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Thirty-year outcome of anxiety and depressive disorders and personality status: comprehensive evaluation of mixed symptoms and the general neurotic syndrome in the follow-up of a randomised controlled trial

Published online by Cambridge University Press:  12 April 2021

Peter Tyrer Open the ORCID record for Peter Tyrer [Opens in a new window] ,
Helen Tyrer ,
Tony Johnson  and
Min Yang
Peter Tyrer*
Affiliation:
Division of Psychiatry, Imperial College, W12 0NN, London, UK
Helen Tyrer
Affiliation:
Division of Psychiatry, Imperial College, W12 0NN, London, UK
Tony Johnson
Affiliation:
University College, London, UK
Min Yang
Affiliation:
West China School of Public Health, Sichuan University, Chengdu, China Faculty of Health, Art and Design, Swinburne University of Technology, Melbourne, Australia
*
Author for correspondence: Peter Tyrer, E-mail: p.tyrer@imperial.ac.uk
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Abstract

Background

Cohort studies of the long-term outcome of anxiety, depression and personality status rarely join together.

Methods

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.

Results

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.

Conclusions

The long-term outcome of disorders formerly called ‘neurotic’ is poor with the exception of panic disorder. Personality dysfunction accentuates poor recovery.

Keywords

General neurotic syndromeneuroticismpersonality disorderlong-term outcome
Type
Original Article
Information
Psychological Medicine , Volume 52 , Issue 16 , December 2022 , pp. 3999 - 4008
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Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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References

American Psychiatric Association (1980). Diagnostic and statistical manual for mental disorders, third revision. Washington, DC: APA.Google Scholar
Andersch, S., & Hetta, J. (2003). A 15-year follow-up study of patients with panic disorder. European Psychiatry, 18, 401–408.CrossRefGoogle ScholarPubMed
Åsberg, M., Montgomery, S. A., Perris, C., Schalling, D., & Sedvall, G. (1978). A comprehensive psychopathological rating scale. Acta Psychiatrica Scandinavica (Supplement 271), 5–27.CrossRefGoogle ScholarPubMed
Bandelow, B., Sagebiel, A., Belz, M., Görlich, Y., Michaelis, S., & Wedekind, D. (2018). Enduring effects of psychological treatments for anxiety disorders: Meta-analysis of follow-up studies. British Journal of Psychiatry, 212, 333–338.CrossRefGoogle ScholarPubMed
Bateman, A. W., Gunderson, J., & Mulder, R. (2015). Treatment of personality disorder. Lancet (London, England), 385, 735–743.CrossRefGoogle ScholarPubMed
Beckwith, H., Moran, P. F., & Reilly, J. (2014). Personality disorder prevalence in psychiatric outpatients: A systematic literature review. Personality and Mental Health, 8, 91–101.CrossRefGoogle ScholarPubMed
Boyd, J. H., Burke, J. D. Jr, Gruenberg, E., Holzer, C. E. 3rd, Rae, D. S., George, L. K., … Nestadt, G. (1984). Exclusion criteria of DSM-III: A study of co-occurrence of hierarchy-free syndromes. Archives of General Psychiatry 1984, 41, 983–989.CrossRefGoogle ScholarPubMed
Chambers, J. A., Power, K. G., & Durham, R. C. (2004). The relationship between trait vulnerability and anxiety and depressive diagnoses at long-term follow-up of generalized anxiety disorder. Journal of Anxiety Disorders, 18, 587–607.CrossRefGoogle ScholarPubMed
Cuipers, P., Gentili, C., Banos, R. M., Garcia-Campayo, J., Botella, C., & Cristea, I. A. (2016). Relative effects of cognitive and behavioral therapies on generalized anxiety disorder, social anxiety disorder and panic disorder: A meta-analysis. Journal of Anxiety Disorders, 43, 79–89.CrossRefGoogle Scholar
Das Munshi, J., Goldberg, D., Bebbington, P. E., Bhugra, D. K., Brugha, T. S., Dewey, M. E., … Prince, M. (2008). Public health significance of mixed anxiety and depression: Beyond current classification. British Journal of Psychiatry, 192, 171–177.CrossRefGoogle ScholarPubMed
Eysenck, H. J. (1952). The effects of psychotherapy: An evaluation. Journal of Consulting and Clinical Psychology, 16, 319–324.CrossRefGoogle ScholarPubMed
Ferguson, B., Cooper, S., Brothwell, J., Markantonakis, H., & Tyrer, P. (1992). Clinical evaluation of a new community psychiatric service based on general practice psychiatric clinics. British Journal of Psychiatry, 160, 493–497.CrossRefGoogle ScholarPubMed
Hendriks, S. M., Spijker, J., Licht, C. M., Beekman, A. T., & Penninx, B. W. (2013). Two year course of anxiety disorders: Different across disorders or dimensions? Acta Psychiatrica Scandinavica, 128, 212–221.CrossRefGoogle ScholarPubMed
Hettema, J. M., Prescott, C. A., & Kendler, K. S. (2004). Genetic and environmental sources of covariation between generalized anxiety disorder and neuroticism. American Journal of Psychiatry, 161, 1581–1587.CrossRefGoogle ScholarPubMed
Holmes, E. A., O'Connor, R. C., Perry, V. H., Tracey, I., Wessely, S., Arsenault, L., … Bullmore, E. (2020). Multidisciplinary research priorities for the COVID-19 pandemic: A call for action from mental health science. The Lancet Psychiatry, 7, 547–560.CrossRefGoogle Scholar
Kendler, K. S. (1996). Major depression and generalised anxiety disorder. Same genes, (partly) different environments – revisited. British Journal of Psychiatry, 168(Supplement 30), 68–75.CrossRefGoogle Scholar
Klein, D. F. (1981). Anxiety reconceptualized. In Klein, D. F., & Rabkin, J. G., (Eds.), Anxiety: New research and changing concepts (pp. 235–262). New York, USA: Raven Press.Google Scholar
Klein, D. N., Shankman, S. A., & Rose, S. (2008). Dysthymic disorder and double depression: Prediction of 10-year course trajectories and outcomes. Journal of Psychiatric Research, 42, 408–415.CrossRefGoogle ScholarPubMed
Montgomery, S. A., & Åsberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382–389.CrossRefGoogle ScholarPubMed
Moran, P., Rendu, A., Jenkins, R., Tylee, A., & Mann, A. (2001). The impact of personality disorder in UK primary care: A 1-year follow-up of attenders. Psychological Medicine, 31, 1447–1454.CrossRefGoogle ScholarPubMed
Murphy, S. M., Owen, R. T., & Tyrer, P. J. (1984). Withdrawal symptoms after six weeks treatment with diazepam. Lancet (London, England), 324, 1389.CrossRefGoogle Scholar
Nagy, L. M., Krystal, J. H., Charney, D. S., Merikangas, K. R., & Woods, S. W. (1993). Long-term outcome of panic disorder after short-turn imipramine and behavioural group treatment. A 2.9 year naturalistic follow-up study. Journal of Clinical Psychopharmacology, 13, 16–24.CrossRefGoogle Scholar
Reich, J., Schatzberg, A., & Delucchi, K. J. (2018). Empirical evidence of the effect of personality pathology on the outcome of panic disorder. Journal of Psychiatric Research, 107, 42–47.CrossRefGoogle ScholarPubMed
Remes, O., Wainwright, N., Surtees, P., Lafortune, L., Khaw, K. T., & Brayne, C. (2018). Generalised anxiety disorder and hospital admissions: Findings from a large, population cohort study. BMJ Open, 8, e018539.CrossRefGoogle ScholarPubMed
Roest, A. M., Zuidersma, M., & de Jonge, P. (2012). Myocardial infarction and generalised anxiety disorder: 10-year follow-up. British Journal of Psychiatry, 200, 324–329.CrossRefGoogle ScholarPubMed
Rubio, G., & López-Ibor, J.J. Jr. (2007). What can be learnt from the natural history of anxiety disorders? European Psychiatry, 22, 80–86.CrossRefGoogle ScholarPubMed
Seivewright, H., Tyrer, P., & Johnson, T. (1998). Prediction of outcome in neurotic disorder: A 5-year prospective study. Psychological Medicine, 28, 1149–1157.CrossRefGoogle ScholarPubMed
Spitzer, R., & Williams, J. B. (1983). Structured clinical interview for DSM-III (1983 version). New York, USA: New York State Psychiatric Institute.Google Scholar
Svanborg, C., Wistedt, A. A., & Svanborg, P. (2008). Long-term outcome of patients with dysthymia and panic disorder: A naturalistic 9-year follow-up study. Nordic Journal of Psychiatry, 62, 17–24.CrossRefGoogle ScholarPubMed
Tyrer, P. (1984). Psychiatric clinics in general practice - an extension of community care. British Journal of Psychiatry, 145, 9–14.CrossRefGoogle ScholarPubMed
Tyrer, P. (1985). Neurosis divisible? Lancet (London, England), 325, 685–688.CrossRefGoogle Scholar
Tyrer, P. (1989). Classification of neurosis (pp. 159). Chichester: John Wiley.Google Scholar
Tyrer, P. (2001). The case for cothymia: Mixed anxiety and depression as a single diagnosis. British Journal of Psychiatry, 179, 191–193.CrossRefGoogle ScholarPubMed
Tyrer, P., & Alexander, J. (1979). Classification of personality disorder. British Journal of Psychiatry, 135, 163–167.CrossRefGoogle ScholarPubMed
Tyrer, P., Alexander, M. S., Cicchetti, D., Cohen, M. S., & Remington, M. (1979). Reliability of a schedule for rating personality disorders. British Journal of Psychiatry, 135, 168–174.CrossRefGoogle ScholarPubMed
Tyrer, P., & Baldwin, D. (2006). Generalised anxiety disorder. Lancet (London, England), 368, 2156–2166.CrossRefGoogle ScholarPubMed
Tyrer, P., Crawford, M., Sanatinia, R., Tyrer, H., Cooper, S., Muller-Pollard, C., … Weich, S. (2014). Preliminary studies of the ICD-11 classification of personality disorder in practice. Personality and Mental Health, 8, 254–263.CrossRefGoogle ScholarPubMed
Tyrer, P., Nur, U., Crawford, M., Karlsen, S., MacLean, C., Rao, B., … Johnson, T. (2005). The social functioning questionnaire: A rapid and robust measure of perceived functioning. International Journal of Social Psychiatry, 51, 265–275.CrossRefGoogle ScholarPubMed
Tyrer, P., Owen, R. T., & Cicchetti, D. V. (1984). The brief scale for anxiety: A subdivision of the comprehensive psychopathological rating scale. Journal of Neurology, Neurosurgery and Psychiatry, 47, 970–975.CrossRefGoogle ScholarPubMed
Tyrer, P., Reed, G. M., & Crawford, M. (2015). Classification, assessment, prevalence, and effect of personality disorder. Lancet (London, England), 385, 717–726.CrossRefGoogle ScholarPubMed
Tyrer, P., Seivewright, N., Ferguson, B., Murphy, S., Darling, C., Brothwell, J., … Johnson, A. L. (1990). The Nottingham study of neurotic disorder: Relationship between personality status and symptoms. Psychological Medicine, 20, 423–431.CrossRefGoogle ScholarPubMed
Tyrer, P., Seivewright, H., & Johnson, T. (2004). The Nottingham study of neurotic disorder: Predictors of 12-year outcome of dysthymic, panic and generalized anxiety disorder. Psychological Medicine, 34, 1385–1394.CrossRefGoogle ScholarPubMed
Tyrer, P., Seivewright, N., Murphy, S., Ferguson, B., Kingdon, D., Brothwell, J., … Johnson, T. (1988). The Nottingham study of neurotic disorder: Comparison of drug and psychological treatments. Lancet (London, England), 332, 235–240.CrossRefGoogle Scholar
Tyrer, P., Seivewright, H., Simmonds, S., & Johnson, T. (2001). Prospective studies of cothymia (mixed anxiety-depression): How do they inform clinical practice? European Archives of Psychiatry and Clinical Neuroscience, 251(suppl 2), 53–56.CrossRefGoogle ScholarPubMed
Tyrer, P., Tyrer, H., & Yang, M. (2021). Premature mortality of people with personality disorder in the Nottingham study of neurotic disorder. Personality and Mental Health, 15, 32–39.CrossRefGoogle ScholarPubMed
van Dis, E. A. M., van Veen, S. C., Hagenaars, M. A., Batelaan, N. M., Bockting, C. L. H., van den Heuvel, R. M., … Engelhard, I. M. (2020). Long-term outcomes of cognitive behavioral therapy for anxiety-related disorders: A systematic review and meta-analysis. JAMA Psychiatry, 77, 265–273.CrossRefGoogle ScholarPubMed
Williams, P., & Balestrieri, M. (1989). Psychiatric clinics in general practice. Do they reduce admissions? British Journal of Psychiatry, 154, 67–71.CrossRefGoogle ScholarPubMed
Yang, M., & Goldstein, H. (1996). Multilevel models for longitudinal data. In Engel, U., & Reinecke, J., (Eds.), Analysis of change. Advanced techniques in panel data analysis (pp. 191–220). Berlin-New York: Walter de Gruyter.Google Scholar
Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67, 361–370.CrossRefGoogle ScholarPubMed