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Anxiety is closely related to depression. In a clinical situation, the symptoms are often difficult to differentiate. In a meta-analysis, the prevalence of anxiety disorder in patients with depression has been estimated at 57 %. A new diagnostic category – ‘mixed anxiety-depression’ is being proposed for further study.
Anxiety far more commonly precedes depression than vice versa and that particular episodes of depression may begin with anxiety symptoms. Social anxiety disorder and simple phobia are more likely to precede depression. The co-morbidity of depression and anxiety has been associated with more severe symptoms and worse prognosis.

A classical theoretical distinction is that anxiety is associated with ‘helplessness’ while depression is characterized by ‘hopelessness’.
Also uncertainty about the ability to control important outcomes may be associated with anxiety, whereas helplessness together with certainty about negative outcome may be associated with depression.
Furthermore, anxiety disorders are characterized by anxiety / fears about future events and avoidance behavior, whereas depression involves loss of pleasure and thoughts about past events.
Anxiety involves an attentional bias for threatening information. Thus, when given both threatening & non-threatening cues, anxious patients attend selectively to threatening cues. On the other hand, depression involves a memory bias, with depressed subjects showing bias to recall negative information, particularly when it is self referential.


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Views: 208

Comment by Dr Muhammed Rafeeque on January 13, 2010 at 6:48am
It is very easy to diagnose diseases like tuberculosis, cancer, pneumonia. Whereas, diagnosing a psychiatric disease is not that easy. Usually patients come with mixed symptoms, which can lead to diagnostic dilemma. Yesterday one lady consulted me with a salad of mental symptoms and confused me. Her mother said that she has the tendency to wash the hand frequently (obsessive compulson disorder). She is very much depressed with weeping even for silly matters. She avoids the society and usually wants to be in a closed room (major depressive disorder). She is very suspecious, especially about her husband, and thinks that he has relations with prostitutes (paranoid schizophrenia). She has the tendency to talk alone and she also gets several hallucinations and delusions (Delusional disorder). She also gets a feeling of non specific pains and feels as if she has some major disease (panic disorder). Apart from that, she has symptoms of Anxiety neurosis and Phobia. She had several episodes of violent behaviar with her mother and husband. That episodes were followed by euphoria (bi polar disease). This lady is having a combination of almost all mental diseases. I prescribed Lachesis 200, but i am confused with the disease diagnosis.
Comment by Dr Dushyant Kamal Dhari on January 13, 2010 at 8:26am
Yes, in mixed cases of psychiatry the diagnosis is difficult. Homoeopathy as a method of treatment of the patient rather than disease is very useful here.
Comment by Debby Bruck on January 13, 2010 at 8:52am
These are excellent differentials Dr Dushyant. It is a good topic of discussion. Learning to see which is 'anxiety' and which is 'depression' can help us understand and recognize these diseases. It is helpful to define them through the symptoms we can observe.
Comment by Dr Muhammed Rafeeque on January 13, 2010 at 10:57pm
One more point I would like to add: We should not give over importance to common mental symptoms while treating a psychiatric case; physical generals and life space investigation and aetiology are more importance. I had a case of substance abuse (cannabis indica). when I asked about his profession, he said, "I was the secretary of Bill clinton, but had a fight with him and resigned the post". That time he was under the effect of cannabis. Later when i took his case, he said the truth that he is a carpenter!
Comment by Alias Azhar on January 14, 2010 at 1:58am
peace n salam to all,
i total agree with Dr M Rafeeque when he wrore:We should not give over importance to common mental symptoms while treating a psychiatric case; physical generals and life space investigation and aetiology are more importance: coz for me HOW THEY REACT TO THE FEELING is more importent. peace wasalaman
Comment by Stephanie Nile on February 5, 2010 at 7:19am
Dear Dr Muhammed,
Your description of a "salad of mental symptoms" is so very well observed. This is so typical of the situation we are confronted with, even in student clinics.

None of the disease diagnoses you mentioned (in brackets) seem to lead to the center of the case very well.

It would be exciting to see how the case unfolds!

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