Tyrer Peter, Tyrer Helen, Johnson Tony, Yang Min
Division of Psychiatry, Imperial College, W12 0NN, London, UK.
University College, London, UK.
Psychol Med. 2021 Apr 12:1-10. doi: 10.1017/S0033291721000878.
Cohort studies of the long-term outcome of anxiety, depression and personality status rarely join together.
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.
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.
The long-term outcome of disorders formerly called 'neurotic' is poor with the exception of panic disorder. Personality dysfunction accentuates poor recovery.
关于焦虑、抑郁和人格状态长期预后的队列研究很少结合在一起。
1983年至1987年间，招募了210名患有焦虑和抑郁的患者参加一项随机对照试验（诺丁汉神经症研究），并对他们进行了30多年的随访。在试验开始时，评估了人格状态，以及一般神经症综合征，即与神经症人格特质相关的混合性焦虑抑郁（共病性心境恶劣）的综合诊断。人格评估采用了一种程序，可将数据转换为国际疾病分类第11版人格障碍的严重程度分类。在最初的试验之后，又进行了七次评估。还进行了心理病理学和总体预后的观察者评分和自我评分。30年时的主要结局是没有《精神疾病诊断与统计手册》（DSM）诊断的患者比例。使用调整了年龄和性别的多水平重复测量模型对数据进行分析。假设缺失数据是随机缺失的，并且模型允许所有受试者纳入分析，在模型估计中自动处理缺失数据。
30年时，基线诊断为惊恐障碍的患者中有69%没有DSM诊断，而广泛性焦虑障碍、心境恶劣或混合症状（共病性心境恶劣）患者的这一比例为37%-47%（p = 0.027）。除了那些在入组时没有人格功能障碍的患者外，所有患者在30年后在总体心理病理学、焦虑和抑郁、社会功能和总体预后方面的结局都更差。
除惊恐障碍外，以前称为“神经症”的疾病的长期预后较差。人格功能障碍会加剧恢复不良。
