Influence of Psychiatric Comorbidity on Recovery and Recurrence in Generalized Anxiety Disorder, Social Phobia, and Panic Disorder: A 12-Year Prospective Study

Harvard University, Cambridge, Massachusetts, United States
American Journal of Psychiatry (Impact Factor: 12.3). 07/2005; 162(6):1179-87. DOI: 10.1176/appi.ajp.162.6.1179
Source: PubMed


The authors sought to observe the long-term clinical course of anxiety disorders over 12 years and to examine the influence of comorbid psychiatric disorders on recovery from or recurrence of panic disorder, generalized anxiety disorder, and social phobia.
Data were drawn from the Harvard/Brown Anxiety Disorders Research Program, a prospective, naturalistic, longitudinal, multicenter study of adults with a current or past history of anxiety disorders. Probabilities of recovery and recurrence were calculated by using standard survival analysis methods. Proportional hazards regression analyses with time-varying covariates were conducted to determine risk ratios for possible comorbid psychiatric predictors of recovery and recurrence.
Survival analyses revealed an overall chronic course for the majority of the anxiety disorders. Social phobia had the smallest probability of recovery after 12 years of follow-up. Moreover, patients who had prospectively observed recovery from their intake anxiety disorder had a high probability of recurrence over the follow-up period. The overall clinical course was worsened by several comorbid psychiatric conditions, including major depression and alcohol and other substance use disorders, and by comorbidity of generalized anxiety disorder and panic disorder with agoraphobia.
These data depict the anxiety disorders as insidious, with a chronic clinical course, low rates of recovery, and relatively high probabilities of recurrence. The presence of particular comorbid psychiatric disorders significantly lowered the likelihood of recovery from anxiety disorders and increased the likelihood of their recurrence. The findings add to the understanding of the nosology and treatment of these disorders.

Download full-text


Available from: Maria E Pagano
    • "GAD is frequently comorbid with other psychiatric disorders (Wittchen et al., 1994; Alonso et al., 2004), particularly major depressive disorder (MDD), which is present in two-thirds of patients with GAD at any time in their lives (Judd et al., 1998). Patients with GAD who also have comorbid MDD show greater disability, greater quality-of-life impairments (Wittchen et al., 2002; Hoffman et al., 2008), and higher risk of recurrence (Bruce et al., 2005) and suicide attempts (Massion et al., 1993). "
    [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate the effectiveness of pregabalin in patients with resistant generalized anxiety disorder (GAD) and severe depressive symptoms, we carried out a post-hoc analysis of a multicenter, prospective, and observational 6-month study. We included patients who were at least 18 years old, fulfilled the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) criteria for GAD, showed inadequate responses to previous courses of antidepressant treatment, had Montgomery-Asberg Rating Scale scores of at least 35, had not received pregabalin previously, and were prescribed pregabalin upon entry into this study. We included 1815 patients fulfilling the DSM-IV criteria for GAD, and 133 (7.3%) fulfilled the selection criteria for these analyses. Ninety-seven percent of the patients received pregabalin (mean dose: 222 mg/day) in combination with other psychotropics. The Hamilton Anxiety Scale total score was reduced by a mean of 20.3 points (95% confidence interval, 22.1-18.4) (57.2% reduction) at month 6. Pregabalin also ameliorated comorbid depressive symptoms, with a reduction in the mean score of the Montgomery-Asberg Rating Scale of 22.3 points (95% confidence interval, 24.2-20.4) (56.6% reduction). Our results suggest that pregabalin, as part of a combination regimen with antidepressants and/or benzodiazepines, might be effective for the treatment of patients with GAD who have shown inadequate response to previous antidepressants and have severe depressive symptoms.
    No preview · Article · Jun 2015 · International clinical psychopharmacology
  • Source
    • "Mental health and alcohol use disorders frequently co-occur in clinical settings (Hirschfeld et al., 1989; Swendsen and Merikangas, 2000; Kessler, 2004; Teesson et al., 2009; Alegria et al., 2010). It is becoming increasingly apparent that in addition to integrated care requirements (Davis et al., 2008; Carroll et al., 2009; Kidorf et al., 2013), patients with comorbid alcohol and mental health disorders (CAMHD) are characterized by more severe clinical outcomes (Hirschfeld et al., 1989; Bruce et al., 2005) and specific social difficulties (Merikangas et al., 1998b; Swendsen and Merikangas, 2000; Davis et al., 2008; Kessler and Wang, 2008b; Jaworski et al., 2011). "
    [Show abstract] [Hide abstract]
    ABSTRACT: This article examines whether young individuals in the general population with comorbid alcohol use and mental health disorders experience worse internalising and externalising behaviour problems than those with single disorders. A large cohort of women at the Mater Misericordiae Hospital in Brisbane, Australia, was enrolled during pregnancy in a longitudinal study. Mother/offspring dyads were followed over twenty-one years. At age 21, offspring behaviour problems were examined using the Young Adult Self Report, alcohol and mental health disorders with the Composite International Diagnostic Interview. Associations between comorbidity and behaviour problems were assessed using multinomial logistic regression, accounting for life-course factors. Twelve percent of young adults had alcohol/mental health DSM-IV disorders with significant temporal overlap. A further 16% had alcohol disorders only and 23% mental health disorders only. The comorbid group scored significantly higher on total and externalizing behaviour problems but not internalizing behaviour problems. Stronger associations of aggression/delinquency with comorbidity were not fully accounted for by factors known to influence separate development of mental health and alcohol disorders. Young adults with comorbid alcohol/mental health disorders experience more, and more severe, behavioural problems than those with single disorder types, indicating an increased burden from comorbidity, with implications for treatment and public order.
    Full-text · Article · Oct 2014 · Psychiatry Research
  • Source
    • "The consequences of these disorders (King et al., 2000; Gore et al., 2011; Mojtabai, 2011; Whiteford et al., 2013), particularly when co-occurring, are increasingly recognised as a major public health issue and their global health and economic burden is high. Mental health and alcohol disorders contribute to 183.9 million Disability Adjusted Life Years annually, peaking in young adults (Whiteford et al., 2013), and treatment of comorbid mental health and alcohol disorders is both more complex (Tiet and Mausbach, 2007; Connolly et al., 2011) and more costly than single disorders (King et al., 2000), with worse projected outcomes (Bruce et al., 2005). As such, understanding how these joint conditions emerge is of great interest to researchers, policy makers and health professionals (Rush and Koegl, 2008; Swendsen et al., 2009; Cerda et al., 2010; Green et al., 2012). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Alcohol and mental health disorders are highly prevalent in the general population, with co-occurrence recognised as a major public health issue. Socio-economic factors are frequently associated with both disorders but their temporal association is unclear. This paper examines the association between prenatal socio-economic disadvantage and comorbid alcohol and mental health disorders at young adulthood. Methods: An unselected cohort of women was enrolled during early pregnancy in the large longitudinal Mater-University of Queensland Study of Pregnancy (MUSP), at the Mater Misericordiae Public Hospital in Brisbane, Australia. The mothers and their offspring were followed over a 21 year period. Offspring from the MUSP birth cohort who provided full psychiatric information at age 21 and whose mothers provided socioeconomic information at baseline were included (n=2399). Participants were grouped into no-disorder, mental health disorder only, alcohol disorder only or comorbid alcohol and mental health disorders according to DSM-IV diagnoses at age 21 as assessed by the Composite International Diagnostic Interview. We used multivariate logistic regression analysis to compare associations of disorder group with single measures of prenatal socio-economic disadvantage including family income, parental education and employment, and then created a cumulative scale of socioeconomic disadvantage. Results: Greater socio-economic disadvantage was more strongly associated with comorbidity (OR 3.36; CI95 1.37, 8.24) than with single disorders. This relationship was not fully accounted for by maternal mental health, smoking and drinking during pregnancy. Conclusion: Multiple domains of socio-economic disadvantage in early life are associated with comorbid alcohol and mental health disorders.
    Full-text · Article · Sep 2014 · Drug and Alcohol Dependence
Show more