Table 1 Diagnostic criteria of anxious-depressive attack [2]

A. Anxious-depressive attack occurs suddenly and recurrently regardless of one’s situation in various mental disorders.

B. The following symptoms proceed in descending order, but symptom no. 4 is elective.

 1. Abrupt surge of intense discomfort consisting of mixed emotions of anxious and depressive nature with or without being moved to tears. A peak comes within several seconds or less than a minute (sudden intense feelings of anxiety or depression).

 2. Intrusive rumination including mostly negative memories, consisting of mainly recent or past adverse events (flashbacks) or rarely worry, which continues for several tens of minutes to several hours (intrusive rumination of regretful memories or future worries).

 3. Prominent agitation, unrest, or loneliness that occurs during rumination and was very violent and inappropriate to ruminative contents (emotional distress due to painful thoughts).

 4. Various coping behaviors to manage intense discomfort occasionally appear (coping behaviors to manage emotional distress).

C. Physical symptoms, e.g., shortness of breath and palpitations, are extremely modest.

D. The disturbance is not attributable to the direct psychological effects of any stress, physiological effects of a substance, or a neurological or other medical condition.

E. The disturbance is not better explained by another neuropsychiatric disorder (e.g., panic disorder, post-traumatic stress disorder, non-epileptic seizure, frontal epilepsy, intermittent explosive disorder, anxious distress specified for depression, sudden emotional excitement of schizophrenia, or Ataque de nervios).