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May 1984

Comparative Diagnostic Criteria for Melancholia and Endogenous Depression

Author Affiliations

From the Department of Psychiatry, Duke University Medical Center (Dr Davidson) and Veterans Administration Medical Center (Dr Davidson and Ms Strickland), Durham, NC; and the Department of Biostatistics, University of North Carolina (Drs Turnbull and Belyea), Chapel Hill, NC.

Arch Gen Psychiatry. 1984;41(5):506-511. doi:10.1001/archpsyc.1984.01790160092012

• Five scales were evaluated for the diagnosis of melancholia or endogenous depression. Of 21 total items, none appeared in all five scales, but four items occurred in four of the scales: autonomy of mood, pervasive anhedonia, psychomotor change, and guilt. Vegetative changes were represented inconsistently, with anorexia and weight loss in three scales, as was distinct quality of mood. Thereafter, item agreement between the scales fell off. Scale performance was tested in 50 depressive patients. Major differences were found in frequency of melancholia and scale orientation toward inpatients and outpatients. A number of old controversies remain dormant in these scales. Unresolved are the relationship between melancholia and severity of depression; the relevance of precipitating events, previous depressive episodes, type of onset, and adequacy of personality; and whether to classify by category or continuum. The merits of statistically and consensually derived scales also need to be evaluated.

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