Diagnosing major depressive disorder X: can the utility of the DSM-IV symptom criteria be improved?
There are two practical problems with the DSM-IV symptom criteria for major depressive disorder (MDD)--they are somewhat lengthy and therefore difficult to remember, and there are difficulties in applying some of the criteria in patients with comorbid medical illnesses because of symptom nonspecificity. Therefore, in the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services project, we attempted to develop a briefer definition of major depression that is composed entirely of mood and cognitive symptoms. Our goal was to develop an alternative set of diagnostic criteria for major depression that did not include somatic symptoms but would nonetheless demonstrate a high level of concordance with the current DSM-IV definition. We examined several alternative definitions of MDD. After eliminating the somatic criteria from the DSM-IV MDD criteria and adding the symptom "reduced drive," there was a very high level of concordance with DSM-IV classification (95%). This new definition thus offers two advantages over the current DSM-IV definition--it is briefer and it is free of somatic symptoms, thereby making it easier to apply with medically ill patients. We discuss using improvement in the clinical utility, rather than validity of diagnostic criteria, as the basis for making revisions in the nomenclature.
Zimmerman
Mark
M
Department of Psychiatry and Human Behavior, Brown University School of Medicine, Rhode Island Hospital, Providence, Rhode Island, USA. mzimmerman@lifespan.org
Chelminski
Iwona
I
McGlinchey
Joseph B
JB
Young
Diane
D
D000553:Ambulatory Care; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000145:classification / Q000175:diagnosis* / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004328:Drive; D005260:Female; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data*; D011594:Psychometrics; D012044:Regression Analysis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D009626:Terminology as Topic