Thresholds for health and thresholds for illness: panic disorder <i>versus</i> subthreshold panic disorder

Batelaan, Neeltje M.; Graaf, Ron de; Balkom, Anton van; Vollebergh, Wilma; Beekman, Aartjan T.F.

doi:10.1017/s0033291706009007

Cited by 60 publications

(69 citation statements)

References 40 publications

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“…Along the same line, a double threshold concept has been suggested which defines one threshold for mental disorder and a second (lower) threshold for mental health [80]. The resulting between-threshold zone of subthreshold mental illness could be useful in applying treatment according to disease severity, optimizing cost-effectiveness, and controlling the burden to the healthcare system [81]. …”

Section: Nosological Issuesmentioning

confidence: 99%

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%

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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“…epressive and anxiety symptoms are extremely common in the general population and in primary care (Batelaan et al, 2007;Cuijpers et al, 2004;Katon and Roy-Byrne, 1991;Olfson et al, 1996;Ormel et al, 1993;Rucci et al, 2003;Zinbarg et al, 1994), and they frequently co-occur (Das-Munshi et al, 2008;Piccinelli et al, 1999;Preisig et al, 2001;Spijker et al, 2010). Co-occurring subthreshold depression and subthreshold anxiety are associated with impaired functioning (Das-Munshi et al, 2008;Preisig et al, 2001;Roy-Byrne et al, 1994).…”

mentioning

confidence: 99%

Mixed Anxiety Depression Should Not Be Included in DSM-5

Batelaan¹,

Spijker²,

Graaf³

et al. 2012

The Journal of Nervous and Mental Disease

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Subthreshold anxiety and subthreshold depressive symptoms often co-occur in the general population and in primary care. Based on their associated significant distress and impairment, a psychiatric classification seems justified. To enable classification, mixed anxiety depression (MAD) has been proposed as a new diagnostic category in DSM-5. In this report, we discuss arguments against the classification of MAD. More research is needed before reifying a new category we know so little about. Moreover, we argue that in patients with MAD symptoms and a history of an anxiety or depressive disorder, symptoms should be labeled as part of the course trajectories of these disorders, rather than calling it a different diagnostic entity. In patients with incident co-occurring subthreshold anxiety and subthreshold depression, subthreshold categories of both anxiety and depression could be classified to maintain a consistent classification system at both threshold and subthreshold levels.

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“…Here, we present the adapted web-based version of this treatment, and the results of a RCT in which we compared the effects of this treatment with those of a waiting-list. Prevalence rates of minor forms of panic disorder are known to be high and individuals with minor forms of panic disorder suffer a similar impact on their quality of life and functioning as those with full-blown panic disorder (Batelaan, De Graaf, Van Balkom, Vollebergh, & Beekman, 2007;Kessler et al, 2006;Magruder & Calderone, 2000;W. H. O.…”

mentioning

confidence: 99%

Web-based therapist-assisted cognitive behavioral treatment of panic symptoms: A randomized controlled trial with a three-year follow-up

Ruwaard¹,

Broeksteeg²,

Schrieken³

et al. 2010

Journal of Anxiety Disorders

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Thresholds for health and thresholds for illness: panic disorder versus subthreshold panic disorder

Cited by 60 publications

References 40 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

Mixed Anxiety Depression Should Not Be Included in DSM-5

Web-based therapist-assisted cognitive behavioral treatment of panic symptoms: A randomized controlled trial with a three-year follow-up

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