Showing papers on "Mood disorders published in 1998"
TL;DR: Treatment of depression in patients with CVD improves their dysphoria and other signs and symptoms of depression, improves quality of life, and perhaps even increases longevity.
Abstract: This article reviews the burgeoning literature on the relationship of mood disorders and heart disease. Major depression and depressive symptoms, although commonly encountered in medical populations, are frequently underdiagnosed and undertreated in patients with cardiovascular disease (CVD). This is of particular importance because several studies have shown depression and its associated symptoms to be a major risk factor for both the development of CVD and death after an index myocardial infarction. This review of the extant literature is derived from MEDLINE searches (1966-1997) using the search terms "major depression," "psychiatry," "cardiovascular disease," and "pathophysiology." Studies investigating pathophysiological alterations related to CVD in depressed patients are reviewed. The few studies on treatment of depression in patients with CVD are also described. Treatment of depression in patients with CVD improves their dysphoria and other signs and symptoms of depression, improves quality of life, and perhaps even increases longevity. Recommendations for future research are proposed.
1,567 citations
TL;DR: Research on relationships between anxiety and depression has proceeded at a rapid pace since the 1980s, with data converging on an integrative hierarchical model of mood and anxiety disorders in which each individual syndrome contains both a common and a unique component.
Abstract: Research on relationships between anxiety and depression has proceeded at a rapid pace since the 1980s. The similarities and differences between these two conditions, as well as many of the important features of the comorbidity of these disorders, are well understood. The genotypic structure of anxiety and depression is also fairly well documented. Generalized anxiety and major depression share a common genetic diathesis, but the anxiety disorders themselves are genetically hetergeneous. Sophisticated phenotypic models have also emerged, with data converging on an integrative hierarchical model of mood and anxiety disorders in which each individual syndrome contains both a common and a unique component. Finally, considerable progress has been made in understanding cognitive aspects of these disorders. This work has focused on both the cognitive content of anxiety and depression and on the effects that anxiety and depression have on information processing for mood-congruent material.
1,536 citations
TL;DR: The cellular composition of area sg24 in two different sets of brains was examined to identify a biological marker associated with familial mood disorders that may provide important clues regarding the pathogenesis of these common psychiatric conditions.
Abstract: Mood disorders are among the most common neuropsychiatric illnesses, yet little is known about their neurobiology. Recent neuroimaging studies have found that the volume of the subgenual part of Brodmann's area 24 (sg24) is reduced in familial forms of major depressive disorder (MDD) and bipolar disorder (BD). In this histological study, we used unbiased stereological techniques to examine the cellular composition of area sg24 in two different sets of brains. There was no change in the number or size of neurons in area sg24 in mood disorders. In contrast, the numbers of glia were reduced markedly in both MDD and BD. The reduction in glial number was most prominent in subgroups of subjects with familial MDD (24%, P = 0.01) or BD (41%, P = 0.01). The glial reduction in subjects without a clear family history was lower in magnitude and not statistically significant. Consistent with neuroimaging findings, cortical volume was reduced in area sg24 in subjects with familial mood disorders. Schizophrenic brains studied as psychiatric controls had normal neuronal and glial numbers and cortical volume. Glial and neuronal numbers also were counted in area 3b of the somatosensory cortex in the same group of brains and were normal in all psychiatric groups. Glia affect several processes, including regulation of extracellular potassium, glucose storage and metabolism, and glutamate uptake, all of which are crucial for normal neuronal activity. We thus have identified a biological marker associated with familial mood disorders that may provide important clues regarding the pathogenesis of these common psychiatric conditions.
1,435 citations
TL;DR: A meta-analysis of all available EE and outcome studies in schizophrenia confirmed that EE is a significant and robust predictor of relapse in schizophrenia and demonstrated that the EE-relapse relationship was strongest for patients with more chronic schizophrenic illness.
Abstract: Background Expressed emotion (EE) is a measure of the family environment that has been demonstrated to be a reliable psychosocial predictor of relapse in schizophrenia. However, in recent years some prominent nonreplications of the EE-relapse relationship have been published. To more fully address the question of the predictive validity of EE, we conducted a meta-analysis of all available EE and outcome studies in schizophrenia. We also examined the predictive validity of the EE construct for mood disorders and eating disorders. Methods An extensive literature search revealed 27 studies of the EE-outcome relationship in schizophrenia. Using meta-analytic procedures, we combined the findings of these investigations to provide an estimate of the effect size associated with the EE-relapse relationship. We also used meta-analysis to provide estimates of the effect sizes associated with EE for mood and eating disorders. Results The results confirmed that EE is a significant and robust predictor of relapse in schizophrenia. Additional analyses demonstrated that the EE-relapse relationship was strongest for patients with more chronic schizophrenic illness. Interestingly, although the EE construct is most closely associated with research in schizophrenia, the mean effect sizes for EE for both mood disorders and eating disorders were significantly higher than the mean effect size for schizophrenia. Conclusion These findings highlight the importance of EE in the understanding and prevention of relapse in a broad range of psychopathological conditions.
1,229 citations
TL;DR: Depression, anxiety, and alcohol abuse and dependence were most prevalent, and there was a high degree of comorbidity between them, and the prevalence rate encountered for schizophrenia was lower than generally presumed.
Abstract: This article reports the initial results of a prospective study on the prevalence of psychiatric disorders in the Dutch population aged 18-64. The objectives and the design of the study are described elsewhere in this issue. A total of 7076 people were interviewed in person in 1996. The presence of the following disorders was determined by means of the CIDI: mood disorders, anxiety disorders, eating disorders, schizophrenia and other non-affective psychoses, and substance use disorders. Psychiatric disorders were found to be quite common. Some 41.2% of the adult population under 65 had experienced at least one DSM-III-R disorder in their lifetime, among them 23.3% within the preceding year. No gender differences were found in overall morbidity. Depression, anxiety, and alcohol abuse and dependence were most prevalent, and there was a high degree of comorbidity between them. The prevalence rate encountered for schizophrenia was lower (0.4% lifetime) than generally presumed. A comparison with findings from other countries is made. Relevant determinants of psychiatric morbidity were analysed.
1,226 citations
TL;DR: In this paper, the structural relationships of dimensions of key features of selected emotional disorders and dimensions of the tripartite model of anxiety and depression were tested using outpatients with mood disorders (N = 350).
Abstract: Using outpatients with anxiety and mood disorders (N = 350), Ihe authors tested several models of the structural relationships of dimensions of key features of selected emotional disorders and dimensions of the tripartite model of anxiety and depression. Results supported the discriminant validity of the 5 symptom domains examined (mood disorders; generalized anxiety disorder, GAD; panic disorder; obsessive-compulsive disorder; social phobia). Of various structural models evaluated, the best fitting involved a structure consistent with the tripartite model (e.g., the higher order factors, negative affect and positive affect, influenced emotional disorder factors in the expected manner). The latent factor, GAD, influenced the latent factor, autonomic arousal, in a direction consistent with recent laboratory findings (autonomic suppression). Findings are discussed in the context of the growing literature on higher order trait dimensions (e.g., negative affect) that may be of considerable importance to the understanding of the pathogenesis, course, and co-occurrence of emotional disorders.
1,150 citations
TL;DR: The results suggest that the lifetime pattern of axis I comorbidity characteristic of borderline patients and distinguishing for the disorder is a particularly good marker for borderline personality disorder.
Abstract: Objective:The purpose of this study was to assess the lifetime rates of occurrence of a full range of DSM-III-R axis I disorders in a group of patients with criteria-defined borderline personality disorder and comparison subjects with other personality disorders. Method:The axis I comorbidity of 504 inpatients with personality disorders was assessed by interviewers who were blind to clinical diagnosis and who used a semistructured research interview of demonstrated reliability.Results:Four new findings emerged from this study. First, anxiety disorders were found to be almost as common among borderline patients (N=379) as mood disorders but far more discriminating from axis II comparison subjects (N=125). Second, posttraumatic stress disorder (PTSD) was found to be a common but not universal comorbid disorder among borderline patients, a finding inconsistent with the view that borderline personality disorder is actually a form of chronic PTSD. Third, male and female borderline patients were found to differ...
851 citations
TL;DR: The study suggests that recurrent brief hypomania belongs to the bipolar spectrum and should be verified on larger national cohorts in other epidemiological and clinical studies.
729 citations
TL;DR: In this paper, the authors report the results of a cross-national investigation of patterns of comorbidity between substance use and psychiatric disorders in six studies participating in the International Consortium in Psychiatric Epidemiology.
667 citations
TL;DR: Relatives of anorexic and bulimic probands had increased risk of clinically subthreshold forms of an eating disorder, major depressive disorder, and obsessive-compulsive disorder and obsessional personality traits may be a specific familial risk factor for anorexia nervosa.
Abstract: Background We used contemporary family-epidemiological methods to examine patterns of comorbidity and familial aggregation of psychiatric disorders for anorexia and bulimia nervosa. Methods Direct interviews and blind best-estimate diagnostic procedures were used with diagnostically "pure" groups of probands with eating disorders and a matched control group. Lifetime prevalence rates of eating disorders, mood disorders, substance use disorders, anxiety disorders, and selected personality disorders were determined in female probands with restricting anorexia nervosa (n=26) or bulimia nervosa (n=47), control women (n=44), and first-degree biological relatives (n=460). Results Relatives of anorexic and bulimic probands had increased risk of clinically subthreshold forms of an eating disorder, major depressive disorder, and obsessive-compulsive disorder. Familial aggregation of major depressive disorder and obsessive-compulsive disorder was independent of that of anorexia nervosa and bulimia nervosa. These relatives also had increased risk of other anxiety disorders, but the mode of familial transmission was not clear-cut. The risk of substance dependence was elevated among relatives of bulimic probands compared with relatives of anorexic probands, and familial aggregation was independent of that of bulimia nervosa. The risk of obsessive-compulsive personality disorder was elevated only among relatives of anorexic probands, and there was evidence that these 2 disorders may have shared familial risk factors. Conclusions There may be a common familial vulnerability for anorexia nervosa and bulimia nervosa. Major depressive disorder, obsessive-compulsive disorder, and substance dependence are not likely to share a common cause with eating disorders. However, obsessional personality traits may be a specific familial risk factor for anorexia nervosa.
606 citations
Journal Article•
TL;DR: The evaluation of postpartum mood disturbance is discussed and guidelines for the treatment of affective illness during the puerperium are offered.
Abstract: Mood disturbance occurs commonly during the postpartum period. The symptoms may be transient and relatively mild (as in postpartum blues) or may be associated with significant impairment of functioning (as in postpartum depression and puerperal psychosis). Despite the prevalence of postpartum mood disorders, depressive symptoms that emerge during the puerperium are often overlooked. Puerperal affective illness places the mother at risk for the development of recurrent depression and has also been associated with significant long-term effects on child development and behavior. Therefore, the prompt recognition and efficacious treatment of puerperal mood disorders are essential in order to avoid adverse outcomes for both mother and infant. This article discusses the evaluation of postpartum mood disturbance and offers guidelines for the treatment of affective illness during the puerperium.
TL;DR: The objectives and design of a prospective study of the prevalence, incidence and course of psychiatric disorders in a representative sample of non-institutionalized Dutch adults, which determines the lifetime occurrence of DSM-III-R disorders are described.
Abstract: The article describes the objectives and design of a prospective study of the prevalence, incidence and course of psychiatric disorders in a representative sample of non-institutionalized Dutch adults. A total of 7146 men and women aged 18-64, contacted through a multistage sample of municipalities and households, were interviewed at home in 1996. The primary diagnostic instrument was the CIDI, which determines the lifetime occurrence of DSM-III-R disorders. The disorders included were: mood disorders, anxiety disorders, eating disorders, schizophrenia and other non-affective psychotic disorders, and dependence and abuse of psychoactive substances. Follow-up measurements in the same sample were scheduled at 12 and 36 months. The net response to the first measurement was 69.7%. Poststratification weightings were applied for gender, age, marital status and degree of urbanization. Limitations and advantages of the study design are discussed. Findings are reported elsewhere in this issue.
TL;DR: It is demonstrated that the mean grey matter volume of this cortex is abnormally reduced in subjects with major depressive disorder (MDD) and bipolar disorder, irrespective of their treatment status or current mood state, and preliminary histopathological assessments of subgenual PFC tissue taken post mortem suggest this decrement is associated with a reduction in glia without an equivalent loss of neurons.
Abstract: The prefrontal cortex (PFC) ventral to the genu of the corpus callosum has been implicated in the modulation of visceral responses to stressful and emotionally provocative stimuli, based upon analysis of lesion effects involving this area in humans and experimental animals. In a recent magnetic resonance imaging (MRI) study of familial mood disorders, we demonstrated that the mean grey matter volume of this cortex is abnormally reduced in subjects with major depressive disorder (MDD) and bipolar disorder, irrespective of their treatment status or current mood state. Moreover, in preliminary histopathological assessments of subgenual PFC tissue taken post mortem from subjects with MDD and bipolar disorder we obtained results suggesting that this decrement in grey matter volume is associated with a reduction in glia without an equivalent loss of neurons. The potential functional significance of these neuroimaging and microscopic abnormalities is discussed with respect to evidence that subgenual PFC dysfunction may disturb stress-related autonomic and neuroendocrine responses and reward-related mesolimbic dopamine function. These data may thus hold important implications for the development of neural models of mood disorders that can account for the abnormal hedonic, motivational, neuroendocrine, and autonomic manifestations evident in these idiopathic conditions.
TL;DR: There is enough evidence to begin to evaluate inclusion of neuroimaging findings in the mood disorder classification system, and two new mood disorder subtypes are proposed, vascular depression and vascular mania are proposed.
TL;DR: TCI traits are associated with mood disorders and help in assessing suicidality and planning treatment, and differences in personality cause psychopathology.
TL;DR: A model is proposed in which differential sensitivity to mood disorders explains the differential response by some women to periods of normal hormonal changes.
TL;DR: The course of severe unipolar and bipolar disorder seems to be progressive in nature despite the effect of treatment, and the rate of recurrence after successive episodes was the same for the two disorders.
Abstract: BACKGROUND In recent years, studies of the risk of recurrence in affective disorder in relation to the number of prior episodes have given contradictory results.
METHOD Survival analysis was used to calculate the rate of recurrence after successive episodes in a case register study including all hospital admissions with primary affective disorder in Denmark during 1971-1993. A total of 20,350 first-admission patients were discharged with a diagnosis of affective disorder, depressive or manic/cyclic type.
RESULTS The rate of recurrence increased with the number of previous episodes in both unipolar and bipolar disorder. Initially, the two types of disorders followed markedly different courses, but later in the course of the illness the rate of recurrence was the same for the two disorders.
CONCLUSIONS The course of severe unipolar and bipolar disorder seems to be progressive in nature despite the effect of treatment.
TL;DR: Primary analyses found unipolar disorders to be four times more common in GAD than bipolar disorders (67% vs. 17%), providing indirect support for the previously reported observation that GAD and major depression may share a common genetic diathesis.
Abstract: Generalized anxiety disorder (GAD) is a relatively common mental disorder in the general population, afflicting approximately 3% of community residents during their lifetime. It is not a benign condition, since significantly increased disability and dysfunction are found in GAD subjects compared to non-GAD subjects. For decades GAD has frequently been observed in the context of other mental and substance abuse disorders. Initially the weight of clinical opinion indicated that GAD was a residual disease which should only be diagnosed when other mental disorders are not present. More recently there has been a growing recognition that comorbidity is a fundamental characteristic of the course and nature of GAD. In a series of secondary analyses conducted in subjects in the National Comorbidity Study database, we found that 8 out of 10 subjects with lifetime GAD also had a comorbid mood disorder during their lifetime. We found unipolar disorders to be four times more common in GAD than bipolar disorders (67% vs. 17%), providing indirect support for the previously reported observation that GAD and major depression may share a common genetic diathesis. In addition, our analyses support the conclusion that when comorbid mood disorders are present in GAD, a significant increase in associated disability and dysfunction is also found. Thus this comorbid relationship has important implications for clinical course and outcome.
TL;DR: The authors sought to define the latent factors associated with childhood anxiety and depression, using a structural equations/confirmatory factor-analytic approach involving multiple informants (i.e., parent and child report) of symptoms.
Abstract: The authors sought to define the latent factors associated with childhood anxiety and depression, using a structural equations/confirmatory factor-analytic approach involving multiple informants (i.e., parent and child report) of symptoms. A sample of 216 children and adolescents with diagnoses of an anxiety disorder or comorbid anxiety and mood disorders and their parents were administered measures of childhood fear, anxiety, and depression. Results of comparative modeling best supported 3-factor solutions (fear, anxiety, and depression) that were consistent with recent conceptual models of anxiety and depression (e.g., tripartite model). Results also suggested that 3 widely used measures of childhood negative emotion are conceptually heterogeneous (containing item sets that loaded on different latent factors). Implications for the assessment of childhood negative emotions are discussed.
TL;DR: The involvement of the TPH gene in susceptibility to manic-depressive illness is suggested, although this preliminary result requires confirmation in further groups of patients and controls.
Abstract: Background Genes encoding proteins involved in serotonergic metabolism are major candidates in association studies of mood disorders and suicidal behavior. This association study explores whether the tryptophan hydroxylase ( TPH ) gene, which codes for the rate-limiting enzyme of serotonin biosynthesis, is a susceptibility factor for manic-depressive illness, with or without a history of suicide attempts. Methods The TPH intron 7 A218C polymorphism was determined using a polymerase chain reaction–based method in DNA samples from 152 patients with bipolar disorder and 94 healthy control subjects. Results There was a significant association between TPH genotypes and manic-depressive illness. Among patients with bipolar disorder, no association was found between TPH alleles and suicidal behavior. Conclusions This result suggests the involvement of the TPH gene in susceptibility to manic-depressive illness. This preliminary result requires confirmation in further groups of patients and controls.
TL;DR: Both affective symptoms and neuroendocrine abnormalities were related to inflammatory disease activity but not to degree of disability, supporting the hypothesis that these symptoms are causally associated with brain injury.
Abstract: Objective To investigate the association between affective and neuroendocrine abnormalities, commonly observed in multiple sclerosis, with inflammatory disease activity. Design Cross-sectional design. Twenty-three patients with definite relapsing-remitting multiple sclerosis and age- and sex-matched control subjects were investigated. Depression and anxiety were assessed using structured interviews, self-report measures, and Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised criteria. Neurologic impairment was assessed by the Kurtzke Expanded Disability Status Scale and function of hypothalamic-adrenal-pituitary axis was analyzed using a corticotropin-releasing hormone stimulation test after dexamethasone suppression. Inflammatory disease activity was evaluated first by routine and experimental laboratory tests, and second by magnetic resonance assessment of gadolinium uptake of multiple sclerotic plaques. Setting University hospital, a major provider of acute neurologic care. Results Compared with controls, patients with multiple sclerosis had higher scores on depression and anxiety scales and exhibited a failure of suppression of cortisol release after dexamethasone pretreatment. Both affective symptoms and neuroendocrine abnormalities were correlated with cerebrospinal fluid white blood cell counts and presence of gadolinium-enhancing lesions on magnetic resonance images; however, no association with the degree of neurologic impairment was observed. Conclusion Affective and neuroendocrine disorders were related to inflammatory disease activity but not to degree of disability, supporting the hypothesis that these symptoms are causally associated with brain injury.
TL;DR: It is suggested that apathy is a frequent symptom after head injury and may occur either alone or in association with depression.
Abstract: Although several studies have examined the demographics of mood disorders and personality changes following closed head injury (CHI), there are no studies that address the prevalence of apathy afte...
TL;DR: TPM may be useful in patients with mood disorders unresponsive to traditional therapy and warrants further clinical investigation.
TL;DR: Data suggest an association between serotonin system impairment and MDMA use in humans and the possibility that serotonin deficit in MDMA individuals was partially related to a premorbid condition, in relationship with novelty-seeking behaviour and mood disorders, can not be excluded.
Abstract: (+/-)3,4-Methylene-dioxymethamphetamine (MDMA, or 'Ecstasy') effects on serotonin system function and behaviour in humans are unclear. Fifteen MDMA users, who did not have other drug dependencies or alcohol abuse, and had not used other drugs for prolonged periods, and 15 control individuals were included in a study to assess the biological and psychological changes after chronic use of MDMA. Prolactin and cortisol responses to D-fenfluramine challenge, clinical psychobehavioural changes, personality characteristics, including mood, aggressiveness and temperamental aspects, were evaluated 3 weeks after MDMA discontinuation. MDMA users had significantly reduced prolactin and cortisol responses in comparison with control individuals (p < 0.001 and p < 0.005, respectively). Dysphoria and mood changes were exhibited in seven individuals, tiredness in five and sensation-seeking behaviour in twelve at the clinical evaluation. Significantly higher scores were found in MDMA individuals than in control individuals for Minnesota Multiphasic Personality Inventory subscale for Depression, for Buss Durkee Hostility Inventory direct and guilt subscales, for Hamilton Depression Rating Scale and for novelty-seeking Tridimensional Personality Questionnaire subscale. Prolactin responses to D-fenfluramine stimulation area under the curve among MDMA users were negatively correlated with direct aggressiveness scores for Buss Durkee Hostility Inventory; a negative correlation between prolactin responses and novelty-seeking scores was also evidenced among MDMA users. These data suggest an association between serotonin system impairment and MDMA use in humans; in interpretation of these results, the possibility that serotonin deficit in MDMA individuals was partially related to a premorbid condition, in relationship with novelty-seeking behaviour and mood disorders, can not be excluded.
Journal Article•
TL;DR: This article presents data from 186 BPI women and 141 BPI men ascertained as part of the NIMH Genetics Initiative, a multisite collaborative molecular genetic study, and discusses gender differences in population and other clinical samples.
Abstract: Bipolar I (BPI) mood disorder is a severe recurrent mental Illness with a population prevalence of 1 percent. Evidence is strong for genetic risk factors in onset. However, unlike unipolar mood disorders, in which women outnumber men by 2 to 1, for BPI disorder, the male:female ratio is equal. Perhaps for this reason, relatively little research has examined gender-related risks in BPI course. This article presents data from 186 BPI women and 141 BPI men ascertained as part of the NIMH Genetics Initiative, a multisite collaborative molecular genetic study. Subjects were interviewed using the Diagnostic Interview for Genetic Studies (DIGS). DIGS items included a medical history, and for women, questions concerning psychiatric disorders in relation to childbearing, the menstrual cycle, and menopause. Almost half of BPI women who had been pregnant reported having experienced severe emotional disturbances in relation to childbearing, with close to one-third reporting episode onset during pregnancy. Two-thirds of BPI women reported frequent premenstrual mood disturbances and almost 20 percent of postmenopausal BPI women reported severe emotional disturbances during the menopausal transition. More BPI women than men reported thyroid disorder and migraine headaches. Findings are discussed in relation to gender differences in population and other clinical samples, and in terms of their implications for the development of new treatments and preventive interventions.
TL;DR: The significantly higher prevalence of smoking among individuals with schizophrenic disorders may support the growing evidence of linkages between the effects of nicotine and the neurobiology of schizophrenia.
TL;DR: The literature does not support the relevance of self-medication as a course of alcoholism, unless one includes the use of alcohol to alleviate alcohol-induced psychological and neurochemical perturbations, and the clinical importance of distinguishing between substance-induced and independent mood disorders is reviewed.
TL;DR: The limited data available suggest that symptoms of hypomania, mania, depression, and psychosis are common during therapy and appear to be dose dependent.
Abstract: Corticosteroids such as prednisone are commonly prescribed for a variety of illnesses mediated by the immune system. This paper reviews the available literature on mood symptoms during corticosteroid treatment. Few studies have used well-recognized measures of symptoms or clearly defined diagnostic criteria to characterize such mood changes. The limited data available suggest that symptoms of hypomania, mania, depression, and psychosis are common during therapy. Symptoms appear to be dose dependent and generally begin during the first few weeks of treatment. Risk factors for the development of mood instability or psychosis are not known. The similarities of the psychiatric symptoms resulting from corticosteroid treatment to the symptoms of bipolar disorder are discussed.
TL;DR: Women with BD have a later onset of mania, are more likely to have a rapid cycling course, experience mixed episodes, experience more depressive episodes and report more overall impairment in all MOS subscale scores with significant impairment in physical health and pain.
TL;DR: A population of 88 patients affected by CDH was studied, using the DSM-IIIR criteria, and the presence of a psychiatric disorder in 90% of this population was documented.
Abstract: Clinical evidence suggests that chronic daily headache (CDH) occurs in association with psychopathologies: previous studies have focused particularly on migraine. To evaluate this association, we studied, using the DSM-IIIR criteria, a population of 88 patients (18M, 70F) affected by CDH (mean duration 7.4 +/- 8.7 years). We documented the presence of a psychiatric disorder in 90% of this population. The most frequent diagnosis was a comorbidity of anxiety and mood disorders. The comorbidity of psychiatric disorders and headache has important implications as far as treatment is concerned.