Natural history and course of adult anxiety disorders

Abstract

In general, the anxiety disorders appear to be chronic if left untreated in thc general population. Persons seeking treatment are likely to have more severe disorders and more comorbidity, but there is little data on this point. However, even treated persons appear to have chronic course; relatively few become free of symptoms, but a substantial proportion achieve a good outcome (little impairment) despite residual symptoms. A gradual amelioration may occur with the passage of years but, here again, there is little data. Individual disorders appear to differ in course and outcome, with social phobia and agoraphobia showing greater persistence and severity. Prognostic factors include severity, duration, and comorbidity (axis I and II). A variety of psychological therapies appear to affect course and outcome, although design problems limit interpretation of many studies. Prospective studies are needed that examine the outcome of subjects with all of the anxiety disorders obtained from the community. In addition to diagnostic stability, such studies can be expected to show important differences in outcome among individual disorders. increased suicidal risk; however, differences in definitions of terms describing outcome make comparisons across samples difficult. We have studied two samples of children/adolescents with MDD. In the initial sample, we reassessed 70 inpatients with MDD who had been evaluated extensively 1-6 years earlier. Fifty-nine (84%) were reinterviewed using the Kiddie-LIFE, and their intervening course was evaluated. From retrospective assessment, 98% had recovered within 1 year of initial evaluation, but 61% had at least one recurrence during the follow-up period. Of those with recurrence, 47% had thc recurrence within 1 year. The second sample is a prospective follow-up of 50 children/adolescent outpatients with major depressive disorder who were followed up prospectively for 1 year after completing a double-blind, randomized, placebo-controlled study of fluoxetine. Of the 50 subjects who completed 1 year of followup, eight (16%) had failed to recover in the 1 year follow-up period. Recovery was defined as at least 60 days with minimal symptoms. Of the remaining 42 subjects who met this recovery criterion, 23 had no recurrence following recovery and 19 had another episode of depression following recovery. The mean ages of those with a recurrence and those without a recurrence were 12.7 + 3.3 years and 11.8 +_ 2.5 years, respectively. Differences between those who did or did not have a recurrence were examined. There was a trend for those with comorbid anxiety disorders, dysthymic disorder, and melancholic depression to be more likely to have a recurrence.