This issue is of no less practical importance. If personality disorder constitutes the primary pathology, its treatment should be a integral part of the management of (certain types) of depression. Consequently, a refined diagnosis of depression should encompass diagnostic scrutiny

of personality structure, its possible frailties, and the corresponding life events. In summary, the practice of judging axes I, II, and IV independently ignores the possibility – probability even – that in depression these three domains broadly overlap, and does not lend itself Inhibitors,research,lifescience,medical to the formulation of hypotheses or the carrying out of corresponding research. In psychodynamic psychiatry, relationships between mood, personality, and life events arc taken for granted. In experimental psychiatry, belief in the selfevident has been lost, but with the diagnostic Inhibitors,research,lifescience,medical approach that it champions, the remedy could become as serious as the disease. Categories and clinical realities

Finally, the question should be raised as to what extent the multiplicity of available diagnoses adequately covers the real situation of the individuals who attend our clinics and therapeutic units. Proliferation of diagnostic categories From the third edition Inhibitors,research,lifescience,medical onwards, the DSM has standardized Inhibitors,research,lifescience,medical diagnoses

and operationalized diagnostic criteria. Precise syndromal definition has been abandoned, and the diagnosis of depression is tied to a fixed number of symptoms from a given series, regardless of the actual symptoms. Various depression types are distinguished, not on the basis of symptoms, but on their severity and duration. Major depression is defined as severe (at least more severe than dysthymia), time-limited, and of at least 2 weeks’ duration, while dysthymia is defined as a less severe, long-lasting mood anomaly. In this way, the DSM system creates “disorders,” Thiamine-diphosphate kinase Inhibitors,research,lifescience,medical characterized by a compilation of KU-57788 mouse nonsymptomatological and (crude) symptomatological criteria. The dangers of this system are substantial. The number of symptoms necessary to qualify for a particular diagnosis has been determined arbitrarily. A considerable number of syndromes qualify for the same diagnosis. Moreover, much evidence indicates that the diagnostic constructs thus defined have little predictive validity as to their course, outcome, or treatment response.14 For instance, major depression can occur once in a lifetime or be recurrent; it may remit completely or partially; antidepressants may be efficacious or inactive; and psychological interventions effective or to no avail.