Atypical Depression: Useful Concept, but it's Time to Revise the DSM-IV Criteria
Atypical Depression: Useful Concept, but it's Time to Revise the DSM-IV Criteria
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DOI：
10.1038/npp.2009.100
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发表时间：
2009-12-01
影响因子：
7.6
通讯作者：
Thase, Michael E.
中科院分区：
文献类型：
--
作者：
Thase, Michael E.
Stewart 等人 (2009) 概述了支持 DSM-IV 中“具有非典型特征”情节说明符定义有效性的证据。尽管认识到非典型抑郁症概念的历史意义和临床实用性，但本文对 DSM-IV 标准提出了质疑。结论是，情绪反应性（A 或强制性标准）既与其他症状标准没有显着相关性，也无法用于诊断非典型抑郁症，因此应该被消除。诊断标准评级的操作性、规范性和可靠性方面的问题进一步限制了有效性。尽管分类存在这些局限性，但与非典型抑郁症相关的许多特征都与情感疾病的早期发作有关，包括特质样的人际敏感性、共病社交焦虑和广场恐惧症、童年身体或性创伤史，以及双相情感障碍“软”一面的指标。神经生理学研究还表明，慢性、早发的非典型抑郁症不同于忧郁症和正常抑郁症。对哥伦比亚小组开创性研究的重新分析表明，与苯乙肼相比，丙咪嗪（可以说是非典型抑郁症的最强验证剂）的优先反应似乎仅限于患有慢性早发综合征的患者。 DSM-V 中的非典型抑郁症标准需要修订，包括明确特定症状的操作定义。发病年龄和共病焦虑的重要性值得进一步研究。研究检验以类特质人际关系敏感性和慢性早发病程为特征的非典型抑郁症亚型的有效性，可能会进一步增强 DSM-V 分类的临床实用性。神经精神药理学 (2009) 34, 2633-2641; doi：10.1038/npp.2009.100； 2009 年 9 月 9 日在线发布
Stewart et al (2009) have outlined the evidence in support of the validity of the DSM-IV definition of the 'With Atypical Features' episode specifier. Although recognizing the historical significance and clinical utility of the concept of atypical depression, this article takes issue with the DSM-IV criteria. It is concluded that mood reactivity, the A or obligative criterion, is neither significantly associated with the other symptomatic criteria nor useful to diagnose atypical depression, and thus should be eliminated. Problems with operationalization, specification, and reliability of ratings of the diagnostic criteria further limit validity. Despite these limitations in classification, many of the features associated with atypical depression are linked to an early onset of affective illness, including trait-like interpersonal sensitivity, comorbid social anxiety and agoraphobia, a history of childhood physical or sexual trauma, and indicators of the 'soft' side of the bipolar spectrum. Neurophysiologic studies also suggest that chronic, early-onset atypical depressions differ from both melancholia and normality. Re-analyses of the Columbia group's seminal studies suggest that preferential response to phenelzine vs imipramine-arguably the strongest validator of atypical depression-similarly appears to be limited to patients with chronic, early-onset syndromes. The criteria for atypical depression need to be revised in DSM-V, including sharpening the operational definitions for the specific symptoms. The importance of age of onset and comorbid anxiety warrant further study. Research examining the validity of a subform of atypical depression characterized by trait-like interpersonal sensitivity and a chronic, early-onset course may further enhance the clinical utility of the DSM-V classification. Neuropsychopharmacology (2009) 34, 2633-2641; doi:10.1038/npp.2009.100; published online 9 September 2009