Classification And Unipolar Depression

The idea of unipolar depression is primarily a medical one; that is, it involves a particular way of looking at psychological disturbance. This centres on the notion of a syndrome that is distinct from other psychiatric syndromes. Some of these can be relatively easily distinguished—for example, paranoid schizophrenia—while others are acknowledged to be related. The disorders that most resemble unipolar depression are other affective disorders, that is, conditions that are characterized centrally by mood disturbance. They cover a number of anxiety disorders, other depressive conditions, and bipolar mood disorder.

Bipolar disorder is identified by the presence of two sorts of episode in which the associated mood is either depressed or predominantly elated. It is distinct from unipolar disorder in a variety of ways (such as inheritance, course, and outcome), and the distinction is therefore almost certainly a useful one. However, depressive episodes in bipolar disorder cannot be distinguished symptomatically from those of unipolar depression. As perhaps half of all cases of bipolar disorder commence with a depressive episode, this means that unipolar depression is a tentative category—the disorder will be reclassified as bipolar in 5% of cases (Ramana & Bebbington, 1995).

Mood Disorders: A Handbook of Science and Practice. Edited by M. Power. © 2004 John Wiley & Sons, Ltd. ISBN 0-470-84390-X.

Psychiatric disorders are classified in the hope that the classification can provide mutually exclusive categories to which cases can be allocated unambiguously (case identification). Categories of this type are the basis of the medical discipline of epidemiology, which is the study of the distribution of diseases (that is, medical classes) in the population. This has been a very powerful method for identifying candidate causal factors, and is thus of great interest to psychiatrists as well as to clinicians from other specialities.

Syndromes are the starting point of aetiological theories, and of other sorts of theory as well—theories of course and outcome, of treatment, and of pathology (Wing, 1978). There is no doubt that the medical approach to malfunction has been a very effective one, generating new knowledge quickly and efficiently by testing out theories of this type (Bebbington, 1998).

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