Weissman M M, Wickramaratne P, Adams P B, Lish J D, Horwath E, Charney D, Woods S W, Leeman E, Frosch E
Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY.
Arch Gen Psychiatry. 1993 Oct;50(10):767-80. doi: 10.1001/archpsyc.1993.01820220017003.
The comorbidity between panic disorder and major depression (MDD) in individuals has been amply documented. However, data from family studies to determine whether panic disorder and MDD aggregate separately or together in families have been inconclusive, in part because of the absence of studies with the full range of proband groups. This report presents results from a family study with the necessary mutually exclusive groups: panic disorder without MDD, panic disorder with MDD, MDD without panic disorder, and normal controls.
Diagnostic information was obtained from 193 probands and 1047 of their adult relatives with the Schedule for Affective Disorders and Schizophrenia--Lifetime Version for Anxiety Disorders by direct interview, and/or from multiple informants, without knowledge of proband diagnoses. Best-estimate diagnoses were based on all available information by clinicians independently of data collection and without knowledge of probands' and other relatives' status.
Findings indicated the specific and independent transmission of panic disorder and MDD, the separation of panic disorder from MDD, and the nonfamilial nature of late-onset MDD. The pattern of results was unaffected by the use of different diagnostic criteria, number of informants, interview status of relatives, presence of substance abuse or agoraphobia or the sequence of MDD and panic disorder in probands, or whether probands were selected from treatment clinics or community sample.
We conclude that panic disorder and MDD are separate disorders with substantial co-occurrence in individuals, and that panic comorbid with MDD is not a single, distinct disorder. Finally, we illustrate an approach to examining comorbidity in family data through analysis of mutually exclusive, parallel diagnoses in probands and relatives.
个体中惊恐障碍与重度抑郁症（MDD）的共病现象已有大量文献记载。然而，家庭研究中用于确定惊恐障碍和MDD在家庭中是分别聚集还是共同聚集的数据尚无定论，部分原因是缺乏对所有先证者群体进行研究。本报告呈现了一项家庭研究的结果，该研究包含了必要的相互排斥的群体：无MDD的惊恐障碍、伴有MDD的惊恐障碍、无惊恐障碍的MDD以及正常对照。
通过直接访谈，和/或从多名信息提供者处获取了193名先证者及其1047名成年亲属的诊断信息，使用的是《情感障碍与精神分裂症问卷——焦虑障碍终生版》，且信息提供者不知先证者的诊断情况。最佳估计诊断基于临床医生独立于数据收集过程且不知先证者及其他亲属情况的所有可用信息。
研究结果表明惊恐障碍和MDD具有特定且独立的传递性，惊恐障碍与MDD相互分离，以及晚发性MDD的非家族性本质。结果模式不受以下因素影响：使用不同的诊断标准、信息提供者数量、亲属的访谈状态、是否存在物质滥用或场所恐惧症、先证者中MDD和惊恐障碍的先后顺序，或者先证者是从治疗诊所还是社区样本中选取。
我们得出结论，惊恐障碍和MDD是个体中大量共现的不同疾病，且伴有MDD的惊恐障碍并非单一、独特的疾病。最后，我们阐述了一种通过分析先证者及其亲属中相互排斥、平行的诊断来研究家庭数据中共病现象的方法。
