Unipolar depression: diagnostic inconsistency and its implications.
Major depressive disorder using Feighner et al. (Arch. Gen. Psychiatry 26, 57-63, 1972) and DSM-III or DSM-III-R criteria has proven to be a heterogeneous diagnosis. It apparently includes a wide variety of clinical conditions. This report, based upon the results of a multi-year blind follow-up of 500 randomly selected psychiatric outpatients focuses on certain problems associated with the diagnosis of primary unipolar affective disorders. At index, 141 patients received diagnoses of primary unipolar depression. At follow-up, only 62 (44%) of these received the same diagnosis, with an additional 14 (10%) receiving a diagnosis of undiagnosed: questionable primary unipolar depression, and 5 (4%) a diagnosis of bipolar disorder. Thus, about 43% received other diagnoses at follow-up: 35 (25%) diagnoses of secondary depression and 25 (18%) other diagnoses without indication of an affective component. Bipolar patients' stability was significantly better for those who were manic at intake.
Clayton
P J
PJ
Department of Psychiatry, University of Minnesota, Minneapolis 55455.
Guze
S B
SB
Cloninger
C R
CR
Martin
R L
RL
D000328:Adult; D000553:Ambulatory Care; D003866:Depressive Disorder / Q000145:classification / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D006778:Hospitals, Psychiatric; D006801:Humans; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000145:classification / Q000175:diagnosis*; D011569:Psychiatric Status Rating Scales