Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-23T09:22:19.879Z Has data issue: false hasContentIssue false

The relationship between depression with anxious distress DSM-5 specifier and mixed depression: a network analysis

Published online by Cambridge University Press:  03 March 2020

Antonio Tundo
Affiliation:
Istituto di Psicopatologia, Rome, Italy
Laura Musetti
Affiliation:
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
Claudia Del Grande*
Affiliation:
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
Rocco de Filippis
Affiliation:
Istituto di Psicopatologia, Rome, Italy
Luca Proietti
Affiliation:
Istituto di Psicopatologia, Rome, Italy
Donatella Marazziti
Affiliation:
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
Dino Gibertoni
Affiliation:
Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
Liliana Dell’Osso
Affiliation:
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
*
Author for correspondence: Claudia Del Grande, MD, Email: [email protected]

Abstract

Introduction

Epidemiological, clinical, and treatment response characteristics of major depression with anxious distress (ADS) are quite similar to those of mixed depression, but no study investigated the symptom interplay of these conditions.

Objective

To analyze the correlations among symptom criteria for major depression with ADS and for mixed depression using a network analysis.

Methods

Two hundred and forty-one outpatients with major depression were consecutively recruited. DSM-5 criteria for major depression with ADS or with mixed features (MF) and Koukopoulos’ criteria for mixed depression (MXD) were assessed using a structured clinical interview.

Results

A total of 58.9% of patients met DSM-5 criteria for major depression with ADS, 48.5% for MXD, and 2.5% for major depression with MF, so that the symptoms of this specifier were excluded from the network analysis. The most frequent symptoms were difficulty concentrating due to worries (57.7%), feeling keyed up or on edge (51%) (major depression with ADS), and psychic agitation or inner tension (51%) (MXD). Psychic agitation or inner tension had a central position in the network and bridged MXD to major depression with ADS through feeling keyed up or on edge.

Conclusions

Criteria for major depression with ADS and for MXD are partially overlapping, with psychic agitation or inner tension and feeling keyed up or on edge that feature in both conditions and are difficult to distinguish in clinical practice. The clarification of the relationship between these two psychopathological conditions could bring important implications for diagnosis, prognosis, and treatment of depressive episodes.

Type
Original Research
Copyright
© Cambridge University Press 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013.Google Scholar
Gaspersz, R, Lamers, F, Kent, JM, et al. Anxious distress predicts subsequent treatment outcome and side effects in depressed patients starting antidepressant treatment. J Psychiatr Res. 2017;84:4148.CrossRefGoogle ScholarPubMed
Gaspersz, R, Lamers, F, Kent, JM, et al. Longitudinal predictive validity of the DSM-5 anxious distress specifier for clinical outcomes in a large cohort of patients with major depressive disorder. J Clin Psychiatry. 2017;78(2):207213.CrossRefGoogle Scholar
McIntyre, RS, Woldeyohannes, HN, Soczynska, JK, et al. The prevalence and clinical characteristics associated with Diagnostic and Statistical Manual Version-5-defined anxious distress specifier in adults with major depressive disorder: results from the International Mood Disorders Collaborative Project. Ther Adv Chronic Dis. 2016;7(3):153159.CrossRefGoogle ScholarPubMed
Tundo, A, Musetti, L, de Filippis, R, et al. Is there a relationship between depression with anxious distress DSM-5 specifier and bipolarity? A multicenter cohort study on patients with unipolar, bipolar I and II disorders. J Affect Disord . 2019;245:819826.CrossRefGoogle Scholar
Zimmerman, M, Chelminski, I, Young, D, et al. A clinically useful self-report measure of the DSM-5 anxious distress specifier for major depressive disorder. J Clin Psychiatry. 2014;75:601607.CrossRefGoogle ScholarPubMed
Zimmerman, M, Clark, H, McGonigal, P, et al. Reliability and validity of the DSM-5 anxious distress specifier interview. Compr Psychiatry. 2017;76:1117.CrossRefGoogle ScholarPubMed
Shim, IH, Bae, DS, Bahk, WM. Anxiety or agitation in mood disorder with mixed features: a review with a focus on validity as a dimensional criterion. Ann Clin Psychiatry. 2016;28(3):213220.Google ScholarPubMed
Malhi, GS, Byrow, Y, Outhred, T, et al. Exclusion of overlapping symptoms in DSM-5 mixed features specifier: heuristic diagnostic and treatment implications. CNS Spectr. 2017;22(2):126133.CrossRefGoogle ScholarPubMed
Miller, S, Suppes, T, Mintz, J, et al. Mixed depression in bipolar disorder: prevalence rate and clinical correlates during naturalistic follow-up in the Stanley Bipolar Network. Am J Psychiatry. 2016;173(10):10151023.CrossRefGoogle ScholarPubMed
Vazquez, GH, Lolich, M, Cabrera, C, et al. Mixed symptoms in major depressive and bipolar disorders: a systematic review. J Affect Disord. 2018;225:756760.CrossRefGoogle ScholarPubMed
Maj, M. “Mixed” depression: drawbacks of DSM-5 (and other) polythetic diagnostic criteria. J Clin Psychiatry . 2015;76:e381e382. doi: 10.4088/JCP.CrossRefGoogle ScholarPubMed
Perugi, G, Angst, J, Azorin, JM, et al. Mixed features in patients with a major depressive episode: the BRIDGE-II-MIX study. J Clin Psychiatry . 2015;76:e351e358. doi: 10.4088/JCP.14m09092.CrossRefGoogle ScholarPubMed
Stahl, SM. Mixed-up about how to diagnose and treat mixed features in major depressive episodes. CNS Spectr. 2017;22(2):111115.CrossRefGoogle ScholarPubMed
Koukopoulos, A. Mixed features of depression: why DSM-5 is wrong (and so was DSM-IV). Br J Psychiatry. 2013;203(1):35.CrossRefGoogle Scholar
Koukopoulos, A, Sani, G. DSM-5 criteria for depression with mixed features: a farewell to mixed depression. Acta Psychiatr Scand. 2014;129(1):416.CrossRefGoogle ScholarPubMed
Malhi, GS, Lampe, L, Coulston, CM, et al. Mixed state discrimination: a DSM problem that won’t go away? J Affect Disord. 2014;158:810.CrossRefGoogle Scholar
Perlis, RH, Cusin, C, Fava, M. Proposed DSM-5 mixed features are associated with greater likelihood of remission in out-patients with major depressive disorder. Psychol Med. 2014;44(7):13611367.CrossRefGoogle ScholarPubMed
Kim, H, Kim, W, Citrome, L. More inclusive bipolar mixed depression definition by permitting overlapping and non-overlapping mood elevation symptoms. Acta Psychiatr Scand. 2016;134(3):199206.CrossRefGoogle ScholarPubMed
Takeshima, M, Oka, T. DSM-5 defined ‘mixed features’ and Benazzi’s mixed depression: which is practically useful to discriminate bipolar from unipolar depression in patients with depression? Psychiatry Clin Neurosci. 2015;69(2):109116.CrossRefGoogle ScholarPubMed
Sani, G, Vöhringer, PA, Napoletano, F. Koukopoulo’ diagnostic criteria for mixed depression: a validation study. J Affect Disord. 2014;164:1418.CrossRefGoogle ScholarPubMed
Koukopoulos, A, Tundo, A. A mixed depressive syndrome. Clin Neuropharmacol. 1992;15(Suppl 1 Pt A):626A627A.CrossRefGoogle ScholarPubMed
Koukopoulos, A, Koukopoulos, A. Agitated depression as a mixed state and the problem of melancholia. Psychiatr Clin North Am. 1999;22(3):547564.CrossRefGoogle ScholarPubMed
Hamilton, M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23:5662.CrossRefGoogle ScholarPubMed
First, MB, Williams, JBW, Karg, RS, et al. Structured Clinical Interview for DSM-5 Disorders, Clinician Version (SCID-5-CV). Arlington, VA: American Psychiatric Publishing; 2015.Google Scholar
Fruchterman, TMJ, Reingold, EM. Graph drawing by force-directed placement. Softw Pract Exper. 1991;21:11291164.CrossRefGoogle Scholar
van Borkulo, CD, Borsboom, D, Epskamp, S, et al. A new method for constructing networks from binary data. Sci Rep. 2014;4:5918CrossRefGoogle ScholarPubMed
Epskamp, S, Borsboom, D, Fried, EI. Estimating psychological networks and their accuracy: a tutorial paper. Behav Res Methods. 2018;50(1):195212.CrossRefGoogle ScholarPubMed
Beard, C, Millner, AJ, Forgeard, MJ. Network analysis of depression and anxiety symptom relationships in a psychiatric sample. Psychol Med. 2016;46(16):33593369.CrossRefGoogle Scholar
Sani, G, Napoletano, F, Vohringer, PA, et al. Mixed depression. Clinical features and predictors of its onset associated with antidepressant use. Psychother Psychosom. 2014;83:213221.CrossRefGoogle ScholarPubMed