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Mixed features of depression: why DSM-5 is wrong (and so was DSM-IV)

  • Athanasios Koukopoulos (a1), Gabriele Sani (a2) and S. Nassir Ghaemi (a3)

Summary

The DSM system has never acknowledged a central position for mixed states; thus, mixed depressions have been almost completely neglected for decades. Now, DSM-5 is proposing diagnostic criteria for depression with mixed features that will lead to more misdiagnosis and inadequate treatment of this syndrome. Different criteria, based on empirically stronger evidence than exists for the DSM-5 criteria, should be adopted.

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Copyright

Corresponding author

Athanasios Koukopoulos, MD, Centro Lucio Bini, Via Crescenzio 42, 00193 Roma, Italy. Email: a.koukopoulos@fastwebnet.it

Footnotes

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Declaration of interest

In the past 12 months, S.N.G. has received research grants from Pfizer and Takeda Pharmaceuticals, and has provided research consultation to Sunovion Pharmaceuticals.

Footnotes

References

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Mixed features of depression: why DSM-5 is wrong (and so was DSM-IV)

  • Athanasios Koukopoulos (a1), Gabriele Sani (a2) and S. Nassir Ghaemi (a3)

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Mixed features of depression: why DSM-5 is wrong (and so was DSM-IV)

  • Athanasios Koukopoulos (a1), Gabriele Sani (a2) and S. Nassir Ghaemi (a3)
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eLetters

Mixed features of depression and Cyclothymia

Ahmed S Huda, Consultant Psychiatrist
29 July 2013

I work with an Early Intervention Team and have worked with a Young Persons Mental Health Team recently. In the age range I work with the commonest clinical picture I see (commoner than Schizophrenia, Schizoaffective Disorder or Bipolar Affective Disorder) is predominantly low mood but with brief periods of elation (commonly of less than 24 hours' duration) and agitation/ irritability in association with psychotic symptoms such as hearing voices. As they don't fit closely to the archetype of the 3 aforementioned disorders I often code them as "Cyclothymia" with an additional "Psychosis, NOS". The other differential diagnosis that comes into play is Borderline Personality Disorder.I wonder if my cases are similar or are related to the cases the Authors see.My suspicion is that in the community that a vulnerability factor for elated mood (possibly genetic or psychological trauma or both in combination) is closely associated with a vulnerability to psychosis.Depending on the relative prominence of these clinical features we may be able to make a "pure" diagnosis of Schizophrenia, Schizoaffective Disorderor Bipolar Affective Disorder. In the community however more cases have mixtures of features and are harder to allocate to "pure" categories similar to "Mixed Anxiety and Depression". ... More

Conflict of interest: None Declared

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