Depression and anxiety may be the first manifestations of a medical disease

In the current issue of P&P, Fiammetta Cosci and other italian investigators have analyzed the data available on depression and anxiety as early manifestations of medical disease.

Affective disturbances involving alterations of mood, anxiety and irritability may be early symptoms of medical illnesses. The DSM-5 provides examples of medical conditions that may be associated with mood and anxiety disturbances but not a list of medical disorders characterized by affective prodromes.

The results of this study showed that depression seems to be the most common affective prodrome of medical disorders and is consistently reported in Cushing's syndrome, hypothyroidism, hyperparathyroidism, pancreatic and lung cancer, myocardial infarction, Wilson's disease, and AIDS.

Mania, anxiety and irritability Anxiety and irritability may occur in conjunction with depression, but are less frequent on their own. Mania was not found to be consistently associated with specific medical disorders other than Wilson's disease.

Physicians may not pursue medical workup of cases that appear to be psychiatric in nature. They should be alerted that disturbances in mood, anxiety and irritability may antedate the appearance of a medical disorder.