Comorbid Depressive and Anxiety Disorders in 509 Individuals With an At-Risk Mental State: Impact on Psychopathology and Transition to Psychosis

Abstract

Background: The current diagnostic system for subjects at enhanced clinical risk of psychosis allows concurrent comorbid diagnoses of anxiety and depressive disorders. Their impact on the presenting high-risk psychopathology, functioning, and transition outcomes has not been widely researched. Methods: In a large sample of subjects with an At-Risk Mental State (ARMS, n = 509), we estimated the prevalence of DSM/SCID anxiety or depressive disorders and their impact on psychopathology, functioning, and psychosis transition. A meta-analytical review of the literature complemented the analysis. Results: About 73% of ARMS subjects had a comorbid axis I diagnosis in addition to the “at-risk” signs and symptoms. About 40% of ARMS subjects had a comorbid diagnosis of depressive disorder while anxiety disorders were less frequent (8%). The meta-analysis conducted in 1683 high-risk subjects confirmed that baseline prevalence of comorbid depressive and anxiety disorders is respectively 41% and 15%. At a psychopathological level, comorbid diagnoses of anxiety or depression were associated with higher suicidality or self-harm behaviors, disorganized/odd/stigmatizing behavior, and avolition/apathy. Comorbid anxiety and depressive diagnoses were also associated with impaired global functioning but had no effect on risk of transition to frank psychosis. Meta-regression analyses confirmed no effect of baseline anxiety and/or depressive comorbid diagnoses on transition to psychosis. Conclusions: The ARMS patients are characterized by high prevalence of anxiety and depressive disorders in addition to their attenuated psychotic symptoms. These symptoms may reflect core emotional dysregulation processes and delusional mood in prodromal psychosis. Anxiety and depressive symptoms are likely to impact the ongoing psychopathology, the global functioning, and the overall longitudinal outcome of these patients.

Modeling the Interplay Between Psychological Processes and Adverse, Stressful Contexts and Experiences in Pathways to Psychosis: An Experience Sampling Study

“…This finding may tentatively suggest a greater relevance of affective pathways rather than pathways via threat anticipation in the prodromal period of psychosis when a considerable proportion experience comorbid anxiety and depression. 51 We did not find evidence in support of our hypotheses that aberrant salience mediated the effects of threat anticipation and negative affect on PE. What is more, event-related stress was associated with a slight decrease in aberrant salience, which, in turn, was associated with less intense PE in FEP individuals, who all (but one) received prior or ongoing treatment with antipsychotic medication.…”

Effects of online intervention for depression on mood and positive symptoms in schizophrenia

“…A review estimated that at least 50% of patients suffer from comorbid depression (Buckley et al, 2009), and many patients show single depressive symptoms such as low self-esteem (Freeman et al, 1998;Kesting and Lincoln, 2013;Moritz et al, 2010). Second, suicidality, a grave and life-threatening manifestation of depression, is frequent in psychosis and approximately 5% of patients commit suicide (Hor and Taylor, 2010).While some suicides are due to the influence of acoustic hallucinations, depression represents the best predictor for suicidality or selfharm behaviors in patients with schizophrenia (Fusar-Poli et al, 2014). Third, the implicit prevailing treatment paradigmposits that improving positive symptoms and insight will raise quality of life and reduce depression.…”

“…Research suggests, however, that enhancement of insight can even paradoxically aggravate affective problems (Karow et al, 2008;Lincoln et al, 2007). Moreover, depression is not just a secondary consequence of having a severe mental disorder, it is also a frequent premorbid precursor of psychosis (Fusar-Poli et al, 2014). Fourth, depressive symptoms are often formulated by patients as their preferred target of treatment (Byrne et al, 2010;Hafner et al, 2013;Sterk et al, 2013;Moritz et al, in press-b).…”

Pattern of activation during delayed matching to sample task predicts functional outcome in people at ultra high risk for psychosis

“…A recent meta-analysis in 1683 UHR subjects confirmed that baseline prevalence of co-morbid depressive and anxiety disorders is 41 % and 15 % respectively (P. Fusar-Poli et al, 2012b), with comorbidity rates varying greatly between studies (depression: 95% CI 32.5%-49.4%; anxiety: 95% CI 8.9%-25%; (P. Fusar-Poli et al, 2012b)). It is thus surprising that the rate of comorbid depression and/or anxiety in our sample was relatively low (26%).…”