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| Mood [affective] disorders |
It seems likely that psychiatrists will continue to disagree about the classification of
disorders of mood until methods of dividing the clinical syndromes are developed that
rely at least in part upon physiological or biochemical measurement, rather than being
limited as at present to clinical descriptions of emotions and behaviour. As long as this
limitation persists, one of the major choices lies between a comparatively simple
classification with only a few degrees of severity, and one with greater details and more
subdivisions.
The 1987 draft of ICD-10 used in the field trials had the merit of simplicity, containing,
for example, only mild and severe depressive episodes, no separation of hypomania from
mania, and no recommendation to specify the presence or absence of familiarly clinical
concepts, such as the "somatic" syndrome or affective hallucinations and delusions.
However, feedback from many of the clinicians involved in the field trials, and other
comments received from a variety of sources, indicated a widespread demand for
opportunities to specify several grades of depression and the other features noted above.
In addition, it is clear from the preliminary analysis of field trial data that in many
centres the category of "mild depressive episode" often had a comparatively low
inter-rater reliability.
It has also become evident that the views of clinicians on the required number of
subdivisions of depression are strongly influenced by the types of patient they encounter
most frequently. Those working in primary care, outpatient clinics and liaison settings
need ways of describing patients with mild but clinically significant states of depression,
whereas those whose work is mainly with inpatients frequently need to use the more
extreme categories.
Further consultations with experts on affective disorders resulted in the present versions.
Options for specifying several aspects of affective disorders have been included, which,
although still some way from being scientifically respectable, are regarded by
psychiatrists in many parts of the world as clinically useful. It is hoped that their
inclusion will stimulate further discussion and research into their true clinical value.
Unsolved problems remain about how best to define and make diagnostic use of the
incongruence of delusions with mood. There would seem to be both enough evidence
and sufficient clinical demand for the inclusion of provisions for mood-congruent or
mood-incongruent delusions to be included, at least as an "optional extra".
