[Neurotic depression--a disease without a diagnosis or a diagnosis without a glossary? ].
With the transition from ICD-9 to ICD-10 the diagnosis of neurotic depression was omitted. Freyberger showed that this diagnosis in the ICD-10 was replaced mainly by the diagnoses of dysthymia, recurrent depression and depressive episode (with this ranking of frequency). A renowned German psychiatrist criticized this change as replacing an unsubstantiated dichotomic with an unsubstantiated dimensional model. The same was the case with the change from DSM-II to DSM-III: Torgersen criticized here that the heterogeneous diagnosis of neurotic depression was basically replaced by the similarly heterogeneous diagnosis of major depression. The underlying rationale behind the omission of the traditional diagnosis of neurotic depression in the new glossaries must be seen in the critical contributions of such renowned researchers as Winokur, Klerman and Akiskal during the 60's and 70's of the last century. The present work compares these exclusively phenomenological approaches to classification with a psychodynamic approach, and the author defends the possibility of operationalizing such an attempt as validly as a mere descriptive one. This view is supported by the successful work of a group of German scientists in promoting the OPD (operationalized psychodynamic diagnostics) system. Operationalizable elements are not only to be found in the critics' own contributions, but in recent empirical studies on dysthymia and the other subsequent diagnoses as well. An operationalized and verifiable diagnosis of neurotic depression would have to go far beyond the two main criteria of the ICD-9 (psychoreactive genesis, exclusion of psychosis) and include new insights and perspectives; this, however, is considered feasible. It must be recognized that there is no place in the prevailing diagnostic scene for such a diagnostic construct. Perhaps with time diagnostic modes will change, as has often been the case in the past.
Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie der Universität Mainz, Untere Zahlbacher Str. 8, D-55131 Mainz, Germany.
Sven Olaf
SO
Hoffmann
D003866:Depressive Disorder / Q000145:classification / Q000175:diagnosis*; D003865:Major Depressive Disorder / Q000145:classification / Q000175:diagnosis; D003937:Diagnosis, Differential; D039721:Diagnostic and Statistical Manual of Mental Disorders; D019263:Dysthymic Disorder / Q000145:classification / Q000175:diagnosis; D006801:Humans; D038801:International Classification of Diseases; D011574:Psychoanalytic Theory; D012008:Recurrence