Inoue Takeshi, Kimura Toshifumi, Inagaki Yoshifumi, Shirakawa Osamu
Department of Psychiatry, Tokyo Medical University, Tokyo, Japan.
Medical Affairs Department, Medical Division, GlaxoSmithKline K.K., Tokyo, Japan.
Neuropsychiatr Dis Treat. 2020 Jul 12;16:1695-1704. doi: 10.2147/NDT.S246294. eCollection 2020.
Comorbid anxiety disorders in patients with mood disorders have a negative impact on outcomes, such as persistence of depressive symptoms, deterioration of quality of life (QoL), increased suicide risk, mood instability with antidepressant treatment, but often go underrecognized in clinical practice. To identify features useful for supporting the confirmation of comorbid anxiety disorders, we investigated the prevalence of comorbid anxiety disorders and their associated factors in Japanese patients with mood disorders using data from our previously reported JET-LMBP study.
Patients with bipolar disorder (BD; n=114) and patients with major depressive disorder (MDD; n=334), all with major depressive episodes (DSM-IV-TR) were analyzed. Comorbid anxiety disorders were confirmed using the Mini-International Neuropsychiatric Interview. Demographic and clinical features were assessed using patient background forms, including the Quick Inventory of Depressive Symptomatology-Self Report Japanese version, 36-Item Short-Form Health Survey (SF-36), and Child Abuse and Trauma Scale (CATS). Multivariate logistic regression analysis adjusted for age, sex, and severity of depressive symptoms was used to identify factors associated with comorbid anxiety disorders (post hoc analysis).
The prevalence of comorbid anxiety disorders was significantly higher in patients with BD (53.2%) than in patients with MDD (37.2%). Factors associated with comorbid anxiety disorders in BD included no spouse, interpersonal rejection sensitivity, higher CATS sexual abuse scores, and lower SF-36 mental component summary scores. In MDD, factors included hypersomnia, pathological guilt feelings, higher CATS neglect scores, and lower SF-36 physical component summary scores.
Comorbid anxiety disorders were commonly seen in Japanese patients with mood disorders. Childhood abuse, atypical depression symptoms, and deterioration of health-related QoL were commonly associated with comorbid anxiety disorders in BD and MDD, suggesting that the presence of these features may be useful to support the confirmation of comorbid anxiety disorders in these patients.
心境障碍患者共病焦虑症会对治疗结果产生负面影响，如抑郁症状持续存在、生活质量（QoL）下降、自杀风险增加、抗抑郁治疗时情绪不稳定，但在临床实践中常未得到充分认识。为了确定有助于确诊共病焦虑症的特征，我们利用先前报道的JET-LMBP研究的数据，调查了日本心境障碍患者中共病焦虑症的患病率及其相关因素。
分析了双相情感障碍（BD；n = 114）和重度抑郁症（MDD；n = 334）患者，所有患者均有重度抑郁发作（DSM-IV-TR）。使用迷你国际神经精神访谈确诊共病焦虑症。使用患者背景表格评估人口统计学和临床特征，包括抑郁症状快速自评量表-日本版、36项简短健康调查（SF-36）和儿童虐待与创伤量表（CATS）。采用多因素逻辑回归分析，对年龄、性别和抑郁症状严重程度进行校正，以确定与共病焦虑症相关的因素（事后分析）。
BD患者中共病焦虑症的患病率（53.2%）显著高于MDD患者（37.2%）。BD中共病焦虑症的相关因素包括无配偶、人际排斥敏感性、较高的CATS性虐待得分和较低的SF-36心理成分综合得分。在MDD中，相关因素包括嗜睡、病理性内疚感、较高的CATS忽视得分和较低的SF-36身体成分综合得分。
共病焦虑症在日本心境障碍患者中很常见。童年期虐待、非典型抑郁症状以及与健康相关的生活质量下降在BD和MDD中共病焦虑症时常见，提示这些特征的存在可能有助于确诊这些患者的共病焦虑症。
