The Diagnosis of Depressive Syndromes and the Prediction of E.C.T. Response

TLDR

Affective disorders lack a widely accepted classification, creating diagnostic uncertainty and reducing reliability, especially as they have displaced schizophrenia in clinical focus. Resolving disagreement in psychoneurosis–affective and psychoneurosis–personality categories increased diagnostic reliability from 57 % to 83 %.

Abstract

The establishment of a classification of affective disorders commanding wide agreement among clinical practitioners and investigators is one of the most pressing needs of contemporary psychiatry. This group of conditions has, in recent decades, displaced schizophrenia from the centre of the clinical stage. However, despite its prominence and importance in clinical practice, the territory remains inadequately charted. There is evidence to indicate that the uncertainty about the most clear and convenient lines of demarcation within this clinical territory makes a large contribution to the unreliability of psychiatric diagnosis. Thus, in a recent enquiry (Sandifer, Pettus and Quade, 1965) into the reliability of diagnoses made in 91 first admissions to a mental hospital by ten experienced psychiatrists, it was shown that the resolution of disagreement in the areas of “psychoneurosis—affective disorder” and “psychoneurosis—personality disorder” would have raised the overall reliability of diagnosis in this enquiry from 57 per cent. to 83 per cent.