Differentiation of primary affective illness from situational, symptomatic and secondary depression

Archives of General Psychiatry (Impact Factor: 14.48). 07/1979; 36(6):635-43.
Source: PubMed


Analysis of family history and antidepressant drug response variables of 100 "neurotic" depressives followed up prospectively over three to four years disclosed that primary depressions (unipolar and bipolar) could be distinguished from nonprimary cases by (1) the early occurrence of "pharmacological-hypomania;" (2) family history of bipolar illness; (3) family history for affective disorder in two or three consecutive generations, especially when "loaded." Although each of these variables alone occurred in only one fifth to one third of the primary group, they individually displayed better than 95% specificity for it. Thus, the confidence with which the diagnosis of primary affective illness could be made in the presence of any of these variables ranged from 88% to 100%. These findings argue for considering such nonsymptomatological variables for their potential in strengthening the phenomenologic diagnostic criteria for depressive illness.

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    • "The General Behavior Inventory (GBI; Depue, 1987) was developed with the purpose of identifying bipolar and unipolar mood disorders across the full spectrum of severity, including full-blown major depression and bipolar disorder as well as their minor variants such as minor depression and cyclothymia. The GBI can thus be used in community samples of adolescents and young adults for the early identification of individuals who are at increased risk for developing major depressive disorder or bipolar disorder (Akiskal et al., 1979). "
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    ABSTRACT: To assess the usefulness of the General Behavior Inventory (GBI) to predict the development of mood disorders in the offspring of parents with bipolar disorder. The GBI and the K-SADS (first measurement) and the SCID (last measurement) were used to assess psychopathology among 129 adolescent and young adult offspring of a bipolar parent with an interval of 5 years. Based on the SCID results at the last measurement, the offspring were assigned to one of four groups: with bipolar mood disorder, with unipolar mood disorders, with non-mood disorders and without disorders and GBI-scores at the first measurement were compared across the four groups. The scores on the Depression scale of the GBI for the offspring who later developed a bipolar or any mood disorder were significantly higher than for the offspring who did not develop a mood disorder across a 5-year interval. For the offspring with a unipolar mood disorder at the first measurement, the scores on the Depression scale were significantly higher for those who switched to bipolar disorder versus those who remained unipolar. The GBI can be used in a high-risk sample of offspring of parents with bipolar disorder as a self-report measure as an aid to detect those who will develop bipolar disorder across a 5-year interval.
    Journal of Affective Disorders 01/2006; 89(1-3):147-55. DOI:10.1016/j.jad.2005.09.007 · 3.38 Impact Factor
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    ABSTRACT: Retrospective comparisons between primary unipolar depression and depression secondary to anxiety in 65 inpatients revealed a number of differences. Secondary depression was associated with a significantly higher incidence of neurotic traits in childhood, chronic unhappiness, and unsupportive family. Tricyclic antidepressants and ECT were both more effective in primary depression, and some secondary depressives became worse on ECt. When primary depression was sub-divided into familial, nonfamilial and spectrum types, the greatest differences were noted between familial and secondary depressions. In the former group a more stable life style was noted. Secondary and spectrum types differed on only two variables and several similarities were noted. Platelet monoamine oxidase activity was significantly higher in secondary depression.
    Acta Psychiatrica Scandinavica 06/1980; 61(5):377-86. DOI:10.1111/j.1600-0447.1980.tb00876.x · 5.61 Impact Factor
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    ABSTRACT: Eighty-nine depressed outpatients were studied by clinical criteria, Research Diagnostic Criteria (RDC), and the dexamethasone suppression test (DST) of neuroendocrine regulation. A simple outpatient version of the DST, requiring only one blood sample, correctly identified 40% of patients diagnosed clinically as endogenous depression (ED), with a specificity of 98% and a diagnostic confidence of 95%. Differences in age, sex, or severity of symptoms between endogenous and non-endogenous depressives did not account for these results. By comparison, the diagnostic performance of the DST was weaker for the RDC categories Major Depressive Disorder (MDD) and primary MDD. These were less selective and more heterogenous than the clinical category ED. The clinical diagnoses of ED were supported in 98% of cases by the RDC, but 22% of RDC endogenous MDD diagnoses were not supported by the clinical diagnoses. Abnormal DST results were found only in patients with both the clinical diagnosis of ED and the RDC diagnosis of endogenous MDD. Patients with definite endogenous MDD had a significantly higher frequency of abnormal DST results (42%) than those with probable endogenous MDD (14%), or those with other RDC diagnoses (3%). A significant association was found between positive DST results and a positive family history of depression. These results support other evidence for use of a positive DST result as an external validating criterion for ED. The category MDD contained all cases diagnosed clinically as ED, but was diluted by cases diagnosed clinically as non-endogenous depression who had no neuroendocrine disturbance. The results also confirmed that the endogenous/nonendogenous and primary/secondary classifications of depression are not identical.We conclude: (1) that the DST can be used in the differential diagnosis of depressed outpatients as well as inpatients; (2) that the RDC category primary MDD and the Washington University category primary depression are more heterogenous and probably less valid than the clinical category ED; (3) that the RDC for endogenous MDD have only moderate validity; (4) that RDC diagnoses cannot substitute for careful clinical diagnoses in research studies, (5) that the best use of the RDC is to support clinical diagnoses, but not to generate diagnoses independently as a free-standing system; (6) that the concept of endogenous or endogenomorphic depression has validity and should be retained in research studies of depression.
    Journal of Affective Disorders 10/1980; 2(3-2):177-194. DOI:10.1016/0165-0327(80)90004-X · 3.38 Impact Factor
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