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The relationship between depression with anxious distress DSM-5 specifier and mixed depression: a network analysis

Published online by Cambridge University Press:  03 March 2020

Antonio Tundo ,
Laura Musetti ,
Claudia Del Grande Open the ORCID record for Claudia Del Grande [Opens in a new window] ,
Rocco de Filippis ,
Luca Proietti ,
Donatella Marazziti Open the ORCID record for Donatella Marazziti [Opens in a new window] ,
Dino Gibertoni  and
Liliana Dell’Osso
Antonio Tundo
Affiliation:
Istituto di Psicopatologia, Rome, Italy
Laura Musetti
Affiliation:
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
Claudia Del Grande*
Affiliation:
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
Rocco de Filippis
Affiliation:
Istituto di Psicopatologia, Rome, Italy
Luca Proietti
Affiliation:
Istituto di Psicopatologia, Rome, Italy
Donatella Marazziti
Affiliation:
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
Dino Gibertoni
Affiliation:
Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
Liliana Dell’Osso
Affiliation:
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
*
Author for correspondence: Claudia Del Grande, MD, Email: claudiadelgrande83@gmail.com
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Abstract

Introduction

Epidemiological, clinical, and treatment response characteristics of major depression with anxious distress (ADS) are quite similar to those of mixed depression, but no study investigated the symptom interplay of these conditions.

Objective

To analyze the correlations among symptom criteria for major depression with ADS and for mixed depression using a network analysis.

Methods

Two hundred and forty-one outpatients with major depression were consecutively recruited. DSM-5 criteria for major depression with ADS or with mixed features (MF) and Koukopoulos’ criteria for mixed depression (MXD) were assessed using a structured clinical interview.

Results

A total of 58.9% of patients met DSM-5 criteria for major depression with ADS, 48.5% for MXD, and 2.5% for major depression with MF, so that the symptoms of this specifier were excluded from the network analysis. The most frequent symptoms were difficulty concentrating due to worries (57.7%), feeling keyed up or on edge (51%) (major depression with ADS), and psychic agitation or inner tension (51%) (MXD). Psychic agitation or inner tension had a central position in the network and bridged MXD to major depression with ADS through feeling keyed up or on edge.

Conclusions

Criteria for major depression with ADS and for MXD are partially overlapping, with psychic agitation or inner tension and feeling keyed up or on edge that feature in both conditions and are difficult to distinguish in clinical practice. The clarification of the relationship between these two psychopathological conditions could bring important implications for diagnosis, prognosis, and treatment of depressive episodes.

Keywords

Anxious distress specifiermixed depressionmixed featuresmajor depressive episodenetwork analysis
Type
Original Research
Information
CNS Spectrums , Volume 26 , Issue 3 , June 2021 , pp. 251 - 257
Copyright
© Cambridge University Press 2020

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