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Should psychomotor disturbance be an essential criterion for a DSM-5 diagnosis of melancholia?
1Discipline of Psychological Medicine, University of Sydney, Concord Hospital, Sydeny, NSW 2139, Australia. jsnowdon@mail.usyd.edu.au
Background:
The CORE measure has proved useful in rating observed psychomotor disturbance (PMD), which has been held to be a key feature of melancholic depression. However, studies have shown a substantial percentage of subjects fulfilling DSM criteria for melancholia do not have observable PMD.
Methods:
A semi-structured interview schedule was used in assessing and diagnosing depressed older patients. DSM-IV diagnoses were made, and the CORE measure was used to rate PMD. Comparisons were made between melancholia inpatients who scored low and those scoring high on the CORE in relation to presentation and pattern of symptoms.
Results:
Of 32 inpatients with melancholia, 10 scored 0-7, 8 scored 8-10, and 14 scored 15 or more on the CORE. Thirty-two inpatients with psychotic depression scored 13 or more. High-CORE participants manifested unvarying depression more often than did low-CORE participants, and were less likely to state that stress precipitated their depressive episode.
Conclusions:
High-CORE melancholia cases appear to have more in common with psychotic depression than do low-CORE cases. Designation of observable PMD as an essential criterion in making a diagnosis of melancholia could increase the utility of the DSM classification in relation to treatment planning.
Insights
The CORE measure effectively rates psychomotor disturbance (PMD) in melancholic depression. High CORE scores in melancholia patients suggest similarities with psychotic depression, aiding treatment planning.
Area of Science:
- Psychiatry
- Clinical Psychology
- Geriatric Medicine
Background:
- The CORE measure is valuable for assessing psychomotor disturbance (PMD), a key feature of melancholic depression.
- A notable percentage of patients meeting melancholia criteria lack observable PMD.
Purpose of the Study:
- To compare melancholic inpatients with varying CORE scores.
- To investigate the relationship between CORE scores and symptom presentation in depression.
Main Methods:
- Utilized a semi-structured interview for diagnosing depression in older adults.
- Assessed patients using DSM-IV criteria and the CORE measure for PMD.
- Compared symptom patterns between low and high CORE scorers with melancholia.
Main Results:
- 32 melancholic inpatients showed varied CORE scores; 14 scored 15+.
- 32 psychotic depression patients scored 13+ on CORE.
- High-CORE melancholia patients exhibited more persistent depression and less stress-related onset compared to low-CORE patients.
Conclusions:
- High-CORE melancholic depression cases share traits with psychotic depression.
- Incorporating observable PMD into melancholia diagnosis could enhance DSM utility for treatment planning.
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