title: ICD-10 or DSM-IV? Anhedonia, fatigue and depressed mood as screening symptoms for diagnosing a current depressive episode in physically ill patients in general hospital.
abstract: OBJECTIVE
  To explore the usefulness of "anhedonia", "fatigue" and "depressed mood" as screening symptoms for predicting a depressive episode in physically ill patients.
  
  
  METHODS
  290 patients filled in a modified version of the Patient Questionnaire and were subsequently assessed by psychiatrists with the Composite International Diagnostic Interview (CIDI; ICD-10 version).
  
  
  RESULTS
  63 patients suffered from a current depressive episode according to the CIDI. If at least two of the three symptoms were used for screening positively (ICD-10 algorithm), the sensitivity was 93.2% and the specificity 72.7%, while the simpler algorithm of DSM-IV - requiring depressed mood or anhedonia to be present - yielded a slightly higher sensitivity (95.2%) and a slightly lower specificity (66.5%). One in five patients with a depressive episode did not report "depressed mood".
  
  
  CONCLUSIONS
  It remains unclear how relevant the three core symptoms of depression are for the diagnosis of an ICD-10 depression in people who are not physically ill.
  
  
  CONCLUSIONS
  The fact that both diagnostic algorithms yielded comparable results suggests that the more parsimonious DSM-IV algorithm is preferable and "fatigue" could be left out as a screening symptom. Since "depressed mood" was absent in a substantial proportion of patients, special attention has to be paid to "anhedonia". Medical students and non-psychiatric clinicians should be especially trained to ask for anhedonia, so that cases of depression will not be overlooked.
authors.affiliation: Ludwig Boltzmann Institute for Social Psychiatry, Lazarettgasse, Vienna, Austria. ingrid.sibitz@meduniwien.ac.at
authors.forename: Ingrid
authors.initials: I
authors.lastname: Sibitz
authors.forename: Peter
authors.initials: P
authors.lastname: Berger
authors.forename: Marion
authors.initials: M
authors.lastname: Freidl
authors.forename: Andrea
authors.initials: A
authors.lastname: Topitz
authors.forename: Monika
authors.initials: M
authors.lastname: Krautgartner
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Spiegel
authors.forename: Heinz
authors.initials: H
authors.lastname: Katschnig
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000175:diagnosis / Q000523:psychology; D003866:Depressive Disorder / Q000175:diagnosis* / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005221:Fatigue / Q000523:psychology; D005260:Female; D006769:Hospitals, General; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D038801:International Classification of Diseases; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D055815:Young Adult