The depressive spectrum: diagnostic classification and course
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Discussion of “The Depressive Spectrum: Diagnostic Classification and Course” Discussion led by George Winokur, M.D. from the University of Iowa
It is very clear that an increasing number of diagnostic categories are emerging in the field of mood disorders which underscores the poor longitudinal stability of these diagnostic categories or subtypes. In defining subtypes or categories, it is important to specify severity, relationship to other subtypes and threshold for diagnosis. In regard to recurrent brief depression, it is possible that duration of a syndrome may be less important than its recurrence which may be linked to a genetic vulnerability. We have been impressed with the emerging concensus about the fluidity of depressive symptoms within a variety of diagnostic categories and the associated impairment with current subthreshold depressive disorders.
General discussion
A group discussion then ensued about the number of depressive symptoms used to define different diagnostic categories within the mood disorders group. It was argued that investigation of the distribution of depressive mood disorder categories. However, extending the discussion, Dr. Winokur indicated that the number of symptoms may only be one aspect in definition of mood disorders and argued for the inclusion of other information such a family history which may aid in clarifying the heterogeneity of mood disorders.
Dr. Winokur also raised the issue that the range of symptoms, not currently associated with mood disorders, be considered in order to increase the information characterizing these disorders. For example, could there be a split similar to the one suggested for schizophrenia into positive or negative symptoms, that could be applied to mood disorders. Lastly, in addition to the natural history of the disorder, should the treatment history of the disorder be included in diagnostic considerations?
Dr. Angst ended the discussion period by describing some of his findings regarding the course of MDD from the Zurich sample. The different course patterns he has identified are as follows: single episode 15%, 4% chronic, 19% recurrent, 13% decaying recurrent, 4% recurrent with residual, 3% increasing residual and recurrent, and 42% with other patterns. Dr. Angst also indicated that these course descriptors should be considered in light of the different demographic and epidemiological characteristics of the sample at baseline.