期刊
JOURNAL OF AFFECTIVE DISORDERS
卷 132, 期 3, 页码 383-388出版社
ELSEVIER SCIENCE BV
DOI: 10.1016/j.jad.2011.03.004
关键词
Major depressive disorder; Diagnostic Criteria for Psychosomatic; Research; Medically ill; Cluster analysis
资金
- Compagnia di San Paolo, Torino, Italy
- Ely-Lilly
- Janssen-Cilag
- AstraZeneca
- Bristol Meyers Squibb
- Lundbeck
- Pfeizer
- Glaxo-SmithKline
Background: There is increasing awareness of the need of subtyping major depressive disorder, particularly in the setting of medical disease. The aim of this investigation was to use both DSM-IV comorbidity and the Diagnostic Criteria for Psychosomatic Research (DCPR) for characterizing depression in the medically ill. Methods: 1700 patients were recruited from 8 medical centers in the Italian Health System and 1560 agreed to participate. They all underwent a cross-sectional assessment with DSM-IV and DCPR structured interviews. 198 patients (12.7%) received a diagnosis of major depressive disorder. Data were submitted to cluster analysis. Results: Two clusters were identified: depressed somatizers and irritable/anxious depression. The somatizer cluster included 58.6% of the cases and was characterized by DCPR somatization syndromes (persistent somatization, functional somatic symptoms secondary to a psychiatric disorder, conversion symptoms, and anniversary reactions) and DCPR alexithymia. The anxious/irritable cluster had 41.4% of the total sample and included DCPR irritable mood and type A behavior and DSM-IV anxiety disorders. Limitations: The study has limitations due to its cross-sectional nature. Further, these findings require additional validation in another sample. Conclusions: The findings indicate the need of expanding clinical assessment in the medically ill to include the various manifestations of somatization, irritable mood, type A behavior and alexithymia, as encompassed by the DCPR. Subtyping major depressive disorder may yield improved targets for psychosomatic research and treatment trials. (C) 2011 Elsevier B.V. All rights reserved.
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