Anxious-Depressive Attack: An Overlooked Condition A Case Report

Abstract

Patients with anxiety and/or depressive disorders often experience sudden intense feelings of distressing emotions, including sadness, anxiety, loneliness, gloom and so on, without any apparent psychological reason. Tearfulness often precedes or accompanies such emotional outburst. In addition to these emotional symptoms, mild physiological symptoms similar to those seen in a panic attack, such as palpitations, dizziness, trembling and so on, may appear. Immediately after this emotional outburst, distressing trains of thought or images related to recent or past unpleasant events are experienced and ruminated on repeatedly. They are often manifested as flashbacks with or without visual images. Since these conditions are the bitterest experiences for most patients, they may cope with them in various ways such as deliberate self-harm. These patients generally have a more or less depressive mood. These conditions are considerably different from a panic attack, in that the emotional and cognitive storm dominates the physical one. The author named this condition as an Anxious-Depressive Attack (ADA). In this study, we present five cases of ADA and discuss their psychopathology and differential diagnoses. To the author's knowledge, this is the first report proposing the term ADA, which is a unique but common syndrome. Awareness regarding ADA may help improve understanding and treatment of the patient.