title: Can we clinically recognize a vascular depression? The role of personality in an expanded threshold model.
abstract: The vascular depression (VD) hypothesis postulates that cerebrovascular disease may "predispose, precipitate, or perpetuate" a depressive syndrome in elderly patients. Clinical presentation of VD has been shown to differ to major depression in quantitative disability; however, as little research has been made toward qualitative phenomenological differences in the personality aspects of the symptom profile, clinical diagnosis remains a challenge.We attempted to identify differences in clinical presentation between depression patients (n = 50) with (n = 25) and without (n = 25) vascular disease using questionnaires to assess depression, affect regulation, object relations, aggressiveness, alexithymia, personality functioning, personality traits, and counter transference.We were able to show that patients with vascular dysfunction and depression exhibit significantly higher aggressive and auto-aggressive tendencies due to a lower tolerance threshold. These data indicate that VD is a separate clinical entity and secondly that the role of personality itself may be a component of the disease process. We propose an expanded threshold disease model incorporating personality functioning and mood changes. Such findings might also aid the development of a screening program, by serving as differential criteria, ameliorating the diagnostic procedure.
authors.affiliation: From the Department for Psychoanalysis and Psychotherapy (BRT, MM, HLS); Department for Angiology (MEG) Medical University Vienna, Austria.
authors.forename: Bela R
authors.initials: BR
authors.lastname: Turk
authors.forename: Michael E
authors.initials: ME
authors.lastname: Gschwandtner
authors.forename: Michaela
authors.initials: M
authors.lastname: Mauerhofer
authors.forename: Henriette
authors.initials: H
authors.lastname: Löffler-Stastka
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002561:Cerebrovascular Disorders / Q000150:complications* / Q000523:psychology; D003866:Depressive Disorder / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010551:Personality; D011569:Psychiatric Status Rating Scales; D011581:Psychological Tests; D057566:Self Report; D011795:Surveys and Questionnaires