidence
of prevalence and incidence and data relating to time-course of illness, ri
sk factor and outcome, it is concluded: (1) that anxiety-depression comorbi
dity is quite frequent in epidemiological and clinical settings throughout
the world; (2) this comorbidity is diagnosis-specific and is associated wit
h increased vulnerabilities and risks as well as poorer outcome and marked
disabilities; and (3) no such evidence was found for MAD disorders. Contrar
y to what was predicted, the prevalence of MAD disorders was quite low even
when using the more recent criteria of the Diagnostic and Statistical Manu
al of Mental Disorders, 4th edition. (4) Furthermore, there was quite a het
erogeneous pattern in terms of risk, severity and outcome making it questio
nable whether this disorder, as currently defined, is a clinical entity. Th
ese findings are discussed in terms of two perspectives, the 'lumpers' with
their dimensional view and the 'splitters' with their categorical view. It
is concluded that although comorbidity of threshold anxiety and depressive
disorders seems to be an important phenomenon, no such evidence is provide
d for MAD disorders. Copyright (C) 2001 John Wiley & Sons, Ltd.