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.
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.
Sibitz
Ingrid
I
Ludwig Boltzmann Institute for Social Psychiatry, Lazarettgasse, Vienna, Austria. ingrid.sibitz@meduniwien.ac.at
Berger
Peter
P
Freidl
Marion
M
Topitz
Andrea
A
Krautgartner
Monika
M
Spiegel
Wolfgang
W
Katschnig
Heinz
H
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