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Psycology » Psychiatry and psychotherapy » Affective disorders » Classification of depressive disorders on the basis of the disease and the time of occurrence

Monopolar and bipolar disorder

When Kraepelin concluded that mania and depression should be treated as a single clinical entity, the reason for this was the course of the disease: to find that it is essentially the same when the manic and depressive disorders, he introduced them to both a single category of manic-depressive psychosis. This view was widespread until 1962, when Leonhard et al. suggested to distinguish three groups, including the first of these patients suffering from a depressive disorder only (Unipolar depression), In vtoruyustradayuschih only mania (Unipolar mania) In the third of those who are present and depressive disorder and mania (Bipolar disorder). In Nowadays, the term unipolar mania practically do not use, all cases relating to bipolar mania with a group, as almost every patient with mania sooner or later transfers and depression. In support of the idea on the delimitation of monopolar and bipolar disorders Leonhard described differences in heredity and personality traits between patients belonging to these groups. Now, however, widely recognized that the two groups do not differ by no symptoms observed in depressed state, either in response to treatment (except perhaps is lithium therapy, see p. 187). Obviously, the system is considered to some extent the group should overlap, as in humans, related to the category of patients unipolar depression may develop in the future and manic depression. In other words, the monopolar group inevitably contains a fraction of bipolar cases that have not yet appeared. Despite this shortcoming, a division of cases by monopolar and bipolar probably should recognize the most appropriate approach of all proposed before, because such a classification has a specific meaning for the choice of treatment (see p. 194).

Seasonal affective disorder

In some patients, depressive disorder is regularly repeated in the same season. Often this reflects the excessive increase in the frequency of stress on the person at a certain time of year that can be associated with specific operation or with any other aspects of his life. In many cases, however, this is no reason, it is assumed (see, eg, Rosenthal et al. 1984), that they are somehow related to seasonal changes, for example, the duration of daylight. Although such seasonal affective disorder mainly characterized by the time of their occurrence, claim that some of the symptoms when they occur more frequently than in other affective disorders. This hypersomnia and increased appetite, and the patient feels an urgent need for carbohydrates. Typically, the disorder begins in the fall or winter, and recovery occurs in the spring or summer. This model gave reason to believe that an important role here plays decrease in light, attempts were made to use for medicinal purposes irradiation bright artificial light at the end of the daylight hours. As reported, after three or four days of this treatment the patient's condition improves, symptoms alleviated, although after cessation of treatment they usually soon resumed (Rosenthal et al. 1984). Positive result, apparently, provided additional lighting rather than the accompanying decrease in the duration of sleep (sleep deprivation may alleviate depressive symptoms in some patients; see p. 189). These changes could be due to the placebo effect, but in this case it is unlikely since found that bright light is more intense than the dim lighting (Kripke et al. 1983; Rosenthal et al. 1984,1985). However, also reported that the additional lighting in the daytime is not less effective than in the dark (Wehr et al. 1986). This information casts doubt on the correctness of that considered disorders caused reduction of daylight and that its extension by the patient's condition can be corrected by neutralizing the influence of this factor. Is not supported by convincing evidence and the assumption that the observed improvement is due to the known effect of suppressing light melatonin secretion at night.

Involutional depression

In the past depressive disorders that begin in middle age, were considered independent group, characterized by agitation, and hypochondriacal symptoms. It was assumed that they have a specific etiology (e.g., due to involution gonads) or in some way associated with schizophrenia. The data obtained in the study of familial risk, do not support the idea of ​​a separate group. Relatives of patients with so-called involutional depression have an increased frequency of affective disorders, but not revealed much to increase the frequency of involutional disorders (not rarer disorder and early-onset) is not also found increased incidence of schizophrenia (see: Slater, Cowie 1971 p.86; Stenstedt 1952).

Senile depression

First cases of depression that occurs in the elderly, is also considered as an independent group. However, it appeared that the use of classification by age of onset of the disease can not be justified either in clinical practice or in research.


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