Masked Depression: Profile and Severity of Symptoms and Impulsivity in Patients with Generalized Anxiety Disorder

Ana Fresán1, Rebeca Robles-García1, Thelma Beatriz González-Castro2, Sherezada Pool-García3, Carlos Alfonso Tovilla-Zárate4, Yazmín Hernández-Díaz2, Isela Esther Juárez-Rojop5, María Lilia López-Narváez6
1Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñíz, Mexico City, Mexico
2División Académica Multidisciplinaria de Jalpa de Méndez, Universidad Juárez Autónoma de Tabasco, Jalpa de Méndez, Mexico
3Secretaría de Salud, Hospital General de Comalcalco, Comalcalco, Mexico
4División Académica Multidisciplinaria de Comalcalco, Universidad Juárez Autónoma de Tabasco, Comalcalco, Mexico
5División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa, Mexico
6Secretaría de Salud, Hospital General de Yajalón, Yajalón, Mexico

Tóm tắt

Major depressive disorder may remain underdiagnosed as it can be hidden behind somatic complaints or behavioral problems such as impulsivity, making other symptoms difficult to be recognized. The aim of the study was to determine the presence of depression in a sample of patients first-time diagnosed with generalized anxiety disorder that do not refer symptoms related to depression and to compare anxiety symptoms profile and impulsivity features between depressed and non-depressed patients. A total of 86 patients with DSM-IV diagnosis of GAD were recruited from the outpatient psychiatric services of the General Hospital of Comalcalco, Tabasco. Anxiety symptom severity and impulsivity were assessed with previously validated instruments. Depression was rated with the Hamilton Depression Rating Scale and the sample was categorized in depressed and non-depressed patients. More than half of the patients (54.7%) were identified as clinically depressed. These patients reported more severe anxiety symptomatology and more impulsivity than non-depressed patients; depressed patients also reported more somatic symptoms (e.g., gastrointestinal and hypochondriasis) which patients might identify as anxiety symptoms. In Latin-America, it is very common to use somatic symptoms as idioms of expression of emotional distress. Therefore, in patients with GAD with high levels of somatic complaints and impulsivity, depression should be evaluated.

Tài liệu tham khảo

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (Fourth ed.). Washington, DC: American Psychiatric Association. Apiquian, R., Fresán, A., & Nicolini, H. (2000). Evaluation of the Psychopathology: Rating Scales in Spanish. Mexico: JGH Editors. Baxter, A., Scott, K., Vos, T., & Whiteford, H. (2013). Global prevalence of anxiety disorders: a systematic review and meta-regression. Psychological Medicine, 43, 897–910. Berenzon, S., Lara, M., Robles, R., & Medina-Mora, M. (2013). Depresión: estado del conocimiento y la necesidad de políticas públicas y planes de acción en México. Salud Pública de México, 55, 74–80. Berlanga, C., Canetti, A., Chávez, E., De la Fuente, J. R., del Carmen Lara, M., León, C., . . . Sepúlveda, J. (1991). Tratamiento farmacologico de las crisis de angustia. Reporte comparativo de la eficacia y seguridad del alprazolam y la imipramina en un estudio controlado. Salud Mental, 14(1), 1–5. Berlanga, C., Cortés, J., & Bauer, J. (1992). Adaptación y validación de la Escala de Depresión de Carroll en español. Salud Mental, 15(4), 36–40. Carter, R., Wittchen, H., Pfister, H., & Kessler, R. (2001). One-year prevalence of subthreshold and threshold DSM-IV generalized anxiety disorder in a nationally representative sample. Depression and Anxiety, 13, 78–88. Chachamovich, E., Stefanello, S., Botega, N., & Turecki, G. (2009). Which are the recent clinical findings regarding the association between depression and suicide? Rev Bras Psiquiatr. 2009; 31, S18–25. Revista Brasileira de Psiquiatria, 31, S18–25. Desjarlais, R. (1996). World mental health. Problems and priorities in low-income countries. Oxford: Oxford University Press. Escobar, J. (1987). Cross-cultural aspects of the somatization trait. Hospital and Community Psychiatry, 38, 174–180. Fried, E., van Borkulo, C., Cramer, A., Boschloo, L., Schoevers, R., & Borsboom, D. (2017). Mental disorders as networks of problems: a review of recent insights. Social Psychiatry and Psychiatric Epidemiology, 52, 1–10. Goldberg, D., Reed, G., Robles, R., Bobes, J., Iglesias, C., Fortes, S., . . . Saxena, S. (2016). Multiple somatic symptoms in primary care: a field study for ICD-11 PHC, WHO’s revised classification of mental disorders in primary care settings. Journal of Psychosomatic Research, 91, 48–54. Hamilton, M. (1967). Development of a rating scale for primary depressive illness. British Journal of Social and Clinical Psychology, 6, 278–296. Hamilton, M. (1969). Diagnosis and rating of anxiety. British Journal of Psychiatry, 3, 76–79. Hofmeijer-Sevink, M., Batelaan, N., van Megen, H., Penninx, B., Cath, D., van den Hout, M., & van Balkom, A. (2012). Clinical relevance of comorbidity in anxiety disorders: a report from the Netherlands Study of Depression and Anxiety (NESDA). Journal of Affective Disorders, 137, 106–112. Isaac, M., Janca, A., Burke, K., Costa e Silva, J., Acuda, S., Altamura, A., . . . Tacchini, G. (1995). Medically unexplained somatic symptoms in different cultures. A preliminary report from phase I of the World Health Organization international study of somatoform disorders. Psychotherapy and Psychosomatics, 64, 88–93. Jakuszkowiak-Wojten, K., Landowski, J., Wiglusz, M., & Cubała, W. (2015). Impulsivity in anxiety disorders. A critical review. Psychiatria Danubina, 27, S452–S455. Kessler, R., Aguilar-Gaxiola, S., Alonso, J., Chatterji, S., Lee, S., Ormel, J., et al. (2009). The global burden of mental disorders: an update from the WHO World Mental Health (WMH) Surveys. Epidemiologia e Psichiatria Sociale, 18, 23–33. Kirmayer, J., & Young, A. (1998). Culture and somatization: clinical, epidemiological, and ethnographic perspectives. Psychosomatic Medicine, 60, 420–430. Lobo, A., Chamorro, L., Luque, A., Dal-Ré, R., Badia, X., Baró, E., & Psicométricas, G. d. V. e. E. d. E. (2002). Validación de las versiones en español de la Montgomery-Asberg Depression Rating Scale y la Hamilton Anxiety Rating Scale para la evaluación de la depresión y de la ansiedad. Medicina clinica, 118(13), 493–499. Miodek, A., Szemraj, P., Kocur, J., & Rys, A. (2007). Masked depression--history and present days. Polski Merkuriusz Lekarski, 23, 78–80. Moeller, F., Barratt, E., Dougherty, D., Schmitz, J., & Swann, A. (2001). Psychiatric aspects of impulsivity. American Journal of Psychiatry, 158, 1783–1793. Muñoz, R., McBride, M., Brnabic, A., López, C., Hetem, L., Secin, R., & Dueñas, H. (2005). Major depressive disorder in Latin America: the relationship between depression severity, painful somatic symptoms, and quality of life. Journal of Affective Disorders, 86, 93–98. Nicolini, H., Villarreal, G., & Ortega Soto, H. A. (1988). Alteraciones en la memoria de pacientes con crisis de angustia, y efecto del tratamiento farmacológico con alprazolam e imipramina. Salud ment, 11(4), 11–14. Nock, M., Hwang, I., Sampson, N., & Kessler, R. (2010). Mental disorders, comorbidity and suicidal behavior: results from the National Comorbidity Survey Replication. Molecular Psychiatry, 15, 868–876. Páez, F., Jiménez, A., López, A., Ariza, J. P. R., Soto, H. O., & Nicolini, H. (1996). Estudio de validez de la traducción al castellano de la Escala de Impulsividad de Plutchik. Salud Mental, 19(Supl 3), 10–12. Plutchik, R., & Van Praag, H. (1989). The measurement of suicidality, aggressivity and impulsivity. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 13(Suppl), S23–S34. Rickels, K., & Rynn, M. (2001). Overview and clinical presentation of generalized anxiety disorder. The Psychiatric Clinics of North America, 24, 1–17. Vytal, K., Arkin, N., Overstreet, C., Lieberman, L., & Grillon, C. (2016). Induced-anxiety differentially disrupts working memory in generalized anxiety disorder. BMC Psychiatry, 16, 62. https://doi.org/10.1186/s12888-016-0748-2. Wittchen, H., Kessler, R., Pfister, H., Höfler, M., & Lieb, R. (2000). Why do people with anxiety disorders become depressed? A prospective-longitudinal community study. Acta Psychiatrica Scandinavica, 102, S14–S23. World Medical Association. (2013). World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA, 310, 2191.