The Nottingham Study of Neurotic Disorder: predictors of 12-year outcome of dysthymic, panic and generalized anxiety disorder

2004 ◽  
Vol 34 (8) ◽  
pp. 1385-1394 ◽  
Author(s):  
PETER TYRER ◽  
HELEN SEIVEWRIGHT ◽  
TONY JOHNSON
Keyword(s):  
Anxiety Disorder ◽  
Personality Disorder ◽  
Generalized Anxiety Disorder ◽  
Depressive Disorders ◽  
Favourable Outcome ◽  
Dysthymic Disorder ◽  
Generalized Anxiety ◽  
Neurotic Disorder ◽  
Term Outcome ◽  
Long Term Outcome

Background. Controlled prospective studies of the simultaneous long-term outcome of several mental disorders are rare. This study sought to determine if there were important differences between the outcome of anxiety and depressive disorders after 12 years and to examine their main predictors.Method. A cohort of 210 people seen in general practice psychiatric clinics with a DSM-III diagnosis of generalized anxiety disorder (71), panic disorder (74), or dysthymic disorder (65), including combined anxiety-depressive disorder (cothymia) (67) was followed up after 12 years. Interview assessments of symptoms, social functioning and outcome were made, the latter using a new scale, the Neurotic Disorder Outcome Scale. Seventeen baseline predictors were also examined.Results. Data were obtained from 201 (96%) patients, 17 of whom had died. Only 73 (36%) had no DSM diagnosis at the time of follow-up. Using univariate and stepwise multiple linear regression those with cothymia, personality disorder, recurrent episodes and greater baseline self-rated anxiety and depression ratings had a worse outcome than others; initial diagnosis did not contribute significantly to outcome and instability of diagnosis over time was much more common than consistency.Conclusion. Only two out of five people with the common neurotic disorders have a good outcome despite alleged advances in treatment. Those with greater mood symptoms and pre-morbid personality disorder have the least favourable outcome. It is suggested that greater attention be paid to the concurrent treatment of personality disorder and environmental factors rather than symptoms as these may be the real cause of apparent treatment resistance.

scholarly journals Does cognitive-behavioural therapy influence the long-term outcome of generalized anxiety disorder? An 8–14 year follow-up of two clinical trials

2003 ◽  
Vol 33 (3) ◽  
pp. 499-509 ◽  
Author(s):  
R. C. DURHAM ◽  
J. A. CHAMBERS ◽  
R. R. MACDONALD ◽  
K. G. POWER ◽  
K. MAJOR
Keyword(s):  
Anxiety Disorder ◽  
Generalized Anxiety Disorder ◽  
Secondary Care ◽  
Generalized Anxiety ◽  
Behaviour Therapy ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Cognitive Behaviour

Background. Generalized anxiety disorder is a common condition of excessive worry and tension which tends to run a chronic course associated with significant psychiatric and medical problems. Cognitive behaviour therapy (CBT) has been shown to be of clinical value in about 50% of cases with treatment gains maintained over follow-up periods ranging from 6 to 12 months. The potential value of CBT over the longer term has not been subject to rigorous investigation.Method. Results are reported of 8–14 year follow-up of two randomized controlled trials of cognitive-behaviour therapy for generalized anxiety disorder employing structured interview with an assessor blind to initial treatment condition. Comparison groups included medication and placebo in one study based in primary care, and analytical psychotherapy in the other based in secondary care. Follow-up samples (30% and 55% of trial entrants) were broadly representative of the original cohorts.Results. Overall, 50% of participants were markedly improved of whom 30–40% were recovered (i.e. free of symptoms). Outcome was significantly worse for the study based in secondary care in which the clinical presentation of participants was more complex and severe. For a minority (30–40%), mainly from the secondary care study, outcome was poor. Treatment with CBT was associated with significantly lower overall severity of symptomatology and less interim treatment, in comparison with non-CBT conditions, but there was no evidence that CBT influenced diagnostic status, probability of recovery or patient perceptions of overall improvement.Conclusions. Both CBT and the complexity and severity of presenting problems appear to influence the long-term outcome of GAD.

Prediction of outcome in neurotic disorder: a 5-year prospective study

1998 ◽  
Vol 28 (5) ◽  
pp. 1149-1157 ◽  
Author(s):  
H. SEIVEWRIGHT ◽  
P. TYRER ◽  
T. JOHNSON
Keyword(s):  
Initial Response ◽  
Favourable Outcome ◽  
Dysthymic Disorder ◽  
Response To Treatment ◽  
Behaviour Therapy ◽  
Neurotic Disorder ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Predicting Outcome

Background. There have been no previous studies of the outcome of different neurotic disorders in which a prospective group with original randomization to treatment have been followed up over a long period. Such studies are important in identifying the factors associated with good and poor outcome.Methods. A 5-year follow-up assessment was made of a cohort of 210 psychiatric out-patients seen in general practice psychiatric clinics with a DSM-III diagnosis of generalized anxiety disorder (71), panic disorder (74) or dysthymic disorder (65) and randomized to drug treatment, cognitive and behaviour therapy, and self-help. A total of 182 of the patients (87%) were assessed after 5 years by examination of hospital and GP records using a standardized procedure and outcome determined with a four-point outcome scale.Results. One hundred and seven (60%) of the patients had a favourable outcome but the remainder continued to be handicapped either intermittently or continuously throughout the 5-year period. Analysis of the value of initial data in predicting outcome using polychotomous step-wise logistic regression revealed that five variables were significant predictors of poor prognosis: older age; recurrent episodes; the presence of personality disorder at entry; general neurotic syndrome at entry; and symptom severity after 10 weeks. The initial DSM diagnosis and original treatment given, together with ten other variables, were of no predictive value.Conclusions. The long-term outcome of neurotic disorder is better predicted by age, personality and recency of onset than by other clinical variables with the exception of initial response to treatment.

scholarly journals Negative Life Events and Avoidant Coping are Associated with Poorer Long-Term Outcome in Older Adults Treated for Generalized Anxiety Disorder

2010 ◽  
Vol 1 (1) ◽  
pp. jep.003110 ◽  
Author(s):  
Catherine R. Ayers ◽  
Andrew Petkus ◽  
Lin Liu ◽  
Thomas L. Patterson ◽  
Julie Loebach Wetherell
Keyword(s):  
Older Adults ◽  
Anxiety Disorder ◽  
Life Events ◽  
Generalized Anxiety Disorder ◽  
Negative Life Events ◽  
Avoidant Coping ◽  
Generalized Anxiety ◽  
Term Outcome ◽  
Long Term Outcome

The objective of this investigation was to explore predictors of long-term outcome following treatment of generalized anxiety disorder (GAD) in older adults. A small sample of older adults (N = 27) were randomized into a modular cognitive behavioral therapy protocol or enhanced community treatment for 12 weeks and followed for one year. Results from random effects regression models indicated that baseline levels of anxiety symptoms, avoidant coping, and negative life events are significantly associated with anxiety across follow-up. These preliminary data suggest that negative life events and avoidant coping may merit further investigation as predictors of long-term treatment outcome in geriatric GAD.

An examination of generalized anxiety disorder and dysthymic disorder by latent class analysis

2013 ◽  
Vol 44 (8) ◽  
pp. 1701-1712 ◽  
Author(s):  
D. Rhebergen ◽  
I. M. van der Steenstraten ◽  
M. Sunderland ◽  
R. de Graaf ◽  
M. ten Have ◽  
...  
Keyword(s):  
Mental Health ◽  
Anxiety Disorder ◽  
Latent Class Analysis ◽  
Generalized Anxiety Disorder ◽  
Clinical Characteristics ◽  
Latent Class ◽  
Depressive Symptomatology ◽  
Dysthymic Disorder ◽  
Generalized Anxiety ◽  
Class Analysis

BackgroundThe nosological status of generalized anxiety disorder (GAD) versus dysthymic disorder (DD) has been questioned. The aim of this study was to examine qualitative differences within (co-morbid) GAD and DD symptomatology.MethodLatent class analysis was applied to anxious and depressive symptomatology of respondents from three population-based studies (2007 Australian National Survey of Mental Health and Wellbeing; National Comorbidity Survey Replication; and Netherlands Mental Health Survey and Incidence Study-2; together known as the Triple study) and respondents from a multi-site naturalistic cohort [Netherlands Study of Depression and Anxiety (NESDA)]. Sociodemographics and clinical characteristics of each class were examined.ResultsA three-class (Triple study) and two-class (NESDA) model best fitted the data, reflecting mainly different levels of severity of symptoms. In the Triple study, no division into a predominantly GAD or DD co-morbidity subtype emerged. Likewise, in spite of the presence of pure GAD and DD cases in the NESDA sample, latent class analysis did not identify specific anxiety or depressive profiles in the NESDA study. Next, sociodemographics and clinical characteristics of each class were examined. Classes only differed in levels of severity.ConclusionsThe absence of qualitative differences in anxious or depressive symptomatology in empirically derived classes questions the differentiation between GAD and DD.

A 15–20 Year Follow-Up of Adult Psychiatric Patients

1995 ◽  
Vol 167 (3) ◽  
pp. 315-323 ◽  
Author(s):  
David Quinton ◽  
Lesley Gulliver ◽  
Michael Rutter
Keyword(s):  
Personality Disorder ◽  
Social Functioning ◽  
Depressive Disorders ◽  
Psychiatric Patients ◽  
Reliability And Validity ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Systematic Assessment ◽  
One Year

BackgroundAn exploratory study was undertaken of the importance of personality disorder in predicting the long-term outcome for both episodic disorders and social functioning.MethodIn 1966–67, a representative series of patients with children, free of episodic illness for at least one year, was sampled from the Camberwell Psychiatric Register and systematically assessed over a four-year period, using measures of known reliability and validity. Psychiatric disorder was measured using a PSE-compatible instrument. The follow-up after 15–20 years used the PSE and a systematic assessment of social functioning.ResultsOverall outcomes were similar across diagnoses, but an initial categorical diagnosis of personality disorder predicted much poorer outcomes on psychiatric and social measures for patients with unipolar depressive disorders than for those with other diagnoses.ConclusionsThe findings indicate the importance for prognosis of including a systematic assessment of personality disorder in the clinical assessment of patients with depressive disorder.

Generalized anxiety disorder comorbidities: Panic and depressive disorder

2017 ◽  
Vol 41 (S1) ◽  
pp. S486-S486
Author(s):  
M. Turki ◽  
J. Ben Thabet ◽  
N. Charfi ◽  
M. Mezghanni ◽  
M. Maalej Bouali ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Generalized Anxiety Disorder ◽  
Depressive Disorders ◽  
Severe Depression ◽  
Cross Sectional Study ◽  
Generalized Anxiety ◽  
Mild Depression ◽  
Cross Sectional ◽  
History Of ◽  
Competing Interest

IntroductionIt has been well documented that generalized anxiety disorder (GAD) can co-occur with mood disorders and other anxious disorders, particularly panic disorder (PD). These comorbidities can complicate therapeutic management and burden the prognosis.AimTo highlight the relationship between GAD and panic and depressive disorders.MethodsWe conducted a cross-sectional study, among 250 subjects consulting in 6 primary care units in Sfax, Tunisia. These participants, randomly chosen, were asked to answer a questionnaire after their consent. The diagnosis of GAD and PD were assessed by the “Mini International Neuropsychiatric Interview” of the DSM-IV. Depressive symptoms were evaluated using the “Beck Depression Inventory” (BDI).ResultsThe average age was 39 years. The sex ratio M/F was 1/2.The GAD was diagnosed in 10.8% of participants. The mean IDB score was 3.8. According to this scale, a mild depression was noted in 23.6%, moderate 12% and severe in 2.8% of cases. The GAD was statistically associated with psychiatric histories (P = 0.009), particularly depression disorder (P = 0.004) and the history of suicide attempt (P < 0.001).The IDB score was significantly higher in participants with GAD (P < 0.001). Among them, 74% presented moderate to severe depression.GAD co-occurs with PD in 22.2% of cases. This association was statistically significant (P < 0.001). Participants presenting GAD- PD comorbidity are at higher risk of developing depression (P = 0.003).ConclusionOne must always think to screen comorbidities in the presence of either diagnosis, in order to ensure a better management.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Cognitive Therapy for Generalized Anxiety Disorder: Significance of Comorbid Personality Disorders

1994 ◽  
Vol 8 (1) ◽  
pp. 13-18 ◽  
Author(s):  
William C. Sanderson ◽  
Aaron T. Beck ◽  
Lata K. McGinn
Keyword(s):  
Anxiety Disorder ◽  
Personality Disorder ◽  
Personality Disorders ◽  
Cognitive Therapy ◽  
Generalized Anxiety Disorder ◽  
Drop Out ◽  
Beck Anxiety Inventory ◽  
Generalized Anxiety ◽  
Duration Of Treatment ◽  
Significant Difference

Thirty-two patients diagnosed with generalized anxiety disorder were treated with cognitive therapy. Patients attended weekly one-hour sessions and there was no predetermined duration of treatment. Prior to treatment, each patient was evaluated for a comorbid personality disorder (PD) using the Structured Clinical Interview for the DSM-ffi-R Personality Disorders (SCID-II). Patients completed the Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) at the intake evaluation and at their final session. Sixteen of the 32 patients were diagnosed with a comorbid PD at the intake evaluation. A total of 22 patients completed a minimum course of cognitive therapy, which was defined as six sessions. Overall, there was a significant reduction of BAI and BDI scores for patients with and without a PD. There was no significant difference between the two groups. However, patients with a comorbid PD were more likely to drop out of treatment Seven of the 10 dropouts had a comorbid PD as compared to only 9 out of the 22 completers.

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