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Objective:To know the clinical characteristics, seasonal pattern and influencing factors of atypical depression(AD) patients.Methods:A total of 203 depressed outpatients of Peking University Sixth Hospital from January 2021 to August 2021 were included.They were assessed with demographic questionnaire, inventory of depressive symptomatology self-report(IDS-SR30) and seasonal pattern assessment questionnaire(SPAQ). According the score of IDS-SR30, all patients were classified as atypical depression(AD) and non-atypical depression(non-AD). The data were analyzed by t-test, non-parametric test and Logistic regression using SPSS 26.0 software. Results:The prevalence of AD among depressed patients was 36.0% (95% CI=29.3%-42.6%). The IDS-30 score of the AD group was (41.59±10.59), and IDS-30 score of the non-AD group was (36.08±13.17), and the difference between the two groups was statistically significant ( t=3.062, P<0.05). The global seasonal score of the AD group was 6 (3, 9), and 17.8% of the AD group had seasonal pattren.The global seasonal score of the non-AD group was 5 (3, 8), and 14.6% of the non-AD group had seasonal pattern.There was no significant difference in the global seasonal score and the proportion of seasonal pattern between the two groups ( Z=0.389, χ2=0.359, P>0.05). Depression patients who were females ( β=1.08, OR=2.95, 95% CI=1.32-6.59, P<0.05), low self-evaluation ( β=0.82, OR=2.27, 95% CI=1.12-4.59, P<0.05)and psychomotor retardation ( β=0.93, OR=2.54, 95% CI=1.33-4.85, P<0.05) were more likely to be diagnosed as AD, and depression patients having mood variation ( β=-0.94, OR=0.39, 95% CI=0.19-0.81, P<0.05) were more likely to be diagnosed as non-AD. Conclusion:Women, low self-evaluation, psychomotor retardation and unobvious mood variation can predict and help to diagnose atypical depression in depressed patients.
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Objective to evaluate the validation of atypical depression among Chinese outpatients with depressive episodes and explore the role of atypical depressive symptoms in distinguishing bipolar depression from unipolar depression.Methods Structural clinical interviews with self-compiled questionnaires were performed on 276 outpatients with current depressive episode,then comparison of clinical characteristics including age of onset,gender proportion,seasonality,comorbidity of anxiety disorder,bipolar property,psychotic features,number of depressive episodes,and maximum duration of depressive episode were conducted between atypical (defined by DSM-Ⅳ-TR) and nonatypical depression.then the rate of atypical depressive symptoms were compared between unipolar depression and bipolar depression.Results The proportion of atypical depression among all the participants was 23.9％.Compared to nonatypical depression,psychotic features were more likely seen in atypical depression (20.0％ vs 9.1％,P＜0.05),but no difference was found in other clinical features between atypical and nonatypical depression.Except mood reactivity,atypical symptoms including oversleeping(45.5％ vs 26.0％),overeating (22.7％ vs 15.4％),weight gain(24.1％ vs 14.6％),leaden paralysis (56.6％ vs 47.2％),interpersonal rejection sensitivity(66.7％ vs 34.2％) were more likely to occur in bipolar depression than in unipolar depression,the difference was statistically significant for oversleeping and interpersonal rejection sensitivity (P ＜ 0.05).Patients with mood reactivity differed little from those without mood reactivity in other clinical features.No association was found between mood reactivity,leaden paralysis and other criteria symptoms of atypical depression.Conclusion-Atypical depression might be a useful concept,but its diagnostic criteria needs further validation among Chinese population.
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Alexithymia (AL) is characterized as an emotional communicative deficit, associated with operational thinking, impulsivity and heavy bodily sensations. AL is a frequent male profile (prevalence of 10%). Cerebroorganic, psychic or social factors take part in its etiology. A differential diagnosis is essential with blocking of affect and atypical depression. The new concept of pseudoalexithymia is introduced here. AL disturbs seriously the dyadic adjustment into the couple and increases the susceptibility to somatic or mental diseases. Some orientations for diagnosis and treatment are given. In conclusion, this study supports the great importance of AL in society, family and clinic.
La alexitimia (AL) se define como un déficit comunicativo emocional, asociado con el pensamiento operacional, alta impulsividad y copiosas sensaciones corporales. AL es un frecuente perfil masculino (prevalencia del 10%). En su etiología participan factores cerebroorgánicos, psíquicos o sociales. Se plantea su diagnóstico diferencial con el bloqueo emocional y la depresión atípica. Se propone aquí el nuevo concepto de seudoalexitimia. AL impide gravemente el ajuste diádico de la pareja e incrementa la susceptibilidad para la patología somática o mental. Se aportan orientaciones para su diagnóstico y tratamiento. En conclusión, este estudio apoya la gran importancia de la AL en la sociedad, la familia y la clínica.
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OBJECTIVES: The diagnosis of depression is based on a highly variable set of symptoms. Therefore, depression should not be viewed as a single disease, but a heterogenous syndrome comprised of different pathophysiologies. There are several subtypes of depression which were already incorporated in DSM-IV. This article provides a systematic review of pharmacological treatments of two recognized subtypes of depression-dysthymic disorder and atypical depression. METHODS: Systematic search of relevant literatures on dysthymic disorder and atypical depression was performed by proposed search strategy of the Clinical Research Center for Depression of Korean Health 21 R&D Project. All identified literatures were carefully reviewed and classified according to SIGN grading system and summarized in a narrative manner. RESULT: For the treatment of dysthymic disorder and atypical depression, selective serotonin reuptake inhibitors(SSRIs) and moclobemide have more evidence than the other antidepressants. SSRIs and moclobemide showed superior tolerability than tricyclic antidepressants. CONCLUSION: The authors proposed treatment recommendations for dysthymic disorder and atypical depression by the methods of evidence-based medicine(EBM). However, guideline developing methods of EBM also have several inevitable limitations. Therefore, in the absence of clear and significant differences in efficacy, the choice of medication must be individualized for a particular patient based on psychiatrist's own clinical decision.
Subject(s)
Humans , Antidepressive Agents , Antidepressive Agents, Tricyclic , Depression , Diagnosis , Diagnostic and Statistical Manual of Mental Disorders , Dysthymic Disorder , Evidence-Based Medicine , Moclobemide , SerotoninABSTRACT
O objetivo deste estudo foi revisar a epidemiologia, a sintomatologia clínica e a classificação dos diversos subtipos de transtornos depressivos, conforme os modernos sistemas de diagnóstico e de pesquisa, e descrever, de forma crítica, sob à luz da Psicanálise, os principais aspectos psicodinâmicos subjacentes. Destacamos, particularmente, os quadros de depressão melancólica e atípica, enfatizando a necessidade do reconhecimento diagnóstico precoce e da compreensão psicanalítica como instrumentos importantes para a intervenção e para o tratamento.