Mood swings in patients with anxiety disorders compared with normal controls.

BACKGROUND About 70-80% of patients with anxiety syndromes suffer from depression. Mood variability including hypomania, cyclothymia and hyperthymia have been described in 40-50% of patients with depression. There is an emerging literature that such variability could also characterize anxiety disorders. The aim of this study was to visually document and quantify mood variability in patients with anxiety disorders. METHODS Twenty patients with anxiety disorders and 22 normal control subjects completed two visual analogue scales (VAS) on depressed mood and high mood, twice per day for 14 days. The Beck Depression Inventory and the Altman Self-Rating Mood Scale were used for concurrent validity. RESULTS On the VAS, patients showed higher levels of depressed and high moods, and greater mood variability than the controls. Variability of depressed and high moods was highly correlated. LIMITATIONS This was a relatively small sample from a single center. Patients were selected by convenience and were under treatment. The control subjects were not interviewed. CONCLUSIONS Subsyndromal mood variability in patients with anxiety disorders can be visually depicted and quantified. The mood variability of patients with anxiety disorders who also complain of mood swings is greater than the mood fluctuations described by normal subjects.

[1]  D. Klein,et al.  Cyclothymic mood swings in the course of affective disorders and schizophrenia. , 1989, The American journal of psychiatry.

[2]  S. Kutcher,et al.  The prevalence of cyclothymia in borderline personality disorder. , 1990, The Journal of clinical psychiatry.

[3]  G. Andrews.  Comorbidity and the General Neurotic Syndrome , 1996, British Journal of Psychiatry.

[4]  J. Gorman,et al.  Clinical improvement with fluoxetine therapy and noradrenergic function in patients with panic disorder. , 1997, Archives of general psychiatry.

[5]  D. Blacker,et al.  Contested boundaries of bipolar disorder and the limits of categorical diagnosis in psychiatry. , 1992, The American journal of psychiatry.

[6]  E. Frank,et al.  The bipolar spectrum: a clinical reality in search of diagnostic criteria and an assessment methodology. , 1999, Journal of affective disorders.

[7]  R. Spitzer,et al.  DSM-IV diagnostic criterion for clinical significance: does it help solve the false positives problem? , 1999, The American journal of psychiatry.

[8]  H. Akiskal,et al.  Affective comorbidity in panic disorder: is there a bipolar connection? , 1993, Journal of affective disorders.

[9]  H. Akiskal,et al.  The high prevalence of "soft" bipolar (II) features in atypical depression. , 1998, Comprehensive psychiatry.

[10]  F. McMahon,et al.  Bipolar disorder and panic disorder in families: an analysis of chromosome 18 data. , 1998, The American journal of psychiatry.

[11]  D. Sheehan,et al.  The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. , 1998, The Journal of clinical psychiatry.

[12]  K. Kendler,et al.  Neuroticism and self-esteem as indices of the vulnerability to major depression in women , 1999, Psychological Medicine.

[13]  G. Bernstein,et al.  The visual analogue scale for anxiety — Revised: Psychometric properties , 1992 .

[14]  E. Smeraldi,et al.  Patterns of mood variation during antidepressant treatment. , 1998, Journal of affective disorders.

[15]  T. Tuma.  Effect of Age on the Outcome of Hospital Treated Depression , 1996, British Journal of Psychiatry.

[16]  R. Depue,et al.  Dimensional measurement of seasonal variation in mood and behavior , 1991, Psychiatry Research.

[17]  M. J. Woyshville,et al.  On the meaning and measurement of affective instability: clues from chaos theory , 1999, Biological Psychiatry.

[18]  K. Kendler.  Setting boundaries for psychiatric disorders. , 1999, The American journal of psychiatry.

[19]  T. Johnson,et al.  Prediction of outcome in neurotic disorder: a 5-year prospective study , 1998, Psychological Medicine.

[20]  P. Lewinsohn,et al.  Bipolar disorders in a community sample of older adolescents: prevalence, phenomenology, comorbidity, and course. , 1995, Journal of the American Academy of Child and Adolescent Psychiatry.

[21]  D. Hedeker,et al.  A comparative evaluation of three self-rating scales for acute mania , 2001, Biological Psychiatry.

[22]  H. Akiskal,et al.  Criteria for the "soft" bipolar spectrum: treatment implications. , 1987, Psychopharmacology bulletin.

[23]  K. Merikangas,et al.  Clinical significance and comorbidity of subthreshold depression and anxiety in the community , 2001, Acta psychiatrica Scandinavica.

[24]  H. Akiskal,et al.  TEMPS-I: delineating the most discriminant traits of the cyclothymic, depressive, hyperthymic and irritable temperaments in a nonpatient population. , 1998, Journal of affective disorders.

[25]  E. Leibenluft,et al.  Mood variability: a study of four groups. , 1991, The American journal of psychiatry.

[26]  R. Bowen,et al.  Efficacy of Divalproex Sodium in Patients with Panic Disorder and Mood Instability Who Have Not Responded to Conventional Therapy , 1998, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[27]  J. Angst.  The emerging epidemiology of hypomania and bipolar II disorder. , 1998, Journal of affective disorders.

[28]  H. Akiskal,et al.  Systematic clinical methodology for validating bipolar-II disorder: data in mid-stream from a French national multi-site study (EPIDEP). , 1998, Journal of affective disorders.

[29]  J. Hokanson,et al.  A comparison of self-esteem lability and low trait self-esteem as vulnerability factors for depression. , 1994, Journal of personality and social psychology.

[30]  R. Bowen,et al.  Mood Swings in Patients with Panic Disorder , 1994, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[31]  S. McElroy,et al.  Current issues in the identification and management of bipolar spectrum disorders in 'special populations'. , 2000, Journal of affective disorders.

[32]  J. D. Parker,et al.  Confirmatory factor analysis of the Beck Anxiety and Depression Inventories in patients with major depression. , 1998, Journal of affective disorders.

[33]  Philip D. Harvey,et al.  Characterizing affective instability in borderline personality disorder. , 2002, The American journal of psychiatry.

[34]  J. Calabrese,et al.  Development and validation of a screening instrument for bipolar spectrum disorder: the Mood Disorder Questionnaire. , 2000, The American journal of psychiatry.

[35]  F. Goodwin,et al.  The Bipolar Spectrum and the Antidepressant View of the World , 2001, Journal of psychiatric practice.

[36]  S. Dilsaver,et al.  Comorbidity of panic disorder in bipolar illness: evidence from the Epidemiologic Catchment Area Survey. , 1995, The American journal of psychiatry.

[37]  H. Möller,et al.  Re-evaluating the prevalence of and diagnostic composition within the broad clinical spectrum of bipolar disorders. , 2000, Journal of affective disorders.

[38]  A Gottschalk,et al.  Evidence of chaotic mood variation in bipolar disorder. , 1995, Archives of general psychiatry.

[39]  M. Hotopf,et al.  Pragmatic randomised controlled trials in psychiatry , 1999, British Journal of Psychiatry.

[40]  P. Sullivan,et al.  Catechol o-methyltransferase, serotonin transporter, and tryptophan hydroxylase gene polymorphisms in bipolar disorder patients with and without comorbid panic disorder. , 2002, The American journal of psychiatry.

[41]  T. Hergueta,et al.  The mini international neuropsychiatric interview , 1998, European Psychiatry.

[42]  J. Endicott,et al.  The normalcy of self-proclaimed "normal volunteers". , 1989, The American journal of psychiatry.

[43]  B. Birmaher,et al.  Is bipolar disorder specifically associated with panic disorder in youths? , 2002, The Journal of clinical psychiatry.

[44]  A. Feinstein,et al.  How to evaluate a diagnostic marker test. Lessons from the rise and fall of dexamethasone suppression test. , 1988, JAMA.