Dimensional diagnosis of depression: Adding the dimension of course to severity, and comparison to the DSM (original) (raw)
Related papers
Dimensionality and the category of major depressive episode
International Journal of Methods in Psychiatric Research, 2007
The distribution of symptoms in community surveys is exponential, with no obvious discontinuity at the diagnostic threshold. Taxometric and primary care studies confi rm this. The number of symptoms predicts severity, comorbidity, family history, disability, help seeking and treatment recommendations. The latent structure of mental disorders places MDE in the distress misery cluster.
Dimensions in major depressive disorder and their relevance for treatment outcome
Journal of Affective Disorders, 2014
Background: Major Depressive Disorder (MDD) is a heterogeneous disease. More homogeneous psycho(patho)logical dimensions would facilitate MDD research as well as clinical practice. The first aim of this study was to find potential dimensions within a broad psychopathological assessment in depressed patients. Secondly, we aimed at examining how these dimensions predicted course in MDD. Methods: Ten psychopathological variables were assessed in 75 MDD inpatients. Factor and regression analyses assessed putative relations between psychopathological factors and depression severity and outcome after 8 weeks of treatment. Results: A 3 factor model (eigenvalue: 54.4%) was found, representing a psychomotor change, anhedonia and negative affect factor. Anhedonia and negative affect predicted depression severity (R 2 =0.37, F=20.86, p<0.0001). Anhedonia predicted non-response (OR 6.00, CI 1.46-24.59) and both negative affect (OR 5.69, CI 1.19-27.20) and anhedonia predicted non-remission (OR 9.28, CI 1.85-46.51). Limitations: The sample size of the study was relatively modest, limiting the number of variables included in the analysis. Conclusions: Results confirm that psychomotor change, anhedonia and negative affect are key MDD dimensions, two of which are related to treatment outcome.
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.
Number of symptoms, quantification, and qualification of depression
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.
Dimensions of depression: A comparative longitudinal study
Cognitive Therapy and Research, 1989
A study was conducted to examine the factor structure of a set of commonly employed depression-related measures and to determine whether higher-order composite variables based on factor loadings wouM be differentially related to ,changes in depression status. Five cognitive and two behaviorally oriented measures were administered to 66 hospitalized depressives at pretreatment, 4 to 8 weeks later at the end of an initial phase of pharmacological treatment, and at 2-to 4-month intervals during an 8-month follow-up period. A principal-components analysis performed on nine variablesproduced three interpretable factors that differed systematically with respect to amount of differentiation between responders and nonresponders, as well as magnitude of change associated with successful treatment. Analyses performed on individual measures to track maintainers versus relapsers across three time points likewise yielded results consistent with predictions based on factor membership.
Heterogeneity of depression. Classification of depressive subtypes by longitudinal course
The British Journal of Psychiatry, 1994
This paper describes the application of prospective longitudinal data from an epidemiological sample of young adults to define subtypes of major depression. Depression was classified on a spectrum from subthreshold manifestation of symptoms and duration at one end, to cases with recurrent episodes of depression meeting duration criteria for major depressive episodes at the other. There was a direct relationship between the severity of depression over the longitudinal course and both duration and recurrence of depressive episodes. The subgroup of depression with recurrence of both brief and longer duration episodes could be discriminated on most of the indicators of validity including symptoms, impairment, family history, and suicide attempts. In light of the young age of this cohort, the strong history of suicide attempts and othercomplications of depressionamong the subjectswith recurrent depressionwas striking. These findingsunderscorethe importance of employing course as a classification criterion of depression, and the inclusion of subthreshold episodes of depression in the characterisation of course.
Diagnosis and Classification Subtyping of Depressive Disorders: Comparison of Three Methods
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:
PHQ-8 Days: a measurement option for DSM-5 Major Depressive Disorder (MDD) severity
Population Health Metrics, 2011
Background: Proposed draft diagnostic criteria for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) suggest that dimensional assessments can supplement dichotomous diagnoses by incorporating measures of severity, frequency, and duration, providing the ability to monitor changes in symptoms over time and to guide appropriate treatment. Methods: This report is based on data from the Behavioral Risk Factor Surveillance System 2006 from 198,678 survey participants who responded to all eight Patient Health Questionnaire (PHQ-8) items. We evaluated use of the days version of the PHQ-8 to determine an optimal cut-point for identifying respondents with depression and to evaluate the performance characteristics of the PHQ-8 at this cut-point. Results: A PHQ-8 score of 55 or more days was determined to be the optimal cut-point when compared to the DSM-derived PHQ-8 algorithm for a major depressive episode (five or more symptoms present "more than half the days," at least one of which must be anhedonia or depression). In the full sample, the sensitivity and the specificity of this cut-point were 0.91 (0.90-0.93) and 0.99 (0.99-0.99), respectively. Conclusion: The days version of the PHQ-8 may be a valuable dimensional alternative to the traditional PHQ-8 by offering finer granularity of dimensionality (a score of 0 to 112).
Persistent Depression as a Novel Diagnostic Category: Prevalent, Significant,Valid?
Noro Psikiyatri Arsivi, 2015
Introduction: Persistent depressive disorder (PDD) introduced in the Diagnostic and Statistical Manual of Mental Disorders (DSM) 5 as a novel diagnostic category represents a consolidation of two separate DSM-IV categories, chronic major depressive disorder (MDD) and dysthymic disorder. The present study aims to investigate the frequency and clinical as well as socio-demographic correlates of PDD in comparison with those of episodic MDD among patients seeking treatment for depressive symptoms. Methods: Participants were 140 depressive out-and in-patients under treatment at the psychiatry clinic of the Adnan Menderes University Research Hospital. Each patient was assessed by means of a structured clinical interview (SCID-I) and relevant psychometric instruments including the Hamilton Depression Inventory and Eskin Suicidal Behavior Inventory. Results: Among the depressive patients, 61% fulfilled the criteria for PDD and 39% for episodic MDD. As compared with patients with episodic MDD, the PDD patients were older (d=.54), lower in educational attainment (d=.55), more likely to have comorbid generalized anxiety disorder (OR=3.7), and more prone to report symptoms of anxiety, hopelessness, pessimism, and somatic complaints. Nevertheless, the PDD patients displayed heterogeneous characteristics with respect to clinical severity and suicidal behavior. Conclusion: Our findings suggest that majority of depressive patients, including those fulfilling the criteria for MDD, have been suffering from a persistent ailment rather than an episodic disorder. Clinicians with a crosssectional perspective are more likely to diagnose MDD, whereas those with a longitudinal perspective are more likely to identify PDD in the majority of depressive patients. The incorporation of both of these perspectives into DSM-5 in a complementary manner will possibly enhance our insight into depressive disorders and improve our treatment results.