Robert A. Woodruff

The natural history of affective disorders—I. Symptoms of 72 patients at the time of index hospital admission

Abstract Fifty-four patients hospitalized with primary affective disorder (depression) were compared with eighteen patients hospitalized with secondary affective disorder (depression). Primary affective disorder was defined as an affective illness occurring in a patient who had no previous psychiatric history other than that compatible with affective illness. Secondary affective disorder was defined as a depression occurring in a patient with a pre-existing, non-affective, psychiatric illness. The distribution and prevalence of affective symptoms in the current episode of illness was found to be the same among the two groups. This investigation indicates that the cross-sectional picture does not serve to distinguish primary from secondary affective disorders among hospitalized patients.

Mourning and Depression: Their Similarities and Differences*:

Previous studies have shown that bereaved people respond to their loss with a set of psychological symptoms which are in many instances indistinguishable from depressive illness, but accepted by them and their environment as normal (1,3,5). On the other hand, patients with primary affective disorder experience their condition as a “change”, “not usual self” (7), which leads them to seek help, and in this way they define themselves as patients. A comparison of frequencies of psychiatric symptoms between depressed 34, and bereaved 34, subjects matched for sex and age shows that hospitalized depressed subjects have more symptoms — 15 — than bereaved subjects (7). However, there is enough overlap that, on the basis of symptoms, the two groups cannot be differentiated satisfactorily for research purposes. In psychiatry, most diagnostic criteria are arbitrary. If they are set narrow some patients with a mild form of illness are excluded, while if broad criteria are employed persons with other conditions or no illness at all are included. For research purposes if the symptoms of depression occur only after the death of a near relative the subjects should not be included in the group diagnosed as suffering from primary affective disorder.

‘Secondary’ affective disorder: A study of 95 cases

Patients with ‘secondary’ affective disorder differ from those with ‘primary’ affective disorder in that there are additional symptoms of their pre-existing illness among the former. Hysteria, anxiety neurosis, antisocial personality, alcoholism, and drug dependency are the psychiatric conditions most frequently associated with ‘secondary’ affective disorders. There are other differences which may also be related to the presence of pre-existing illness. These differences include the findings that patients with ‘secondary’ affective disorder are younger, more often male, and are rarely manic; they suggest that it is appropriate to distinguish between ‘primary’ and ‘secondary’ affective disorder for research purposes.

Strategies of patient management in the presence of diagnostic uncertainty.

Abstract The authors have outlined some strategies which are used in the management of patients for whom diagnosis by formal criteria is either difficult or impossible. Certain rules considered to be clinical judgment can be made explicit. For instance, the authors allow the diagnosis of depression with greater freedom than that of schizophrenia. There are practical as well as theoretical reasons for so doing. Other diagnostic decisions are discussed. Some usually unstated strategies have been illustrated.