Book contents
- Frontmatter
- Contents
- List of patient vignettes
- Preface
- Acknowledgments
- 1 Melancholia: a conceptual history
- 2 Melancholia defined
- 3 Defining melancholia by psychopathology
- 4 Defining melancholia: laboratory tests
- 5 Examination for melancholia
- 6 The differential diagnosis of melancholia
- 7 Suicide in melancholia
- 8 Electroconvulsive therapy for melancholia
- 9 Achieving effective ECT
- 10 The validity of the pharmacotherapy literature in melancholia
- 11 Basic pharmacotherapy for melancholic patients
- 12 Pharmacotherapy for melancholic patients in complicating circumstances
- 13 Proposed treatments for melancholia
- 14 The pathophysiology of melancholia
- 15 Future directions
- References
- Index
4 - Defining melancholia: laboratory tests
Published online by Cambridge University Press: 14 August 2009
- Frontmatter
- Contents
- List of patient vignettes
- Preface
- Acknowledgments
- 1 Melancholia: a conceptual history
- 2 Melancholia defined
- 3 Defining melancholia by psychopathology
- 4 Defining melancholia: laboratory tests
- 5 Examination for melancholia
- 6 The differential diagnosis of melancholia
- 7 Suicide in melancholia
- 8 Electroconvulsive therapy for melancholia
- 9 Achieving effective ECT
- 10 The validity of the pharmacotherapy literature in melancholia
- 11 Basic pharmacotherapy for melancholic patients
- 12 Pharmacotherapy for melancholic patients in complicating circumstances
- 13 Proposed treatments for melancholia
- 14 The pathophysiology of melancholia
- 15 Future directions
- References
- Index
Summary
The lesson of the history of psychiatry is that progress is inevitable and irrevocable from psychology to neurology, from mind to brain, never the other way round. Every medical advance adds to the list of diseases which may cause mental derangement. The abnormal mental state is not the disease, nor its essence or its determinant, but an epiphenomenon. This is why psychological theories and therapies, which held out such promise at the turn of the century when so much less was known of localization of function in the brain, have added so little to understanding and treatment of mental illness, despite all the time and effort devoted to them.
The serological identification of syphilis is the model of a specific laboratory test for a general medical disorder. The test separates the behavioral syndrome of neurosyphilis from phenotypically similar but etiologically diverse conditions of mood and psychotic disorders. No such assessment exists for psychiatric disorders, despite more than a century of effort. A major hurdle in this quest has been the inability to define syndromes with biological homogeneity, thus confounding samples and eliciting conflicting findings. The dexamethasone suppression test (DST) was positive (non-suppression) in about 50% of depressed patients but was deemed unsuitable as a laboratory test in depressive illness, despite the evidence that samples of depressed patients were heterogeneous. Severely depressed patients, however, have substantial perturbations in their neuroendocrine functioning and measures of the endocrine system remain the best laboratory-based opportunity to demarcate mood disorders.
- Type
- Chapter
- Information
- MelancholiaThe Diagnosis, Pathophysiology and Treatment of Depressive Illness, pp. 62 - 84Publisher: Cambridge University PressPrint publication year: 2006