A. Palma, P. Pancheri - Vol. 6, Dicembre 2000, num.4
Testo Immagini Bibliografia Summary Riassunto Indice
Depressione Subsindromica e il Problema dell’Inquadramento
Diagnostico. Una fase di decorso della depressione, una dimensione patologica
autonoma, o un disturbo associato ad altre patologie primarie sia psichiche
che somatiche?
Sub-syndromal depression and the issue of diagnostic framing. A phase in
the course of depression, a separate pathological dimension, or a disorder
associated with other primary psychological or somatic disorders?
Background and objectiveSome workers underline that the extreme variability of psychopathological phenomena, at times, hardly responds and adapts to taxonomic criteria contained in rigid, category-based diagnostic systems. In fact, among the most common problems of psychiatric practice is the one to rapidly recognise and differentiate a mild downward mood swift that maintains the characteristics of a transient adaptive physiological response from one that, on the contrary, is to become a permanent pathological reaction. In the case of minor depressive disorders, the issue of threshold in differential diagnosis between demoralisation and mild depression is constantly proposed, mostly with the purpose to decide whether and how to treat according to the requirements of an individual case. This paper, besides providing an epidemiological connotation of the "sub-threshold depression" issue, deals with some problems of diagnostic framing that emerge in assessing of minor clinical pictures of depression, according to a qualitative clinical profile. In fact, the aim is to provide an overview of current diagnostic problems and responses to the issue of minor depressions which are by some workers held to be at the edge of pathological significance.
Method
We present a summary of recent innovations in clinical nosology, as they emerge
from modern handbooks and textbooks as well as a review of literature on proposed
diagnostic criteria worked-out for sub-threshold depression. To classify minor
clinical conditions with negative affect, some studies are considered that
were singled-out after a thorough Medline screening; such studies have taken
into account the role of personality traits, pre-morbid temperament, and the
"spectrum" concept, as related to sub-threshold depressive conditions.
Results and Conclusions
Experimental research in the last decades focused mostly on similarities and
comparisons of efficacy/tolerability between new antidepressants in Major
Depression; however, the question of biological differences and possible vulnerability
markers (which may also be genetic) that could account for clinical heterogeneity
of depression in terms of severity, duration, and clinical course, still remains
open. Sub-threshold depression, despite the risk to underestimate it, proved
to be a widely diffused clinical entity in primary care medicine and in psychiatric
population, with a life-time prevalence of 8-9% and 20%, respectively. A great
deal of literature holds that sub-threshold depressive symptomatology bears
an important clinical significance and its under-estimation generally results
in a negative outcome of mood disorders. In longitudinal studies, minor depressive
disorders showed to constitute antecedents of the onset of more severe episodes.
Often, a general condition of "subjective distress" protracted in
time has favoured the development of recurrent depressive disorder. In any
case, sub-threshold depression, both isolated or comorbid with medical problems
or considered as an aspect of temperament, is described in most studies as
a phase of the clinical course of mood disorders with a pathological connotation.