Parker Gordon, Snowdon John, Parker Kay
School of Psychiatry, University of New South Wales, and Mood Disorders Unit, Black Dog Institute, Prince of Wales Hospital, NSW 2031, Sydney, Australia.
Int J Geriatr Psychiatry. 2003 Dec;18(12):1102-9. doi: 10.1002/gps.1020.
To determine if we could find support for a three-class depression sub-typing model (and identify differentiating constituent clinical features) in a sample of elderly depressed patients.
Depression is currently modelled dimensionally, with little concession to descriptive psychopathology and distinction of meaningful clinical depressive sub-types. We have proposed a three-class hierarchical specificity model for sub-typing the depressive disorders (comprising psychotic, melancholic and non-melancholic depression), with specificity referring to two clinical features (psychotic symptoms and psychomotor disturbance or PMD) separating the first two classes from a residual non-melancholic class.
Subjects were aged 65 years or more, non-demented and being treated for depression. Extensive clinical assessment was undertaken, while several standardised measures were administered. 'Bottom up' analyses were data driven, while 'top down' analyses respected DSM-III-R decision rules. Dimensional and categorical multivariate analyses sought to identify features differentiating psychotic depression (PD), melancholic depression (MEL) and a residual non-melancholic (NON-MEL) class.
Of the 123 referred patients (having a mean age of 75.6 years), 46 had DSM-defined PD, 46 had MEL and 31 were assigned as NON-MEL. Mean total CORE scores (measuring PMD) more clearly distinguished the groups than scores on two depression severity measures. Psychotic depression was best distinguished from melancholic depression by psychotic features, as well as more severe PMD and anhedonia. Melancholic depression was best distinguished from non-melancholic depression by PMD, terminal insomnia and pathological guilt.
The specificity of PMD to the definition of the psychotic and melancholic depression was confirmed in our elderly depressed sample. Clinical features identified as distinguishing psychotic, melancholic and non-melancholic depression were broadly consistent with findings from our previous studies involving younger subjects and with our three-class hierarchical model.
确定在老年抑郁症患者样本中能否找到对三类抑郁症亚型模型的支持（并识别出有区别的构成性临床特征）。
目前抑郁症是以维度方式建模的，对描述性精神病理学以及有意义的临床抑郁症亚型区分考虑甚少。我们提出了一个用于对抑郁症进行亚型分类的三级层次特异性模型（包括精神病性、 melancholic和非melancholic抑郁症），特异性指的是将前两类与剩余的非melancholic类区分开的两个临床特征（精神病性症状和精神运动性障碍或PMD）。
研究对象年龄在65岁及以上，无痴呆且正在接受抑郁症治疗。进行了广泛的临床评估，并实施了多项标准化测量。“自下而上”的分析以数据为驱动，而“自上而下”的分析遵循DSM-III-R的决策规则。维度和分类多变量分析旨在识别区分精神病性抑郁症（PD）、melancholic抑郁症（MEL）和剩余的非melancholic（NON-MEL）类别的特征。
在123名转诊患者（平均年龄75.6岁）中，46人患有DSM定义的PD，46人患有MEL，31人被归类为NON-MEL。平均CORE总分（测量PMD）比两项抑郁症严重程度测量的得分更能清晰地区分这些组。精神病性抑郁症与melancholic抑郁症的最佳区分在于精神病性特征，以及更严重的PMD和快感缺失。Melancholic抑郁症与非melancholic抑郁症的最佳区分在于PMD、终末期失眠和病理性内疚。
在我们的老年抑郁症样本中，PMD对精神病性和melancholic抑郁症定义的特异性得到了证实。被确定为区分精神病性、melancholic和非melancholic抑郁症的临床特征与我们之前涉及年轻受试者的研究结果以及我们的三级层次模型大致一致。
