[Importance of DSM IV (APA) and ICD-10 (WHO) in diagnosis and treatment of mood disorders]

M Bourgeois
L'Encéphale 1995, 21: 47-52
Since 1993, with ICD-10 (WHO), and 1994, with DSM IV (APA), practitioners have had at their disposal two (practically compatible) classifications of mental disorders containing operational criteria for diagnosis, and helpful in guiding clinical and therapeutic approach. Moreover, the use of one of these classifications (ICD-10) is compulsory in French state psychiatric institutions. We shall try to convince that these manuals are useful, and indeed unavoidable, henceforth, not only for researchers but also for practitioners, for the following reasons: "Any form of order is preferable to chaos" (Lévi Strauss); An implicit classification is always at work, even where the clinician feels he is working by intuition and treating each patient as a unique and individual case. It is not necessarily a bad thing to compare one's own stereotypes with currently held beliefs; All efforts to evaluate treatments, both psychotherapeutic and chemotherapeutic, are now based on these clinical definitions and models. Particularly as regards mood disorders, DSM III and DMS IV have managed to rid us of the uncertainties and contradictions surrounding etiopathogenesis (endogenous? psychogenic? reactive? defensive? adaptive? biological? etc.) which previously ruled out any explanatory classification. There still remain a number of pathological pictures of proven existence but with different levels of significance and different treatments. The bipolar/unipolar distinction (BP/UP) has been strengthened. Major depression (actual "depression", of moderate severity) remains the central model, and exists in both the unipolar and bipolar forms. There is also chronic (more than 2 years) progressive dysthymia (UP) which corresponds almost exactly to "Depressive personality". For bipolar disorders, the distinction between bipolar I disorders and bipolar II disorders, which is now well-documented, has been retained. Cyclothymia (lasting over 2 years) is in a sense the bipolar equivalent of dysthymia. Mixed disorders are distinguished from rapid-cycling bipolar disorders. It is now known that the range of bipolar disorders requires treatment with thymoleptic drugs and that antidepressants should be used only in unipolar disorders, and occasionally in bipolar forms to treat certain acute episodes of depression. Furthermore, many specific clinical forms are defined: postnatal depression, seasonal depression, adaptive difficulties with depressive mood or anxiety and depression, iatrogenic depression or depression related to medication or to intercurrent illnesses. Moreover, criteria are also suggested "for future studies" of post-psychotic depression in schizophrenic patients, minor depression, brief recurrent depressive episodes and anxio-depressive syndrome.


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