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Letters to the Editor
July 7, 2008

Heterogeneity of Patients With Coronary Artery Disease and Distress and the Need to Identify Relevant Subtypes

Arch Gen Psychiatry. 2008;65(7):851-852. doi:10.1001/archpsyc.65.7.851

Drs Frasure-Smith and Lespérance1 showed that in patients with stable coronary artery disease (CAD), major depressive disorder (MDD) and generalized anxiety disorder (GAD) show substantial overlap and both are associated with prospective major adverse coronary events. The self-report screening instruments for depression (Beck Depression Inventory Second Edition) and anxiety (Hospital Anxiety and Depression Scale anxiety subscale) were strongly correlated and their predictive values for the diagnosis of MDD were virtually the same. Drs Frasure-Smith and Lespérance suggest that a distress disorder under which both depression and anxiety would fall would be a more appropriate diagnostic category to be included in DSM-V. In general psychiatry, the suggestion of combining MDD and GAD has many advocates but also many opponents, fueled by differences between patients with MDD and GAD in magnetic resonance imaging patterns and response to benzodiazepines.

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