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Thirty-year outcome of anxiety and depressive disorders and personality status: comprehensive evaluation of mixed symptoms and the general neurotic syndrome in the follow-up of a randomised controlled trial

Published online by Cambridge University Press:  12 April 2021

Peter Tyrer Open the ORCID record for Peter Tyrer [Opens in a new window] ,
Helen Tyrer ,
Tony Johnson  and
Min Yang
Peter Tyrer*
Affiliation:
Division of Psychiatry, Imperial College, W12 0NN, London, UK
Helen Tyrer
Affiliation:
Division of Psychiatry, Imperial College, W12 0NN, London, UK
Tony Johnson
Affiliation:
University College, London, UK
Min Yang
Affiliation:
West China School of Public Health, Sichuan University, Chengdu, China Faculty of Health, Art and Design, Swinburne University of Technology, Melbourne, Australia
*
Author for correspondence: Peter Tyrer, E-mail: p.tyrer@imperial.ac.uk
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Abstract

Background

Cohort studies of the long-term outcome of anxiety, depression and personality status rarely join together.

Methods

Two hundred and ten patients recruited with anxiety and depression to a randomised controlled trial between 1983 and 1987 (Nottingham Study of Neurotic Disorder) were followed up over 30 years. At trial entry personality status was assessed, together with the general neurotic syndrome, a combined diagnosis of mixed anxiety–depression (cothymia) linked to neurotic personality traits. Personality assessment used a procedure allowing conversion of data to the ICD-11 severity classification of personality disorder. After the original trial, seven further assessments were made. Observer and self-ratings of psychopathology and global outcome were also made. The primary outcome at 30 years was the proportion of those with no Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnosis.

Data were analysed using multilevel repeated measures models that adjusted for age and gender. Missing data were assumed to be missing at random, and the models allowed all subjects to be included in the analysis with missing data automatically handled in the model estimation.

Results

At 30 years, 69% of those with a baseline diagnosis of panic disorder had no DSM diagnosis compared to 37–47% of those with generalised anxiety disorder, dysthymia or mixed symptoms (cothymia) (p = 0.027). Apart from those with no personality dysfunction at entry all patients had worse outcomes after 30 years with regard to total psychopathology, anxiety and depression, social function and global outcome.

Conclusions

The long-term outcome of disorders formerly called ‘neurotic’ is poor with the exception of panic disorder. Personality dysfunction accentuates poor recovery.

Keywords

General neurotic syndromeneuroticismpersonality disorderlong-term outcome
Type
Original Article
Information
Psychological Medicine , Volume 52 , Issue 16 , December 2022 , pp. 3999 - 4008
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Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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