30-month stability of personality disorder diagnoses in depressed outpatients.

OBJECTIVE: This study examined the 30-month stability of axis II conditions. METHOD: One hundred eight depressed outpatients received comprehensive, semistructured personality disorder assessments at baseline and at follow-up. RESULTS: The diagnostic stability of personality disorders ranged from low to moderate at the categorical level and was generally moderate at the dimensional level. Most disorders exhibited good discriminant validity, in that the association between a disorder at baseline and at follow-up was greater than the associations between that disorder at baseline and the other 11 axis 11 disorders at follow-up. Two variables, sex and lifetime history of substance abuse or dependence, were significantly related to change in level of personality disorder features over time. CONCLUSIONS: Personality disorders have low to moderate stability over a 30-month period in depressed outpatients.

A randomized double-blind study of fluoxetine versus placebo in the treatment of dysthymia.

OBJECTIVE: The purpose of this study was to assess the efficacy of fluoxetine, a selective serotonergic antidepressant, in the treatment of dysthymia. METHOD: Thirty-five patients who met criteria for dysthymia, but not major depression, began randomized, double-blind 8-week trials of fluoxetine or placebo. RESULTS: Of 32 patients who completed the study, 10 (62.5%) of the 16 patients given fluoxetine and three (18.8%) of the 16 given placebo responded to treatment. Response was defined as 1) 50% or greater decrease in Hamilton Rating Scale for Depression score and 2) a score of 1 or 2 on the Clinical Global Impression (CGI) improvement subscale. Fluoxetine subjects showed significantly greater improvement at week 8 than placebo subjects on the Hamilton depression and CGI scales, but not on the Hopkins Symptom Check-list (58-item) or the Cornell Dysthymia Rating Scale. CONCLUSIONS: When compared to placebo, fluoxetine showed short-term effectiveness in treating dysthymic symptoms.

Understanding the comorbidity between early-onset dysthymia and cluster B personality disorders: a family study.

OBJECTIVE: A number of studies have documented significant comorbidity between dysthymia and axis II personality disorders, particularly those grouped in cluster B. However, the nature of this comorbidity is poorly understood. The purpose of this investigation was to use the family study method to test five competing models of the comorbidity between early-onset dysthymia and cluster B personality disorders. METHOD: Proband groups consisted of subjects with early-onset dysthymia and a co-occurring cluster B personality disorder (N = 28), subjects with early-onset dysthymia without a cluster B personality disorder (N = 69), and a comparison group of subjects who had never been psychiatrically ill (N = 45). The groups were compared on rates of dysthymia with a cluster B personality disorder, dysthymia without a cluster B personality disorder, and cluster B personality disorders without dysthymia in their first-degree relatives (N = 675). RESULTS: The relatives of both subgroups of dysthymic probands exhibited higher rates of dysthymia with a cluster B personality disorder, dysthymia without a cluster B personality disorder, and cluster B personality disorders without dysthymia than the relatives of the never ill probands. In addition, the relatives of probands with comorbid dysthymia exhibited higher rates of cluster B personality disorders without dysthymia than the relatives of probands with noncomorbid dysthymia. CONCLUSIONS: This pattern of results is consistent with the notion that dysthymia and cluster B personality disorders co-occur because of shared etiological factors. This was the only one of five models of the comorbidity between dysthymia and cluster B personality disorders that was supported by the family data.

Long-term treatment of double depression: a preliminary study with serotonergic antidepressants.

1. There is increasing evidence that many patients with major depression also have coexisting dysthymia, and that antidepressant treatment may alleviate both conditions. 2. Open-label study of fluoxetine and trazodone for 18 patients meeting DSM-III-R criteria for concurrent dysthymia and major depression. 3. Fourteen patients completed three-month medication trials, and seven (50%) of completers) responded to treatment. At five months, eight (57.1%) were in remission. Fluoxetine was significantly better tolerated than trazodone, with respective dropout rates of 7.7% and 80%. 4. Findings are consistent with efficacy of serotonergic agents in this condition.

A preliminary study of serotonergic antidepressants in treatment of dysthymia.

There is increasing evidence that antidepressants may alleviate symptoms of dysthymia, but few prior studies on selective serotonergic agents. Twenty patients meeting criteria for dysthymia, but not meeting criteria for major depression, received open label trials of a serotonergic antidepressant, either fluoxetine or trazodone. Seventeen (85%) completed three-month medication trials, and of these, twelve (70.6% of completers) responded to treatment. Seven (41.2% of completers) were still in remission on follow-up at five months. Both fluoxetine and trazodone were well tolerated in dysthymics, and showed similar short-term effectiveness in treating dysthymic symptoms.

Psychosocial predictors of the short-term course and outcome of major depression: a longitudinal study of a nonclinical sample with recent-onset episodes.

Three variables have been hypothesized to play important roles in prolonging the course of depressive episodes: a ruminative response style, significant interpersonal relationships, and childhood adversity. The authors examined whether these variables predicted the short-term course of major depressive disorder (MDD). Participants (n = 84) were college students with a recent-onset major depressive episode. Assessments included several interview and self-report measures, and data on interpersonal relationships were obtained from close confidants. Follow-up interviews were conducted 6 months later. After controlling for baseline severity, harsh discipline in childhood significantly predicted mean level of depression across the follow-up and level of depression at follow-up. Harsh discipline was also significantly associated with relapse but not with recovery. After controlling for baseline severity, rumination and the interpersonal variables did not predict the outcome of MDD.

Thirty-month naturalistic follow-up study of early-onset dysthymic disorder: course, diagnostic stability, and prediction of outcome.

Dysthymic disorder (DD) is defined and distinguished from major depressive disorder (MDD) largely on the basis of its course. Surprisingly, however, there have been few prospective, longitudinal studies of the naturalistic course of DD. This article reports the major findings from a prospective, longitudinal 30-month follow-up study of 86 outpatients with early-onset DD (EOD) and 39 outpatients with episodic MDD. Follow-up assessments included the Longitudinal Interval Follow-Up Evaluation and Hamilton Rating Scale for Depression. Compared with patients with episodic MDD, patients with EOD exhibited less improvement from the baseline evaluation and were more symptomatic at follow-up. Only 39% of patients with EOD recovered from DD during the follow-up period. The diagnosis of DD was fairly stable, with 52% of the EOD group meeting full criteria for DD at follow-up. These data provide prospective confirmation of the chronic course of DD.

A construct validation study of the Response Styles Questionnaire Rumination Scale in participants with a recent-onset major depressive episode.

This study examined the construct validity and clinical utility of S. Nolen-Hoeksema's (1991) Response Styles Questionnaire (RSQ) Rumination scale. Eighty-eight participants with recent-onset major depressive episodes were assessed and followed for 6 months, using semistructured interviews and self-report inventories. The RSQ Rumination scale exhibited poor 6-month stability and appeared to be closely linked to participants' clinical status-mood state. The scale was significantly correlated with conceptually related constructs such as emotion-focused coping, negative affectivity-temperament, and self-criticism. However, baseline negative temperament and self-criticism predicted key aspects of the 6-month course and outcome of major depressive episodes, whereas baseline rumination did not. Finally, rumination appeared to be closely associated with the severity of the depressive episode, rather than defining a distinct clinical subtype.

The relationship between age at onset and comorbidity in psychiatric disorders.

The Epidemiologic Catchment Area community sample data were analyzed to determine whether there is a general tendency for subjects with two or more disorders to have an earlier age of onset of the index disorder than subjects with only one disorder. DSM-III axis I disorders and antisocial personality were each used as index disorders in separate logistic regressions. The results show that an earlier age of onset is associated with greater comorbidity in major depression, with a similar trend for alcoholism. Schizophrenia and the phobias, however, showed significant results in the opposite direction. Overall, the results argue for specific rather than general effects of age of onset on comorbidity.

Who participates in a family study?

Potential subject participation biases in a family study of outpatients with mood disorders and personality disorders (PDs) were explored at three levels: (1) differences between probands who granted permission to contact all relatives, those who gave permission to contact only a subset of relatives, and those who denied permission to contact any relatives; (2) differences between relatives whom the proband granted permission to contact and those whom the proband denied permission to contact; and (3) for the relatives who could be contacted, differences between those who agreed to participate and those who declined. Subjects included 156 outpatients with mood disorders and PDs and 611 of their first-degree relatives. Axis I and II disorders in probands and relatives were evaluated using structured diagnostic interviews. In addition, informant reports on relatives were obtained from family history (FH) interviews. Results indicated that probands who gave and who withheld consent to contact their relatives did not differ significantly on most variables. However, relatives whom we were not permitted to contact were significantly more likely to have drug abuse and PDs. Finally, of the relatives we were permitted to contact, there were few differences between those who participated in the study and those who refused to participate. These findings indicate that the greatest risk of sampling bias in family studies stems from probands' reluctance to grant access to relatives with drug abuse and PDs.