Boulenger J P, Lavallée Y J
Department of Psychiatry, University of Sherbrooke, Quebec, Canada.
J Clin Psychiatry. 1993 Jan;54 Suppl:3-8.
Mixed anxiety and depression (MAD) is a new diagnostic category introduced in the ICD-10 classification for patients seen mainly in primary care settings. These patients are defined as those suffering from symptoms of anxiety and depression of limited and equal intensity accompanied by at least some autonomic features, who do not qualify for specific diagnosis of anxiety or depressive disorders and are independent of stressful life events. The validity of this clinical entity is presently under investigation in the DSM-IV-MAD field trial. Cases of mixed anxiety and depression, however, are not limited to those meeting the criteria of this new "subsyndromal" category. Many patients fulfilling criteria for either depressive or anxiety disorders may also respectively present symptoms, syndromes, or a diagnosis of anxiety or depression. It is still not known whether anxious and depressive symptoms are two different expressions of the same psychopathologic underlying process. Tyrer's recent description of a "general neurotic syndrome" is an attempt to reunify syndromes separated in our present classifications. In this comprehensive approach, anxiety, depression, or MAD states are associated at different times with specific personality features and considered as expressing different levels of overreactivity to various stressful situations. This hypothesis would explain the close relationship existing between these two categories of symptoms and the common efficacy of some psychopharmacologic agents for both anxiety and depressive disorders.
混合性焦虑抑郁障碍（MAD）是国际疾病分类第10版（ICD - 10）中引入的一个新诊断类别，主要用于描述在初级保健机构就诊的患者。这些患者被定义为患有强度有限且相当的焦虑和抑郁症状，并伴有至少一些自主神经功能特征，不符合焦虑症或抑郁症的特定诊断标准，且与应激性生活事件无关。目前，这一临床实体的有效性正在《精神疾病诊断与统计手册》第四版（DSM - IV）混合性焦虑抑郁障碍现场试验中进行研究。然而，混合性焦虑抑郁障碍的病例并不局限于符合这一新的“亚综合征”类别的患者。许多符合抑郁症或焦虑症诊断标准的患者也可能分别出现焦虑或抑郁的症状、综合征或诊断。目前仍不清楚焦虑症状和抑郁症状是否是同一心理病理过程的两种不同表现。泰勒最近对“一般神经症综合征”的描述，试图将我们目前分类中分开的综合征重新统一起来。在这种综合方法中，焦虑、抑郁或混合性焦虑抑郁障碍状态在不同时间与特定人格特征相关联，并被视为对各种应激情况过度反应的不同程度表现。这一假设可以解释这两类症状之间存在的密切关系，以及某些精神药物对焦虑症和抑郁症的共同疗效。
