General Neurotic Syndrome Research Articles

The influence of personality disorder in predicting suicidal behaviour in common mental disorders: A 30-year study.

Two hundred ten patients with anxiety and depressive disorders were followed up over 30 years. Personality status was assessed at baseline using the Personality Assessment Schedule (PAS), an instrument that classifies personality disorder in a similar way to the new ICD‐11 classification. Assessments of suicidal behaviour were made at 5, 12 and 30 years and suicidal thoughts at 12 and 30 years and analysed by personality status, clinical diagnosis and scores on the General Neurotic Syndrome Scale, a combined diagnosis of mixed anxiety depression and personality dysfunction. Suicide attempts were most frequent in the first 5 years of the study and reduced over time. Baseline personality status was the best predictor of suicide attempts at 5 years (no personality disorder 29.3%, personality disorder 51.6%, p = 0.006), and at 12 years (no personality disorder 11.9%, personality disorder 25.7%, p = 0.042), but no important differences were found at 30 years, when comorbid mental state disorder was the strongest predictor (p < 0.001). Similar but less marked findings were found for the general neurotic syndrome. It is concluded that the presence of personality disorder is a robust predictor of suicidal behaviour in the shorter term but in the long‐term comorbid pathology is a better predictor.

Relationships between treatments received in the Nottingham Study of Neurotic Disorder over 30 years and personality status.

We compared the drug treatments and health service contacts of anxious and depressed patients separated by personality disturbance in 200 patients over 30 years. Contact details with health professionals at 5, 12 and 30 years were recorded and analysed by multilevel models at all time points. Over 30 years, patients with dependent and anankastic personality disturbance and cothymia (the general neurotic syndrome) were 2.27 times more likely to receive selective serotonin reuptake inhibitors (SSRIs) and new antidepressants (95% confidence interval [CI]: 1.22-4.24), particularly paroxetine, and were 1.6 weeks (95% CI: 1.2-2.3) longer on the drug than those without the syndrome. Similar results with SSRIs and new antidepressants in patients with personality disorder fell short of significance after adjusting for age, sex and DSM status. Most patients had a DSM diagnosis at follow-up points, and these had increased psychological treatment, psychiatric admissions, multiple drugs, SSRIs and new antidepressants. At later follow-up, most drug treatments decreased apart from psychological treatment, SSRIs and new antidepressants, and baseline personality disorder had little impact on treatment histories compared with others. We conclude that the (Galenic) general neurotic syndrome is associated with greater use of treatments in the long term, showing that combined personality and symptomatic pathology overcomes that of personality disorder alone.

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.

Cohort studies of the long-term outcome of anxiety, depression and personality status rarely join together. 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. 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. The long-term outcome of disorders formerly called 'neurotic' is poor with the exception of panic disorder. Personality dysfunction accentuates poor recovery.

The Nottingham study of neurotic disorder: predictors of 12 year costs

To examine the relationship between clinical, demographic and socio-economic characteristics and the long-term costs of a cohort of neurotic patients. Analysis of the costs of a cohort of 210 people entered in the Nottingham study of neurotic disorders, a randomized controlled evaluation of five treatments for neurotic disorders. Service use data were collected at 5 and 12 years after study entry. Multiple regression analyses were conducted. The total cost per patient over the 12-year follow-up period was calculated to be $11,940 (SD $15,520) ( pound7450, SD pound9690). Higher costs were significantly associated with the presence of general neurotic syndrome, an initial diagnosis of dysthymia and a recurrent episode of illness. The total costs of care for a range of neurotic disorders are broadly comparable with other estimates of costs reported in the literature for similar populations. Those responsible for higher costs in the longer-term have comorbid anxiety, depressive and personality disorders.

The core elements of neurosis: mixed anxiety-depression (cothymia) and personality disorder.

Although there has been great diagnostic activity within the conditions formally included under the general rubric of neurosis in the last 20 years, there is little evidence that the many new diagnoses (i.e., generalized anxiety disorder, panic disorder, social anxiety disorder, and dysthymic disorder) have helped clinicians and improved the health of those diagnosed. This is largely because of the extensive comorbidity between these disorders negates much of their attempted separation and it is argued that the core of neurosis is a mixed anxiety-depressive disorder, or cothymia, combined with significant personality disorder of any type. The specific association of the anxious-fearful personality cluster (cluster C) and neurosis, called the general neurotic syndrome, is also relevant but appears to have lesser significance as the personality elements are not stable. Data are presented that justify these conclusions from a long-term follow-up study of anxiety and depressive disorders.

Comorbidity and the General Neurotic Syndrome

The observation that people with an anxiety or depressive disorder also have an increased likelihood of having had other anxiety or depressive disorders in their lifetime means either that the separate causes of these disorders have aggregated, much more than chance would allow, or that some general vulnerability factor has made them liable to each and all of the disorders they report. In this paper, three separate sources of information-symptoms occurring in the general population, disorders occurring in the general population, and disorders occurring in patients who have sought treatment-are reviewed. In all three domains of information, a general vulnerability factor, associated with personality trait measures of high trait anxiety and poor coping, emerges as a principal cause of these symptoms or disorders, and accounts for the majority of the variation in the comorbidity of symptoms or disorders. This vulnerability factor is shown to be under substantial gentic control. Nevertheless it can be modified by appropriate treatment, and prevention strategies exist to reduce the incidence of the anxiety and depressive disorders.

The benzodiazepine antagonist flumazenil is anxiolytic in high state anxiety and anxiogenic in low state anxiety in a study of 23 female animal phobics

tency with either a categorical view of panic disorder as a stable clinical entity or panic disorder as one facet only of a 'general neurotic syndrome'. Result: PSE profile at baseline was virtually identical with that at follow up. Few patients had 'changed' in PSE syndrome diagnosis after 5 to 6 years. Conclusion: These data, although not conclusive, are supportive of the concept of DSM III-R Panic Disorder as a stable clinical entity and are correspondingly difficult to reconcile with the view that Panic Disorder is but one facet only of a general neurotic syndrome.

The galway study of panic disorder IV: Temporal stability of diagnosis by present state examination test retest

BACKGROUND A long-term outcome study of DSM-III-R panic disorder included the Present State Examination (PSE) at baseline and follow up five to six years later. METHOD PSE test-retest and individual within-patient change scores on various PSE syndromes were assessed for consistency with either a categorical view of panic disorder as a stable clinical entity or panic disorder as one facet only of a neurotic syndrome'. RESULTS PSE profile at baseline was virtually identical with that at follow up. Few patients had changed in PSE syndrome diagnosis after five to six years. CONCLUSION These data, although not conclusive, are supportive of the concept of DSM-III-R panic disorder as a stable clinical entity and are correspondingly difficult to reconcile with the view that panic disorder is but one facet only of a general neurotic syndrome.

Stability trends and longitudinal correlations of negative and positive syndromes within a three-year follow-up of initially hospitalized schizophrenics.

Our study investigates whether the distinction between positive and negative symptoms in schizophrenia--as discussed in the literature--can be confirmed by a factor analysis and whether such a distinction proves stability over time. In a further step, symptom factors are correlated to different external variables for the purpose of validation. Processed data cover 36 months obtained from a prospective 5-year follow-up study of 163 initially hospitalized schizophrenics. The results permit for dividing the symptoms into a total of five factors--two representing positive and negative symptoms and one representing the general neurotic syndrome. This factor structure proved to be stable over time. Correlations between symptom factors and external variables justify a trait-interpretation of the negative factor anhedonia.

Experience in reflexology of vertebral artery syndrome

We studied the effectiveness of puncture reflexology (PR) in vertebral artery syndrome (SPA). We observed 61 patients with SPA at the age from 25 to 55 years (men 24, women 37). Previously, patients underwent outpatient and inpatient treatment in different years. In 23 patients, a form of compression-irritative SPA was revealed, in 38 patients - a reflex angiospastic syndrome. The symptomatology of SPA consisted of paroxysmal headaches, more often of the hemicranic type, cochleo-vestibular and visual disturbances, varying degrees of autonomic disorders and general neurotic syndrome. Radiographs of the cervical spine showed signs of degenerative-dystrophic changes, Kovacs subluxation, and in 2 cases of Chimerly's anomaly. Signs of hemodynamic disturbances of varying severity in the vertebrobasilar basin (changes in vascular tone, decreased blood flow) were observed on RZH in most patients. Changes in hemodynamics in most cases dominated on the side of pathology.

Clinical and humoral effects of beta-blockade with ICI 118,551 in the general neurotic syndrome

Fifty-six patients satisfying the diagnostic criteria for the general neurotic syndrome, a mixed anxiety-depressive disorder, were randomly allocated to treatment with a selective β( 2)-blocking drug, ICI 118,551, in a dose of 50 mg tds, or placebo for 4 weeks after a 2-week placebo run-in period. Ratings of anxiety using the Hamilton anxiety rating scale and patient self-assessments in 46 evaluable patients showed no significant difference in the outcome of active drug and placebo groups, and also no significant improvement over time during the study. This unusual finding supports the impression of the general neurotic syndrome as a severe form of neurotic disorder which shows little evidence of placebo response. Diastolic blood pressure was increased and heart rate reduced after 2 weeks on ICI 118,551, and plasma levels of noradrenaline and adrenaline showed no evidence of an expected decrease with active drug; on the contrary the data showed some evidence of increased catecholamine levels. The results suggest that selective β-blockade has little part to play in the treatment of anxiety and that on repeated dosage the effects of selective blockade are attenuated or reversed.

Anxiety, personality and anxiety disorders

The roles of trait anxiety, locus of control and defense style in the genesis and maintenance of anxiety are described. A model of the genetic and environmental determinants of these three measures is presented. The contributions that such vulnerability factors make to anxiety and the anxiety disorders is estimated and discussed in relation to the issue of co-moribidity and the general neurotic syndrome. Some evidence is presented about the specificity of the various anxiety disorders even though other conditions may have co-occurred, for they are often found to be secondary to the index condition. Such a two-factor theory of neurosis, one that implies both a general vulnerability due to high trait anxiety and poor coping, and an independent but specific vulnerability to a particular disorder, will make definitive research very complex. Aetiological factors or treatments that are believed to be specifically associated with only one disorder will have to be shown to be associated with that disorder alone and not with other anxiety disorders or with asymptomatic normals high on these general vulnerability factors.

Evidence for a General Neurotic Syndrome

Neurotic syndromes are defined by characteristic patterns of symptoms, but the validity of the distinction between one syndrome and another depends on associations between the syndromes and clinical history, or treatment response factors that are independent of the defining phenomena. In both a group of twin volunteers and a group of patients with panic disorder/agoraphobia, the lifetime experience of more than one diagnosis of a neurotic syndrome was common but there was no evidence of patterns of co-occurrence of diagnoses being associated with particular syndromes. Receiving a diagnosis was associated with abnormal scores on measures of neuroticism and locus of control, the extent of the abnormality increasing with the number of different diagnoses satisfied. It is argued that the concept of a general neurotic syndrome depends in part on the presence of such predisposing personality factors, and that reduction in this predisposition to neurosis should be the focus of treatment.