Depression and the Newcastle Scales Their Relationship to Hamilton's Scale

Abstract

Ninety-seven patients, treated with E.C.T. and followed up to three months, were rated initially on the Newcastle diagnosis and E.C.T. prediction scales and Hamilton's scale. After E.C.T. and at three months they were rated on a four-point global scale and Hamilton's scale. With respect to original diagnoses of endogenous and neurotic depression, only eight patients were misclassified by the diagnosis scale. Patients categorized as \`endogenous' had a significantly better outcome at three months as judged by Hamilton's and global scales than those classified as \`neurotic'. Patients for whom a good outcome was predicted by the E.C.T. scale also had a significantly better outcome as judged by the two assessment methods than those for whom a poor outcome was predicted. Increasing scores on the diagnosis and E.C.T. scales were closely correlated with mean falls in Hamilton's score. On rating 11 patients independently on the two Newcastle scales, two or more raters achieved complete concordance with respect to differential diagnosis and good or bad E.C.T. response. Severity of illness as judged by Hamilton's scale was found to be equal for both types of depression, a finding supporting the binary view of depression. With regard to the categorical versus the dimensional question the evidence was inconclusive but was felt to fit a compromise hypothesis—that neurotic depression is dimensional and endogenous categorical.