The Nottingham Study of Neurotic Disorder: Predictors of 12-year outcome of dysthymic, panic and generalized anxiety disorder
File(s)pm12yr2.doc (126.5 KB)
Accepted version
Author(s)
Tyrer, P
Seivewright, H
Johnson, T
Type
Journal Article
Abstract
Background. Controlled prospective studies of the simultaneous long-term outcome of several mental disorders are rare. This study sought to determine if there were important differences between the outcome of anxiety and depressive disorders after 12 years and to examine their main predictors.
Method. A cohort of 210 people seen in general practice psychiatric clinics with a DSM-III diagnosis of generalized anxiety disorder (71), panic disorder (74), or dysthymic disorder (65), including combined anxiety-depressive disorder (cothymia) (67) was followed up after 12 years. Interview assessments of symptoms, social functioning and outcome were made, the latter using a new scale, the Neurotic Disorder Outcome Scale. Seventeen baseline predictors were also examined.
Results. Data were obtained from 201 (96%) patients, 17 of whom had died. Only 73 (36%) had no DSM diagnosis at the time of follow-up. Using univariate and stepwise multiple linear regression those with cothymia, personality disorder, recurrent episodes and greater baseline self-rated anxiety and depression ratings had a worse outcome than others; initial diagnosis did not contribute significantly to outcome and instability of diagnosis over time was much more common than consistency.
Conclusion. Only two out of five people with the common neurotic disorders have a good outcome despite alleged advances in treatment. Those with greater mood symptoms and pre-morbid personality disorder have the least favourable outcome. It is suggested that greater attention be paid to the concurrent treatment of personality disorder and environmental factors rather than symptoms as these may be the real cause of apparent treatment resistance.
Method. A cohort of 210 people seen in general practice psychiatric clinics with a DSM-III diagnosis of generalized anxiety disorder (71), panic disorder (74), or dysthymic disorder (65), including combined anxiety-depressive disorder (cothymia) (67) was followed up after 12 years. Interview assessments of symptoms, social functioning and outcome were made, the latter using a new scale, the Neurotic Disorder Outcome Scale. Seventeen baseline predictors were also examined.
Results. Data were obtained from 201 (96%) patients, 17 of whom had died. Only 73 (36%) had no DSM diagnosis at the time of follow-up. Using univariate and stepwise multiple linear regression those with cothymia, personality disorder, recurrent episodes and greater baseline self-rated anxiety and depression ratings had a worse outcome than others; initial diagnosis did not contribute significantly to outcome and instability of diagnosis over time was much more common than consistency.
Conclusion. Only two out of five people with the common neurotic disorders have a good outcome despite alleged advances in treatment. Those with greater mood symptoms and pre-morbid personality disorder have the least favourable outcome. It is suggested that greater attention be paid to the concurrent treatment of personality disorder and environmental factors rather than symptoms as these may be the real cause of apparent treatment resistance.
Date Issued
2004-11-04
Date Acceptance
2004-11-01
Citation
Psychological Medicine, 2004, 34 (8), pp.1385-1394
ISSN
0033-2917
Publisher
Cambridge University Press
Start Page
1385
End Page
1394
Journal / Book Title
Psychological Medicine
Volume
34
Issue
8
Copyright Statement
© 2004 Cambridge University Press. This article has been published in a revised form in Psychological Medicine https://doi.org/10.1017/S0033291704002569. This version is free to view and download for private research and study only. Not for re-distribution, re-sale or use in derivative works.
Sponsor
Nicola Pigott Fund (Central & NW London Mental NHS Charity T
Medical Research Council (MRC)
B.Q.D.A
Identifier
http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000225680700002&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Grant Number
N/A
G9901114
BQDA - Prof M King
Subjects
Social Sciences
Science & Technology
Life Sciences & Biomedicine
Psychology, Clinical
Psychiatry
Psychology
PERSONALITY-DISORDER
DEPRESSIVE-DISORDERS
MAJOR DEPRESSION
HOSPITAL ANXIETY
SCALE
CLASSIFICATION
VALIDITY
DIAGNOSIS
THERAPY
DRUG
Publication Status
Published
Date Publish Online
2004-11-04