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
5 - Examination for melancholia
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
I began to sense the onset of the symptoms at mid afternoon or a little later – gloom crowding in on me, a sense of dread and alienation and, above all, stifling anxiety. Rational thought was usually absent from my mind at such times, hence trance.
I can think of no more appropriate word for this state of being, a condition of helpless stupor in which cognition was replaced by that positive and active anguish.
The bedrock of psychiatric clinical research is the structured interview. It is designed to collect large amounts of information in a form suitable for multivariate analysis. To achieve reliability, questions are asked in a specific form and sequence. The opportunity for follow-up questioning, clarification, and discussion with the patient is limited. Experienced clinicians recognize the artificial nature of these instruments. Kendell commented on the exaggerated value given to structured interviews and rating scales, and the tendency to disregard the validity of a well-done clinical examination.
For most of medical history, syndromes have been identified intuitively by gifted physicians on the basis of their experience. They saw a pattern where others saw only confusion, or they saw a different pattern than had their predecessors.
The art of the medical examination is learned at the bedside. It is not taught from books alone. It remains the bedrock of clinical psychiatric diagnosis.
Clinical diagnosis, however, is simplified when depressive mood disorders are considered a single state differing only in severity.
- Type
- Chapter
- Information
- MelancholiaThe Diagnosis, Pathophysiology and Treatment of Depressive Illness, pp. 85 - 96Publisher: Cambridge University PressPrint publication year: 2006