Mixed Anxiety Depression Should Not Be Included in DSM-5

Batelaan, Neeltje M.; Spijker, Þ Jan; Graaf, Ron de; Cuijpers, Pim

doi:10.1097/nmd.0b013e318257c4c9

Cited by 20 publications

(8 citation statements)

References 26 publications

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“…While some researchers prefer a simultaneous classification of subthreshold anxiety disorder and subthreshold depression [e.g., 67, 79], others advocate a choice between the two [e.g., 77]. …”

Section: Nosological Issuesmentioning

confidence: 99%

“…Therefore, it has been argued that if MADD is actually a prodromal stage of another psychiatric disorder, it should be classified in accordance with this disorder, not as an independent diagnostic concept [79]. While this argument is perfectly understandable from a research perspective, the question of whether a particular patient presenting with symptoms meeting the criteria of MADD will progress to some syndromal disorder, and to which disorder she/he is likely to progress, requires a longitudinal perspective that cannot always be obtained from the patient’s history and would rather necessitate a look into the future.…”

Section: Nosological Issuesmentioning

confidence: 99%

“…Batelaan et al [79] have noted that there is a certain inconsistency in defining MADD as a diagnostic category for co-morbid, subthreshold anxiety and depression, while, at the same time, there is no comparable option when both components are equally important at the threshold level (e.g., a clinical presentation meeting the criteria of both MDD and GAD). Indeed, Tyler [29] has already pointed out that the discussion about the usefulness of MADD as a diagnostic category has mainly be focused on coexisting, subsyndromal presentations.…”

Section: Nosological Issuesmentioning

confidence: 99%

“…Among the non-remitting patients a substantial proportion was found to progress to a syndromal depressive or anxiety disorder or to another syndromal psychiatric diagnosis [27, 72]. While it has been argued that subthreshold symptoms of anxiety and depression may thus mainly be either self-limiting or a prodromal stage to a syndromal condition, not warranting a diagnostic entity in its own right [27, 79], the same findings can also be interpreted as evidence that the development of a more severe form of affective disorder could likely be prevented in a substantial fraction of patients by early recognition and appropriate treatment of MADD, saving both patients’ suffering as well as healthcare and economic resources. Lamentably, factors allowing to reliably predict the course of MADD, and to differentiate between patients who are likely to remit spontaneously and those who are at a substantial risk of progression to a syndromal affective disorder, are yet to be identified [74].…”

Section: Why Madd Is An Important Diagnostic Category In Its Own Rightmentioning

confidence: 99%

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The relevance of ‘mixed anxiety and depression’ as a diagnostic category in clinical practice

Möller

Bandelow

Volz

et al. 2016

Eur Arch Psychiatry Clin Neurosci

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According to ICD-10 criteria, mixed anxiety and depressive disorder (MADD) is characterized by co-occurring, subsyndromal symptoms of anxiety and depression, severe enough to justify a psychiatric diagnosis, but neither of which are clearly predominant. MADD appears to be very common, particularly in primary care, although prevalence estimates vary, often depending on the diagnostic criteria applied. It has been associated with similarly pronounced distress, impairment of daily living skills, and reduced health-related quality of life as fully syndromal depression and anxiety. Although about half of the patients affected remit within a year, non-remitting patients are at a high risk of transition to a fully syndromal psychiatric disorder. The validity and clinical usefulness of MADD as a diagnostic category are under debate. It has not been included in the recently released DSM-5 since the proposed diagnostic criteria turned out to be not sufficiently reliable. Moreover, reviewers have disputed the justification of MADD based on divergent results regarding its prevalence and course, diagnostic stability over time, and nosological inconsistencies between subthreshold and threshold presentations of anxiety and depressive disorders. We review the evidence in favor and against MADD and argue that it should be included into classification systems as a diagnostic category because it may enable patients to gain access to appropriate treatment early. This may help to reduce patients’ distress, prevent exacerbation to a more serious psychiatric disorder, and ultimately reduce the societal costs of this very common condition.

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Section: Nosological Issuesmentioning

confidence: 99%

Section: Nosological Issuesmentioning

confidence: 99%

Section: Nosological Issuesmentioning

confidence: 99%

Section: Why Madd Is An Important Diagnostic Category In Its Own Rightmentioning

confidence: 99%

See 2 more Smart Citations

The relevance of ‘mixed anxiety and depression’ as a diagnostic category in clinical practice

Möller

Bandelow

Volz

et al. 2016

Eur Arch Psychiatry Clin Neurosci

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“…Anxiety is a very common disorder with a lifetime prevalence of ~30% (Kessler et al, 2005). About one in two individuals diagnosed with an anxiety disorder also meet the criteria for a depressive disorder (Batelaan et al, 2012). As a result, anxiety in dentistry has two implications in routine clinical practice: (a) the high prevalence of anxiety disorders and depression in the general population, which may make patients anxious during dental care as a result of trait anxiety; (b) a high prevalence of specific dental anxiety (DA) and phobia (i.e., raising up only in the context of dental care), which has been estimated to affect from 10 to 30% of the population, depending on sample selection (i.e., general population or patients scheduled for intervention), ethnic and sociocultural variables (Facco et al, 2008, 2015a).…”

Section: Introductionmentioning

confidence: 99%

The Odyssey of Dental Anxiety: From Prehistory to the Present. A Narrative Review

Facco

Zanette

2017

Front. Psychol.

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Dental anxiety (DA) can be considered as a universal phenomenon with a high prevalence worldwide; DA and pain are also the main causes for medical emergencies in the dental office, so their prevention is an essential part of patient safety and overall quality of care. Being DA and its consequences closely related to the fight-or-flight reaction, it seems reasonable to argue that the odyssey of DA began way back in the distant past, and has since probably evolved in parallel with the development of fight-or-flight reactions, implicit memory and knowledge, and ultimately consciousness. Basic emotions are related to survival functions in an inseparable psychosomatic unity that enable an immediate response to critical situations rather than generating knowledge, which is why many anxious patients are unaware of the cause of their anxiety. Archeological findings suggest that humans have been surprisingly skillful and knowledgeable since prehistory. Neanderthals used medicinal plants; and relics of dental tools bear witness to a kind of Neolithic proto-dentistry. In the two millennia BC, Egyptian and Greek physicians used both plants (such as papaver somniferum) and incubation (a forerunner of modern hypnosis, e.g., in the sleep temples dedicated to Asclepius) in the attempt to provide some form of therapy and painless surgery, whereas modern scientific medicine strongly understated the role of subjectivity and mind-body approaches until recently. DA has a wide range of causes and its management is far from being a matter of identifying the ideal sedative drug. A patient's proper management must include assessing his/her dental anxiety, ensuring good communications, and providing information (iatrosedation), effective local anesthesia, hypnosis, and/or a wise use of sedative drugs where necessary. Any weak link in this chain can cause avoidable suffering, mistrust, and emergencies, as well as having lifelong psychological consequences. Iatrosedation and hypnosis are no less relevant than drugs and should be considered as primary tools for the management of DA. Unlike pharmacological sedation, they allow to help patients cope with the dental procedure and also overcome their anxiety: achieving the latter may enable them to face future dental care autonomously, whereas pharmacological sedation can only afford a transient respite.

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Mixed Anxiety and Depression

Cassidy-Eagle

Lauderdale

Unti

2015

The Encyclopedia of Adulthood and Aging

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The co‐occurrence of anxiety and depression symptoms, often referred to as mixed anxiety and depression, is a familiar clinical picture to clinicians in outpatient and primary care settings. This entry reviews the prevalence and challenges of the mixed diagnosis in older populations, evaluation and assessment techniques, and treatment options, along with future prevention efforts. Given older adults' preference for seeking help with their primary care providers, collaborative care or integrated care models are optimal.

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Mixed Anxiety Depression Should Not Be Included in DSM-5

Cited by 20 publications

References 26 publications

The relevance of ‘mixed anxiety and depression’ as a diagnostic category in clinical practice

The relevance of ‘mixed anxiety and depression’ as a diagnostic category in clinical practice

The Odyssey of Dental Anxiety: From Prehistory to the Present. A Narrative Review

Mixed Anxiety and Depression

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