Anxious Depressive Attack (ADA) -its prevalence and clinical implication

Anxious-Depressive Attack (ADA) is one of the three types of anxiety attacks originally described by Freud. ADA is characterized by the sudden onset of intense anxiety, immediately followed by intrusive ruminations. These intrusive thoughts, often centered on past regrets or future worries, cause significant psychological distress. Some individuals respond to these episodes with maladaptive or impulsive coping behaviors. This study aimed to investigate the prevalence of ADA among new patients at an anxiety disorder specialty clinic and to examine the associated psychiatric and psychological characteristics. New patients (N = 286) presenting to an anxiety disorder clinic in Tokyo were assessed for the presence of ADA independently by a psychiatrist and Certified Public Psychologists (Japan), based on predefined diagnostic criteria. Axis I and Axis II diagnoses were established using the Japanese version of the Mini-International Neuropsychiatric Interview (MINI) and the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II), respectively. Histories of early separation or abuse were assessed using structured questionnaires. Psychological assessments of anxiety, depression, social anxiety, stress, and rejection sensitivity (RS) were conducted. Structural equation modeling (SEM) was performed to examine relationships among these variables. The lifetime prevalence of ADA was 21.68%. ADA was observed across 16 Axis I disorders and 6 Axis II personality disorders. Compared with patients without ADA, those with ADA exhibited significantly higher scores on all psychological measures. SEM demonstrated that both RS and depressive symptoms independently contributed to the occurrence of ADA. ADA was found across a wide range of psychiatric disorders characterized by heightened RS. These findings suggest that ADA may be associated with increased clinical complexity. Active screening for ADA in clinical practice may facilitate early identification and more appropriate intervention strategies.