A Study of Nosological Problems in Depression

International Journal of Methods in Psychiatric Research, 1999

Epidemiological population research produces important information for the planning of public health services and the identification of risk factors. The latter is also of particular importance for the detection of possible aetiological and pathogenic processes and the planning of preventive activities.

Comprehensive Psychiatry, 1996

Current classification systems (ICD-10 and DSM-IV) require a quantitative criterion for differentiating depressive states, suggesting a correlation between the number of symptoms, i.e., the pervasiveness of the syndrome, and the subtype of the illness. All the symptoms (within those contained in the diagnostic lists) are assumed to have comparable value. To investigate the relevance of the number and the type of symptoms reported by 196 patients suffering from depression, we compared the symptoms using independent indicators of severity such as the Clinical Global Index (CGI) and the social functioning subscale of the Global Assessment of Functioning (GAF). A second comparison using the same indicators was made between qualitatively distinct categories of DSM-IV and ICD-IO (i.e., melancholic v nonmelancholic, somatic v nonsomatic, and psychotic v nonpsychotic). There was evidence that increasing numbers of symptoms actually reflect higher levels of severity, but the categorizations that were mainly based on qualitative criteria (e.g., melancholia, somatic syndrome, etc.) usually attained better discrimination compared with those based on the number of symptoms. Moreover, certain symptoms (usually those indicated as endogenous) were more likely to be associated with greater severity and pervasiveness. Finally, the results clearly showed that different symptoms had different weight in establishing the gradient of severity.

Comprehensive Psychiatry, 1971

S INCE THE SUDIES OF KRAEPELIN,l numerous approaches have been used in an attempt to separate those patients with depression as an outstanding component of their illnesses into meaningful diagnostic categories. An increasing body of evidence indicates that one useful way to classify affective disorders is by the polarity of the mood disturbance.2-5 Using this method for classification, there are two main subgroups of affective illnesses. One type, bipolar afiectiue disorder or manic depressive illness, is characterized by the presence of mania. In the second type, the affective disorder is manifest only as depressive episodes without mania and is called unipokzr afectiue disorder or depressive disease. When affectively ill patients are divided into these two subgroups and are compared on a number of independent clinical variables, certain differences emerge, suggesting that these subgroups have validity beyond their differences in the polarity of the affective episode. Genetic studies4-6 have found differences in the patterns of inheritance and the sex ratios of ill individuals. Clinical studies2-4 have demonstrated differences in onset ages, number of episodes, duration of remission between episodes, and number of hospital admissions. Additional evidence7s8 suggests that these two subgroups may also differ in their prepsychotic temperament and personality traits.

Psychiatric Clinics of North America, 2012

2010

Amaç: Melankolik ve melankolik olmayan depresyon, depresyonun s›n›fland›r›lmas›nda belki de en yayg›n kabul gören ayr›m noktas›d›r. Bu çal›flman›n amac› depresyonun belirti, fliddet ve biyolojik tabanl› s›n›flamalar›n› karfl›laflt›r-makt›r. Yöntem: Depresyon tan›s› alm›fl 78 hastadan oluflan örneklemde ilk olarak SCID-I'in 14 depresif belirtisi kullan›larak küme analizi yap›lm›flt›r. ‹kinci olarak biyolojik tabanl› s›n›flama için DST (deksametazon supresyon testi) sonuçlar› ve son olarak da fliddet aç›s›ndan HDRS (Hamilton Depresyon Derecelendirme Ölçe¤i) puanlar›na göre (yüksek ve düflük fliddet gruplar›) grupland›r›lm›fllard›r. Bu gruplar biyolojik de¤iflkenler (tiroid stimule edici hormon -TSH, bazal ve deksametazon sonras› kortizol düzeyleri), klinik (yafl, bafl-lang›ç yafl›, depresyon fliddeti, psikososyal stresörler, kiflilik bozuklu¤u) ve demografik de¤iflkenler aç›s›ndan karfl›laflt›-r›lm›flt›r. Bulgular: DSM-IV'e göre melankoli tan›s› alm›fl grubun küme analizi sonucu endojen grup olarak belirlenmifl grupla yüksek derecede uygunluk gösterdi¤i belirlendi. Küme analizine göre endojen depresyon olarak tan›mlanan grubun yafl ortalamas›n›n daha yüksek, klinik aç›dan depresyon derecesinin daha fliddetli ve bazal kortizol düzeylerinin daha yüksek olduklar› bulundu. HDRS puanlar›na gore daha ciddi depresyonu olan grubun TSH düzeyleri daha düflük bulundu. DST (deksametazon supresyon testi) kortizol yan›t› bask›lanmam›fl hastalarda aile öyküsünde daha fazla depresif bozukluk olan bireyler oldu¤u saptand›. Sonuç: Çal›flmam›z›n sonucu endojen veya melankolik depresyonun farkl› klinik ve biyolojik özelliklere sahip oldu-¤u hipotezini k›smen do¤rulamaktad›r. Anahtar sözcükler: Melankoli, endojen depresyon, depresyon alttipleri, kortizol, TSH Klinik Psikofarmakoloji Bülteni 2010;20:57-65 ABSTRACT:

Research and Advances in Psychiatry, 2016

Journal of Affective Disorders, 1999

Comprehensive Psychiatry, 2000

There has been widespread debate about the validity of the contemporary diagnostic classification system of depression. The major goal of this study is to examine the prognostic significance of each of the major subtypes of depression using data from 5 interviews of a 15-year prospective community-based cohort study. The stability of the following diagnostic subtypes across the duration of the study was examined: major depressive disorder (MDD), dysthymia, recurrent brief depression (RBD), and minor depression. The results show that there was little stability for the specific subtypes of depression among those who continued to manifest depression during the fol-low-up period; 51% of those with MDD and 44% of those with RBD met criteria for another subtype of depression. When stability was observed, the same subtype often occurred in combination with the development of another subtype. Among individuals with a single subtype, severity was greatest among those with dysthymia, whereas individuals with combined subtypes had greater severity than those with a single subtype. The lack of longitudinal stability of the diagnostic subtypes of depression suggests that depression is better expressed as a spectrum rather than a set of discrete subtypes.

2014

Pilar Montesó-Curto2 (Universidad Rovira i Virgili, España), Carme Ferré-Grau (Universidad Rovira i Virgili, España), Mar Lleixà-Fortuño (Universidad Rovira i Virgili, España), Núria Albacar Riobóo (Universidad Rovira I Virgili, España), Antonio Sánchez-Herrero (Hospital Virgen de la Cinta, España), Carina Aguilar-Martín (Atención Primaria Terres de l’Ebre, España), Marilene Lejeune (Area de Biología Molecular, España)