Classification and diagnosis of depression

Depression assessment and management: evaluating a community-based mental health training program for nurses

This mental health training program was designed to increase primary care nurses' knowledge and skills about depression. The program emphasized criteria for assessing depression, presented psychopharmacologic and psychotherapeutic content, discussed care coordination among several agencies and providers, and addressed referral resources. Cultural and developmental issues were highlighted. The 237 participants had significant knowledge gains after the program on comparison of pretest and posttest measures. Client record audit found significant increases in the assessment of and intervention with depression. The training program successfully increased primary care nurses' abilities to use knowledge about depression in clinical practice.

Assessment and management of depression: an imperative for community-based practice

The purpose of this mental health training program was to increase primary care nurses' knowledge and skills about depression. The program emphasized criteria for assessing depression, presented psychopharmacological and psychotherapeutic content, discussed care coordination among multiple agencies and providers, and addressed referral resources. Highlighted were cultural and developmental issues for Native Americans, Mexican-Americans, the elderly, and adolescents. The training program successfully increased primary care nurses' knowledge about depression and their abilities to use this knowledge in clinical practice.

A comparison of DSM-III and ICD-8 diagnoses for major affective disorders and the use of biological markers for depression

The aims of the present study were to investigate the value of adding DSM-III diagnosis and Newcastle Scale Rating to the ICD-8 diagnosis currently used and to investigate the association between Dexamethasone Suppression Test (DST) and the Thyrotropine Releasing Hormone- Thyroid Stimulating Hormone (TRH-TSH) test and the three classification systems for depression. Twenty-six depressed in-patients were included, 17 women and 9 men, with a mean age of 51.5 years. Fourteen patients were psychotic depressed. DST and Newcastle Scale Rating were performed on 18 patients and TRH-TSH test was performed on 16 patients. The addition of DSM-III diagnosis on the 4-digit level did not have any value compared to the ICD-8 diagnosis. However, DSM-III diagnosis on the 5-digit level added important clinical information which corresponded better to Newcastle Scale scores and DST and TRH-TSH test results than ICD-8 diagnosis. The main advantage of the DSM-III classification of depression on the 5-digit level compared to ICD-8 concerns depression on the border between psychosis and neurosis. In clinical practice there is a risk of underestimating the severity of a depression if ICD-8/9 is used as the only criterion for severity. This may have tragic consequences for the patient. This study suggests that rating of the depression on the Newcastle Scale or provision of a DSM-III diagnosis on the 5-digit level are valuable assessment procedures of severity.

Teaching DSM-III to clinicians. Some problems of the DSM-III system reducing reliability, using the diagnosis and classification of depressive disorders as an example

Experiences from teaching DSM-III to more than three hundred Norwegian psychiatrists and clinical psychologists suggest that reliable DSM-III diagnoses can be achieved within a few hours training with reference to the decision trees and the diagnostic criteria only. The diagnoses provided are more reliable than the corresponding ICD diagnoses which the participants were more familiar with. The three main sources of reduced reliability of the DSM-III diagnoses are related to: poor knowledge of the criteria which often is connected with failure of obtaining diagnostic key information during the clinical interview; unfamiliar concepts and vague or ambiguous criteria. The two first issues are related to the quality of the teaching of DSM-III. The third source of reduced reliability reflects unsolved validity issues. By using the classification of five affective case stories as examples, these sources of diagnostic pitfalls, reducing reliability and ways to overcome these problems when teaching the DSM-III system, are discussed. It is concluded that the DSM-III system of classification is easy to teach and that the system is superior to other classification systems available from a reliability point of view. The current version of the DSM-III system, however, partly owes a high degree of reliability to broad and heterogeneous diagnostic categories like the concept major depression, which may have questionable validity. Thus, the future revisions of the DSM-III system should, above all, address the issue of validity.

DSM-III and Norway. History, attitudes and future

The first Norwegian evaluation of the DSM-III system of classification occurred in 1980. A Norwegian translation of the diagnostic criteria was published as part of a textbook in psychiatry in 1984. The Mini DSM-III (Quick reference) was published in 1985. The DSM-III system has been generally well accepted in Norway and is currently used in most research projects besides the ICD system. Several training courses have been arranged for senior psychiatrists and psychologists. Introduction to the DSM-III system is also part of the obligatory training course for psychiatric residents in Norway. From 1987 Norway will use a clinical modification of the ICD-9 system of classification. This modification applies 5 digit coding and includes diagnostic categories found in the DSM-III system but not in the 4 digit ICD-9 version. The DSM-III system of classification represents a major step forward in psychiatric classification. However, revisions are necessary to increase clinical validity. Although Norwegian psychiatry has been inspired by the DSM-III system, Norway remains committed to the ICD systems. The goal must be to make further revisions of the DSM-III and ICD systems, and in the end unite the strengths of these two systems of psychiatric classification.

Depression research: a review with special emphasis etiology

In this review of depression research the author has focused the attention on twin and adoption studies, although problems of classification, epidemiology, and biological and environmental factors related to depression are also touched upon. It is being noted that the available studies in the area are few, the number of twins in the various samples is small and the diagnostic classifications vary. Of particular interest are the results presented by Bertelsen et al. because of the large systematic sample. A summary of the studies that are based upon sampling through twin registers, i.e. the Scandinavian investigations, employing a relatively strict concept of manic depressive psychosis (bipolar disorder), gives a mean concordance of 50% in MZ twins and 15% in DZ twins. Whereas genetical factors seem to play a significant role in the etiology of severely depressed subjects, there is no evidence that hereditary factors are of importance in the neurotic or reactive depressions, since concordance is low in both MZ and DZ. The available adoption studies are also few and replications are definitely necessary before one can arrive at firm conclusions. Mendlewicz & Rainer reported more psychopathology of an affective nature in the biological parents of the adoptees with bipolar illness than in the social parents. In contrast, von Knorring et al. did not observe an increase in affective psychopathology in the biological parents of adoptees with affective disorder. Noteworthy is the excess of affective psychoses in the social parents. The author holds the view that any speculation with regard to genetic transmission is premature. Although the findings from the various investigations are not unambiguous, twin and adoption studies support the notion that genetic factors play a considerable role in bipolar disorder, whereas non-bipolar depression is basically environmentally determined.