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Classification of Depressive Disorders in the DSM-V : Proposal for a Two-Dimension System

Published on Jan 1, 2008in Journal of Abnormal Psychology 5.52
· DOI :10.1037/0021-843X.117.3.552
Daniel N. Klein72
Estimated H-index: 72
(SBU: Stony Brook University)
Cite
Abstract
The number of categories and specifiers for mood disorders has increased with each successive edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM). Many of these categories and specifiers can be viewed as an effort to map the various permutations of severity and chronicity that characterize the depressive disorders. However, this has resulted in a system that (a) is unnecessarily complex and unwieldy, (b) has created problems with artificial distinctions between categories and artifactual comorbidity, and (c) at the same time obscures what may be more fundamental distinctions. A potentially useful and more parsimonious approach to capturing much of the heterogeneity of depressive disorders is to classify the depressive disorders along 2 dimensions, 1 reflecting severity and the other, chronicity. Considerations in the development of these dimensions are discussed, and a set of examples is presented. Although further research and discussion are needed to determine the optimal form of these dimensions, the next edition of the DSM should consider replacing many of the existing categories and specifiers for depressive disorders with the simpler approach of classifying depressive disorders using the 2 dimensions of severity and chronicity.
  • References (87)
  • Citations (69)
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References87
Newest
Published on Nov 13, 2007in Acta Psychiatrica Scandinavica 4.69
G. Garyfallos4
Estimated H-index: 4
(NU: Northwestern University),
A. Adarnopoulou1
Estimated H-index: 1
(NU: Northwestern University)
+ 5 AuthorsA. Paraschos1
Estimated H-index: 1
Objective: The purpose of the present study was to investigate the comorbidity of personality disorders in patients with primary dysthymia compared to those with episodic major depression. Method: A total of 177 out-patients with primary dysthymia and 187 outpatients with episodic major depression were administered a structured diagnostic interview for DSM-III-R Axis II disorders. In addition, all of these patients completed the BDI, and those with the appropriate level of education also complet...
45 Citations Source Cite
Published on Jun 1, 2007in Journal of Affective Disorders 4.08
Francis M. Mondimore21
Estimated H-index: 21
(Johns Hopkins University),
Peter P. Zandi60
Estimated H-index: 60
(Johns Hopkins University)
+ 9 AuthorsDouglas F. Levinson82
Estimated H-index: 82
(Stanford University)
Background The study of chronicity in the course of major depression has been complicated by varying definitions of this illness feature. Because familial clustering is one component of diagnostic validity we compared family clustering of chronicity as defined in the DSM-IV to that of chronicity determined by an assessment of lifetime course of depressive illness.
16 Citations Source Cite
Gavin Andrews88
Estimated H-index: 88
(St. Vincent's Health System),
Traolach Brugha88
Estimated H-index: 88
(University of Leicester)
+ 3 AuthorsTim Slade42
Estimated H-index: 42
(St. Vincent's Health System)
Major depressive episode (MDE) is a chronic disease typifi ed by episodes that remit and recur. It is a major contributor to the burden of disease. The diagnosis of a disorder is an expert opinion that the disorder is present. The nine symptoms of MDE exist on dimensions of greater or lesser intensity, persistence over time, change in usual state, distress and impairment. It is the clinician’s task to judge whether the elicited symptoms warrant the diagnosis. The surprise is that trained clinici...
57 Citations Source Cite
Published on Dec 1, 2006in Journal of Nervous and Mental Disease 1.86
Mark Zimmerman67
Estimated H-index: 67
,
Iwona Chelminski37
Estimated H-index: 37
+ 1 AuthorsDiane Young27
Estimated H-index: 27
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 compo...
47 Citations Source Cite
Published on Nov 1, 2006in Psychiatry Research-neuroimaging 2.21
Jill M. Holm-Denoma11
Estimated H-index: 11
(FSU: Florida State University),
Marcelo T. Berlim30
Estimated H-index: 30
(University of Rio Grande)
+ 1 AuthorsThomas E. Joiner90
Estimated H-index: 90
(FSU: Florida State University)
Abstract This study examines whether distinct symptom profiles, patterns of comorbidity, and suicidal symptoms uniquely characterize individuals diagnosed with double depression (DD) by comparing Brazilians with DD to those with major depressive disorder (MDD). One hundred forty two psychiatric outpatients (ages 20–77 mean = 48.8, S.D. = 13.2; DD, n = 23; MDD, n = 119) participated in structured diagnostic interviews and completed self-report measures of depressive symptoms, suicidality, and fam...
15 Citations Source Cite
Published on Oct 1, 2006in Journal of Nervous and Mental Disease 1.86
Joseph B. McGlinchey20
Estimated H-index: 20
,
Mark Zimmerman67
Estimated H-index: 67
+ 1 AuthorsIwona Chelminski37
Estimated H-index: 37
Abstract:The present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services project examined whether symptoms that are not part of the DSM-IV definition of major depressive disorder (MDD) are better at discriminating depressed from nondepressed patients than the current c
68 Citations Source Cite
Published on Sep 1, 2006in American Journal of Psychiatry 13.65
Patrick J. McGrath36
Estimated H-index: 36
(Columbia University),
Jonathan W. Stewart59
Estimated H-index: 59
+ 6 AuthorsEva Petkova41
Estimated H-index: 41
Objective: Loss of response to a previously effective antidepressant is a common clinical problem. Retrospective analyses have shown that the pattern of response during antidepressant treatment (late onset and persistent versus other patterns) can be used to predict relapse during continuation and maintenance treatment and possibly to identify placebo responses to treatment. This study was designed to test the predictive value of response pattern prospectively and to examine the data for other p...
78 Citations Source Cite
Published on Sep 1, 2006in American Journal of Psychiatry 13.65
Francis M. Mondimore21
Estimated H-index: 21
(Johns Hopkins University),
Peter P. Zandi60
Estimated H-index: 60
+ 10 AuthorsDouglas F. Levinson82
Estimated H-index: 82
Objective: The authors used a large sample collected for genetic studies to determine whether a chronic course of illness defines a familial clinical subtype in major depressive disorder. Method: A measure of lifetime chronicity of depressive symptoms (substantial mood symptoms most or all of the time) was tested for familial aggregation in 638 pedigrees from the Genetics of Recurrent Early-Onset Depression (GenRED) project. Results: In subjects with chronic depression, the mean age at illness o...
41 Citations Source Cite
Published on Jul 1, 2006in Psychological Medicine 5.64
Ari Solomon12
Estimated H-index: 12
(Williams College),
John Ruscio J30
Estimated H-index: 30
(Elizabethtown College)
+ 1 AuthorsPeter M. Lewinsohn94
Estimated H-index: 94
(Oregon Research Institute)
Background. The question of whether unipolar clinical depression differs categorically from limited depressive complaints has important implications for the disorder's assessment, treatment and research. This crucial issue has proven difficult to resolve, in part because many studies to date have relied on self-report measures or on clinically homogeneous samples. We therefore applied Meehl's taxometric method to a large, clinically heterogeneous sample, and examined the latent structure of depr...
33 Citations Source Cite
Published on May 1, 2006in American Journal of Psychiatry 13.65
Daniel N. Klein72
Estimated H-index: 72
,
Stewart A. Shankman24
Estimated H-index: 24
,
Suzanne Rose11
Estimated H-index: 11
Objective: The purpose of this study was to describe the 10-year course and outcome of dysthymic disorder. Method: The authors conducted a naturalistic, prospective, longitudinal follow-up of 97 adults with early-onset dysthymic disorder and 45 adults with nonchronic major depressive disorder selected from consecutive admissions to several outpatient facilities. Follow-up data were obtained for 90% of the cohort. Assessments were conducted at baseline, 30, 60, 90, and 120 months. Measures includ...
122 Citations Source Cite
Cited By69
Newest
Published on Jun 26, 2019in The Canadian Journal of Psychiatry
Daniel N. Klein72
Estimated H-index: 72
(SBU: Stony Brook University)
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Published on Mar 1, 2019in Clinical Psychologist 1.29
Niko Flink1
Estimated H-index: 1
(University of Eastern Finland),
Kirsi Honkalampi34
Estimated H-index: 34
(University of Eastern Finland)
+ 4 AuthorsSari Lindeman3
Estimated H-index: 3
(University of Eastern Finland)
Source Cite
Kalsea J. Koss11
Estimated H-index: 11
(Vandy: Vanderbilt University),
E. Mark Cummings65
Estimated H-index: 65
(ND: University of Notre Dame)
+ 2 AuthorsDante Cicchetti112
Estimated H-index: 112
(UMN: University of Minnesota)
Depressive symptoms are prevalent and rise during adolescence. The present study is a prospective investigation of environmental and genetic factors that contribute to the growth in depressive symptoms and the frequency of heightened symptoms during adolescence. Participants included 206 mother–father–adolescent triads (M age at Time 1 = 13.06 years, SD = .51, 52% female). Harsh parenting was observationally assessed during a family conflict paradigm. DNA was extracted from saliva samples and ge...
1 Citations Source Cite
Published on Jun 1, 2017in Psychiatry Research-neuroimaging 2.21
Aline Richard8
Estimated H-index: 8
(UZH: University of Zurich),
Sabine Rohrmann55
Estimated H-index: 55
(UZH: University of Zurich)
+ 7 AuthorsMartin Preisig47
Estimated H-index: 47
(UNIL: University of Lausanne)
Abstract Little is known about adherence to dietary recommendations and depression. Furthermore, dietary habits may differ among depression subtypes, which has not been evaluated previously. Two population-based Swiss studies, including 3620 individuals from PsyCoLaus and 11,032 individuals from the Swiss Health Survey 2012 (SHS), were used to examine the associations between adherence to common dietary guidelines and odds of depressive disorders. In both studies, depression was assessed by vali...
1 Citations Source Cite
Published on Mar 18, 2017
James P. McCullough26
Estimated H-index: 26
,
Sarah W. Clark1
Estimated H-index: 1
Source Cite
Published on Jan 1, 2017in Clinical psychological science
Scott O. Lilienfeld62
Estimated H-index: 62
(Emory University)
30 Citations Source Cite
Published on Jan 1, 2017in Clinical psychological science
Anna Weinberg26
Estimated H-index: 26
(McGill University),
Stewart A. Shankman24
Estimated H-index: 24
(UIC: University of Illinois at Chicago)
Blunted reward response appears to be a trait-like marker of vulnerability for major depressive disorder (MDD). As such, it should be present in remitted individuals; however, depression is a heterogeneous syndrome. Reward-related impairments may be more pronounced in individuals with melancholic depression. The present study examined neural responses to rewards in remitted melancholic depression (rMD; n = 29), remitted nonmelancholic depression (rNMD; n = 56), and healthy controls (HC; n = 81)....
8 Citations Source Cite
Published on Dec 1, 2016in BMC Genomics 3.50
Yashu Liu2
Estimated H-index: 2
(ASU: Arizona State University),
Lynn Yieh9
Estimated H-index: 9
(Janssen Pharmaceutica)
+ 6 AuthorsJieping Ye8
Estimated H-index: 8
(ASU: Arizona State University)
Background Major depressive disorder (MDD) is a heterogeneous disease at the level of clinical symptoms, and this heterogeneity is likely reflected at the level of biology. Two clinical subtypes within MDD that have garnered interest are “melancholic depression” and “anxious depression”. Metabolomics enables us to characterize hundreds of small molecules that comprise the metabolome, and recent work suggests the blood metabolome may be able to inform treatment decisions for MDD, however work is ...
10 Citations Source Cite
Published on Jun 1, 2016in Journal of Clinical Psychology 2.06
Annette van Randenborgh5
Estimated H-index: 5
,
Markus Pawelzik3
Estimated H-index: 3
+ 1 AuthorsJulius Kuhl43
Estimated H-index: 43
(University of Osnabrück)
Objective Implicit self-esteem, which is based on associative learning processes, is considered to be constituted earlier in life than explicit, verbalized self-esteem. While depressed individuals report negative explicit self-esteem, research has predominantly demonstrated equivalent levels of implicit self-esteem of depressed and healthy individuals. We further illuminate this finding by theorizing and empirically demonstrating that chronically depressed individuals show particularly low level...
3 Citations Source Cite
Published on Apr 1, 2016in Psychological Medicine 5.64
Richard T. Liu19
Estimated H-index: 19
(Brown University)
A basic phenomenological question of much theoretical and empirical interest is whether the latent structure of depression is dimensional or categorical in nature. Prior taxometric studies of youth depression have yielded mixed findings. In a step towards resolving these contradictory findings, the current taxometric investigation is the first to utilize a recently developed objective index, the comparison curve fit index, to evaluate the latent structure of major depression in an epidemiologica...
7 Citations Source Cite