We review psychometric and other evidence relevant to mixed anxiety-depression. Properties of anxiety and depression measures, including the convergent and discriminant validity of self- and clinical ratings, and interrater reliability, are examined in patient and normal samples. Results suggest that anxiety and depression can be reliably and validly assessed; moreover, although these disorders share a substantial component of general affective distress, they can be differentiated on the basis of factors specific to each syndrome. We also review evidence for these specific factors, examining the influence of context and scale content on ratings, factor analytic studies, and the role of low positive affect in depression. With these data, we argue for a tripartite structure consisting of general distress, physiological hyperarousal (specific anxiety), and anhedonia (specific depression), and we propose a diagnosis of mixed anxiety-depression.

Tripartite model of anxiety and depression: psychometric evidence and taxonomic implications.

Upward Spirals of Positive Emotions Counter Downward Spirals of Negativity: Insights from the Broaden-and-Build Theory and Affective Neuroscience on The Treatment of Emotion Dysfunctions and Deficits in Psychopathology

Background. The social rank theory of psychopathology
 suggests that with the evolution of social hierarchies various psychobiological mechanisms became attuned to the success or failure in conflict situations. Specifically, subordinates and those who have lost status are
 at greater risk of pathology than winners and those of higher status. In this theory concepts of defeat and entrapment are seen to be of special relevance to the study of depression. We outline the role of defeat and entrapment within the social rank theory of depression. Methods. New self-report measures of entrapment and defeat
 were developed and used to test predictions of the social rank theory of depression. Both a sample of students and depressed patients were assessed with these new scales and other social rank measures (e.g.
 social comparison and submissive behaviour). Results. The entrapment and defeat measures were found to have good psychometric properties and significantly correlated with depression. They were also strongly associated
 with other rank variables. Defeat maintained a strong association with depression even
 after controlling for hopelessness ( r =0·62), whereas the relationship between
 hopelessness and depression was substantially reduced when controlling for defeat. Entrapment and defeat added substantially to the explained variance of depression after controlling for the other social
 rank variables. Conclusions. Defeat and entrapment appear to be promising variables for the study of depression. These variables may also help to develop linkages between human and animal
 models of psychopathology.

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/S0033291798006710

The role of defeat and entrapment (arrested flight) in depression: an exploration of an evolutionary view

The circadian rhythm of body temperature.

We review the literature on interoception as it relates to depression and anxiety, with a focus on belief, and alliesthesia. The connection between increased but noisy afferent interoceptive input, self-referential and belief-based states, and top-down modulation of poorly predictive signals is integrated into a neuroanatomical and processing model for depression and anxiety. The advantage of this conceptualization is the ability to specifically examine the interface between basic interoception, self-referential belief-based states, and enhanced top-down modulation to attenuate poor predictability. We conclude that depression and anxiety are not simply interoceptive disorders but are altered interoceptive states as a consequence of noisily amplified self-referential interoceptive predictive belief states.

/pdf/interoception-in-anxiety-and-depression-2s7pnp0z2b.pdf

Interoception in anxiety and depression

Current views on the organisation and functions of the circadian rhythm system are outlined. Evidence is presented supportive of the notion that the pathophysiology of the affective disorders involves a disruption of circadian rhythms and that the primary locus of action of agents effective in the affective disorders is on the circadian rhythm system. Potential disruptions of this system are enumerated. Such a hypothesis, it is argued, might potentially unite the disparate neurochemical and neuroendocrinological findings emerging in both depression and mania. There are in addition neuropsychological and nosological implications of such a framework, which may help bridge the divide between molecular and behavioural approaches to research on the affective disorders which are outlined.

Rhythm and blues. Neurochemical, neuropharmacological and neuropsychological implications of a hypothesis of circadian rhythm dysfunction in the affective disorders

Analyse des multiples implications (neurophysiologiques, neuropsychologiques et nosologiques) des constats relatifs a la perturbation des rythmes circadiens dans la resignation apprise et dans la depression

Dysrhythmia, dysphoria, and depression: the interaction of learned helplessness and circadian dysrhythmia in the pathogenesis of depression.

Forty-four patients who met criteria for major depressive disorder were assessed for presence of dysfunctional attitudes and negative self-schema on admission. After six weeks, of sixteen patients who had shown high dysfunctional attitudes, six (35%) had not recovered. By contrast, of seventeen patients who had been equally severely depressed at the outset, but had low dysfunctional attitudes, only one (6%) had not recovered. The rating by the patients of themselves, as opposed to their attitudes, did not however predict. Thirty-one patients were tested six months later. Twenty-one (68%) remained asymptomatic, ten patients had relapsed or not responded to treatment, but neither type of admission measure predicted the state at this point. This is consistent with previous evidence which suggests that vulnerable attitudes assessed when symptomatic predict recovery, but that for prediction of relapse, cognitive measures need to be used when the patient is asymptomatic.

Dysfunctional attitudes and vulnerability to persistent depression.

Circadian rhythm dysfunction has recently been suggested to have a causal role in major depressive disorders. Against this background, experiments on circadian rhythms are outlined that yield a state of sustained sleepless activity. Such states can be brought about it seems by manipulation of the external zeitgebers to which rhythms are synchronized rather than by any alteration of the circadian clock. This can be expected to yield a disorganized rhythmic state rather than any discrete phase shifting or desynchronization of rhythms. This state it is suggested should lead to a mild dysphoria, psychomotor activation and a subtle disordering of thought form. It is proposed that these changes lead to the typical clinical picture of mania when distorted cognitively by mechanisms similar to those found in depression. There are a number of implications of this hypothesis. Firstly, mania should commonly be precipitated by similar psychosocial factors to those which precipitate depression. Secondly, similar neuroendocrine findings should be found in both depression and mania. Thirdly, similar agents should be effective in the treatment of mania and depression. Fourthly, cognitive therapy may play a significant part in the management of acute episodes of mania and reduce liability to chronicity.

David Healy

Papers

Rhythm and blues. Neurochemical, neuropharmacological and neuropsychological implications of a hypothesis of circadian rhythm dysfunction in the affective disorders

Dysrhythmia, dysphoria, and depression: the interaction of learned helplessness and circadian dysrhythmia in the pathogenesis of depression.

Dysfunctional attitudes and vulnerability to persistent depression.

Moods, misattributions and mania: an interaction of biological and psychological factors in the pathogenesis of mania.

Monoamine transport in depression: Kinetics and dynamics