0
November 1985, Vol 42, No. 11 >
Article | November 1985

Somatic Symptoms in Primary Affective Disorder: Title and subTitle BreakPresence and Relationship to the Classification of Depression

Regina C. Casper, MD; D. Eugene Redmond, Jr, MD; Martin M. Katz, PhD; Charles B. Schaffer, MD; John M. Davis, MD; Stephen H. Koslow, PhD
[+] Author Affiliations

Accepted for publication Nov 20, 1984.

Reprint requests to Department of Psychiatry, Michael Reese Hospital and Medical Center, Lake Shore Drive at 31st Street, Chicago, IL 60616 (Dr Casper).


Arch Gen Psychiatry. 1985;42(11):1098-1104. doi:10.1001/archpsyc.1985.01790340082012
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Comments

• The incidence and severity of somatic symptoms were determined in 132 patients with major depressive disorder and 80 normal controls. The role of somatic symptoms was analyzed in relation to the unipolar-bipolar division, Research Diagnostic Criteria (RDC) subtypes, hypersomnia, and appetite increase. The data suggest that (1) the rate and level of somatic symptoms increased with the severity of depression and age, (2) only appetite loss differentiated unipolar from bipolar patients, and (3) the classic somatic symptoms of depression were present in most RDC subtypes and not exclusively associated with the "endogenous" subtype. Hypersomnia or increased appetite identified two overlapping depressive subgroups; patients in both groups were young and characterized by high interpersonal sensitivity. Hypersomniac depressed patients were less anxious and agitated; patients with increased appetite were more hostile and showed a greater decrease in libido than age-matched and sexmatched patients with neither symptom.

REFERENCES

1 +
Hamilton M, White JM:  Clinical syndromes in depressive states . J Ment Sci 1959;;105:985-998.
2 +
Carney MWP, Roth M, Garside RF:  The diagnosis of depressive syndromes and the prediction of ECT response . Br J Psychiatry 1965;;111:659-674.
3 +
Kiloh LG, Garside RF:  The independence of neurotic depression and endogenous depression . Br J Psychiatry 1963;;109:451-463.
4 +
Mendels J, Cochrane C:  The nosology of depression: The endogenousreactive concept . Am J Psychiatry 1968;;124:1-11.
5 +
Fahy TJ, Brandon S, Garside RF:  Classification of depressive illness . Proc R Soc Med 1969;;62:331-339.
6 +
Grinker RR, Miller J, Sabshin M, Nunn R, Nunnaly JC:  Factor patterns , in Hoeber PB (ed): The Phenomena of Depressions . Hagerstown, MD, Harper & Row Publishers Inc, 1961;.
7 +
Pilowsky I, Levine S, Boulton DM:  The classification of depression by numerical taxonomy . Br J Psychiatry 1969;;115:937-945.
8 +
Paykel ES:  Classification of depressed patients: A cluster analysis derived grouping . Br J Psychiatry 1971;;118:275-288.
9 +
Kendell RE:  The classification of depressions: A review of contemporary confusion . Br J Psychiatry 1976;;129:15-28.
10 +
Fowles DC, Gersh F:  Neurotic depression: I. The endogenousneurotic distinction , in Depue RA (ed): The Psychobiology of the Depressive Disorders: Implications for the Effects of Stress . New York, Academic Press Inc, 1979;, pp 55-80.
11 +
Pollitt JD:  Suggestions for a physiological classification of depression . Br J Psychiatry 1965;;111:489-495.
12 +
Van Praag HM, Uleman AM, Spitz JC:  The vital syndrome interview . Psychiatr Neurol Neurochir 1965;;68:329-346.
13 +
Detre T, Himmelhoch J, Swartzburg M, Anderson CM, Byck R, Kupfer DJ:  Hypersomnia and manic-depressive disease . Am J Psychiatry 1972;;128:1303-1305.
14 +
Paykel ES:  Depression and appetite . J Psychosom Res 1977;;21:401-407.
15 +
Davidson JRT, Miller RD, Turnbull CD, Sullivan JL:  Atypical depression . Arch Gen Psychiatry 1982;;39:527-534.
16 +
Paykel ES, Rowan PR, Parker RR, Bhat AV:  Response to phenelzine and amitryptyline in subtypes of outpatient depression . Arch Gen Psychiatry 1982;;39:1041-1049.
17 +
Klein DF, Gittelman R, Quitkin F, Rifkin A: Diagnosis and Drug Treatment of Psychiatric Disorders: Adults and Children . Baltimore, Williams & Wilkins Co, 1980;, pp 243-246.
18 +
Maas JW, Koslow SH, Davis JM, Katz MM, Mendels J, Robins E, Stokes PE, Bowden C:  Biological component of the NIMH Clinical Research Branch Collaborative Program on the Psychobiology of Depression: I. Background and theoretical considerations . Psychol Med 1980;;10:759-776.
19 +
Secunda S, Koslow SH, Redmond DE, Garver D, Ramsey TA, Croughan J, Kocsis J, Hanin I, Lieberman K, Casper R:  Biological component of the NIMH Clinical Research Branch Collaborative Program on the Psychobiology of Depression: II. Methodology and data analysis . Psychol Med 1980;;10:777-793.
20 +
Endicott J, Spitzer RL:  The Schedule for Affective Disorders and Schizophrenia . Arch Gen Psychiatry 1978;;35:837-844.
21 +
Spitzer RL, Endicott J, Robins E:  Research Diagnostic Criteria: Rationale and reliability . Arch Gen Psychiatry 1978;;35:773-782.
22 +
Spitzer RL, Endicott J, Robins E: Research Diagnostic Criteria for a Selected Group of Functional Disorders , ed 3. New York, Biometrics Research Division, New York State Psychiatric Institute, 1978;.
23 +
Hamilton M:  Development of a rating scale for primary depressive illness . Br J Soc Clin Psychol 1967;;6:278-296.
24 +
Katz MM, Itil TM:  Video methodology for research in psychopathology and psychopharmacology . Arch Gen Psychiatry 1974;;31:204-210.
25 +
Derogatis LR, Lipman RS, Rickels K, Uhlenhuth EH, Covi L:  The Hopkins Symptom Checklist (HSCL): A measure of primary symptom dimensions , in Pichot P (ed): Psychological Measurements in Psychopharmacology: Modern Problems in Pharmacopsychiatry . New York, S Karger AG, 1974;, vol 7, pp 79-110.
26 +
Katz MM, Robins E, Croughan J, Secunda S, Swann A:  Behavioral measurement and drug response characteristics of unipolar and bipolar depression . Psychol Med 1982;;12:25-36.
27 +
Endicott J, Spitzer RL:  Use of the Research Diagnostic Criteria and the Schedule for Affective Disorders and Schizophrenia to study affective disorders . Am J Psychiatry 1979;;136:52-56.
28 +
Sargant W:  Some newer drugs in the treatment of depression and their relation to other somatic treatments . Psychosomatics 1960;;1:14-17.
29 +
Cassidy WL, Flanagan NB, Spellman M, Cohen ME:  Clinical observations in manic-depressive disease: A quantitative study of 100 manicdepressive patients and 50 medically sick controls . JAMA 1957;;164:1535-1546.
30 +
Wittenborn JR, Buhler R:  Somatic discomforts among depressed women . Arch Gen Psychiatry 1979;;36:465-471.
31 +
Woodruff RA, Murphy GE, Herjanic M:  The natural history of affective disorders: I. Symptoms of 72 patients at the time of index hospital admission . J Psychiatr Res 1967;;5:255-263.
32 +
Paykel ES, Prusoff B, Klerman GL:  The endogenous-neurotic continuum in depression: Rater independence and factor distributions . J Psychiatr Res 1971;;8:73-90.
33 +
Rosenthal SH, Klerman GL:  Content and consistency in the endogenous depressive pattern . Br J Psychiatry 1966;;112:471-484.
34 +
Rosenthal SH, Gudeman JE:  The endogenous depressive pattern: An empirical investigation . Arch Gen Psychiatry 1967;;16:241-249.
35 +
Kupfer DJ:  REM latency: A psychobiologic marker for primary depressive disease . Biol Psychiatry 1976;;11:159-174.
36 +
Spiker DG, Coble PA, Cofsky J, Foster FG, Kupfer DJ:  EEG sleep and severity of depression . Biol Psychiatry 1978;;13:485-488.
37 +
Pollitt J, Young J:  Anxiety or masked depression? A study based on the action of monoamine oxidase inhibitors . Br J Psychiatry 1971;;119:143-149.
38 +
Foulds MA:  Psychotic depression and age . J Ment Sci 1960;;106:1394-1397.
39 +
Ulrich RF, Shaw DH, Kupfer DJ:  Effects of aging on EEG sleep in depression . Sleep 1980;;3:31-40.
40 +
McGuire A, Russell SM:  Subjective sleep disturbances in the normal population . J Ment Sci 1962;;108:642-654.
41 +
Tune GS:  Sleep and wakefulness in normal human adults . Br Med J 1968;;2:269-271.
42 +
Williams RL, Karacan I, Hursch CJ: EEG of Human Sleep: Clinical Applications . New York, John Wiley & Sons Inc, 1974;.
43 +
Mendelson WF, Gillin JG, Wyatt RJ: Human Sleep and Its Disorders . New York, Plenum Press, 1977;, pp 157-158.
44 +
Dirlich G, Kammerloher A, Schulz H, Lund R, Doerr P, von Zerssen D:  Temporal coordination of rest-activity cycle, body temperature, urinary free cortisol, and mood in a patient with 48-hour unipolar-depressive cycles in clinical and time-cue-free environments . Biol Psychiatry 1981;;16:163-179.
45 +
Beigel A, Murphy DL:  Unipolar and bipolar affective illness . Arch Gen Psychiatry 1971;;24:215-220.
46 +
Nelson JC, Charney DS:  The symptoms of major depressive illness . Am J Psychiatry 1981;;138:1-12.
47 +
Nelson JC, Charney DS, Quinlan DM:  Evaluation of the DSM-III criteria for melancholia . Arch Gen Psychiatry 1981;;38:555-559.
48 +
Feighner JP, Robins E, Guze SB, Woodruff RA, Winokur G, Munoz R:  Diagnostic criteria for use in psychiatric research . Arch Gen Psychiatry 1972;;26:57-63.
49 +
Feinberg M, Carroll BJ, Steiner M, Commorato AJ:  Misdiagnoses of endogenous depression with Research Diagnostic Criteria . Lancet 1979;;1:267.
50 +
Michaelis R:  Depressive Verstimmung und Schlafsucht . Arch Psychiatr Nervenkr 1964;;206:345-355.
51 +
Kraines SH: Mental Depressions and Their Treatment . New York, Macmillan Publishing Co Inc, 1957;.
52 +
Kupfer DJ, Bulik CM, Grochocinski V:  Relationship between EEG sleep measures and clinical ratings of depression: A revisit . J Affective Disord , in press.
53 +
Klein DF:  Endogenomorphic depression . Arch Gen Psychiatry 1974;; 31:447-454.

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Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Hamilton M, White JM:  Clinical syndromes in depressive states . J Ment Sci 1959;;105:985-998.
2 +
Carney MWP, Roth M, Garside RF:  The diagnosis of depressive syndromes and the prediction of ECT response . Br J Psychiatry 1965;;111:659-674.
3 +
Kiloh LG, Garside RF:  The independence of neurotic depression and endogenous depression . Br J Psychiatry 1963;;109:451-463.
4 +
Mendels J, Cochrane C:  The nosology of depression: The endogenousreactive concept . Am J Psychiatry 1968;;124:1-11.
5 +
Fahy TJ, Brandon S, Garside RF:  Classification of depressive illness . Proc R Soc Med 1969;;62:331-339.
6 +
Grinker RR, Miller J, Sabshin M, Nunn R, Nunnaly JC:  Factor patterns , in Hoeber PB (ed): The Phenomena of Depressions . Hagerstown, MD, Harper & Row Publishers Inc, 1961;.
7 +
Pilowsky I, Levine S, Boulton DM:  The classification of depression by numerical taxonomy . Br J Psychiatry 1969;;115:937-945.
8 +
Paykel ES:  Classification of depressed patients: A cluster analysis derived grouping . Br J Psychiatry 1971;;118:275-288.
9 +
Kendell RE:  The classification of depressions: A review of contemporary confusion . Br J Psychiatry 1976;;129:15-28.
10 +
Fowles DC, Gersh F:  Neurotic depression: I. The endogenousneurotic distinction , in Depue RA (ed): The Psychobiology of the Depressive Disorders: Implications for the Effects of Stress . New York, Academic Press Inc, 1979;, pp 55-80.
11 +
Pollitt JD:  Suggestions for a physiological classification of depression . Br J Psychiatry 1965;;111:489-495.
12 +
Van Praag HM, Uleman AM, Spitz JC:  The vital syndrome interview . Psychiatr Neurol Neurochir 1965;;68:329-346.
13 +
Detre T, Himmelhoch J, Swartzburg M, Anderson CM, Byck R, Kupfer DJ:  Hypersomnia and manic-depressive disease . Am J Psychiatry 1972;;128:1303-1305.
14 +
Paykel ES:  Depression and appetite . J Psychosom Res 1977;;21:401-407.
15 +
Davidson JRT, Miller RD, Turnbull CD, Sullivan JL:  Atypical depression . Arch Gen Psychiatry 1982;;39:527-534.
16 +
Paykel ES, Rowan PR, Parker RR, Bhat AV:  Response to phenelzine and amitryptyline in subtypes of outpatient depression . Arch Gen Psychiatry 1982;;39:1041-1049.
17 +
Klein DF, Gittelman R, Quitkin F, Rifkin A: Diagnosis and Drug Treatment of Psychiatric Disorders: Adults and Children . Baltimore, Williams & Wilkins Co, 1980;, pp 243-246.
18 +
Maas JW, Koslow SH, Davis JM, Katz MM, Mendels J, Robins E, Stokes PE, Bowden C:  Biological component of the NIMH Clinical Research Branch Collaborative Program on the Psychobiology of Depression: I. Background and theoretical considerations . Psychol Med 1980;;10:759-776.
19 +
Secunda S, Koslow SH, Redmond DE, Garver D, Ramsey TA, Croughan J, Kocsis J, Hanin I, Lieberman K, Casper R:  Biological component of the NIMH Clinical Research Branch Collaborative Program on the Psychobiology of Depression: II. Methodology and data analysis . Psychol Med 1980;;10:777-793.
20 +
Endicott J, Spitzer RL:  The Schedule for Affective Disorders and Schizophrenia . Arch Gen Psychiatry 1978;;35:837-844.
21 +
Spitzer RL, Endicott J, Robins E:  Research Diagnostic Criteria: Rationale and reliability . Arch Gen Psychiatry 1978;;35:773-782.
22 +
Spitzer RL, Endicott J, Robins E: Research Diagnostic Criteria for a Selected Group of Functional Disorders , ed 3. New York, Biometrics Research Division, New York State Psychiatric Institute, 1978;.
23 +
Hamilton M:  Development of a rating scale for primary depressive illness . Br J Soc Clin Psychol 1967;;6:278-296.
24 +
Katz MM, Itil TM:  Video methodology for research in psychopathology and psychopharmacology . Arch Gen Psychiatry 1974;;31:204-210.
25 +
Derogatis LR, Lipman RS, Rickels K, Uhlenhuth EH, Covi L:  The Hopkins Symptom Checklist (HSCL): A measure of primary symptom dimensions , in Pichot P (ed): Psychological Measurements in Psychopharmacology: Modern Problems in Pharmacopsychiatry . New York, S Karger AG, 1974;, vol 7, pp 79-110.
26 +
Katz MM, Robins E, Croughan J, Secunda S, Swann A:  Behavioral measurement and drug response characteristics of unipolar and bipolar depression . Psychol Med 1982;;12:25-36.
27 +
Endicott J, Spitzer RL:  Use of the Research Diagnostic Criteria and the Schedule for Affective Disorders and Schizophrenia to study affective disorders . Am J Psychiatry 1979;;136:52-56.
28 +
Sargant W:  Some newer drugs in the treatment of depression and their relation to other somatic treatments . Psychosomatics 1960;;1:14-17.
29 +
Cassidy WL, Flanagan NB, Spellman M, Cohen ME:  Clinical observations in manic-depressive disease: A quantitative study of 100 manicdepressive patients and 50 medically sick controls . JAMA 1957;;164:1535-1546.
30 +
Wittenborn JR, Buhler R:  Somatic discomforts among depressed women . Arch Gen Psychiatry 1979;;36:465-471.
31 +
Woodruff RA, Murphy GE, Herjanic M:  The natural history of affective disorders: I. Symptoms of 72 patients at the time of index hospital admission . J Psychiatr Res 1967;;5:255-263.
32 +
Paykel ES, Prusoff B, Klerman GL:  The endogenous-neurotic continuum in depression: Rater independence and factor distributions . J Psychiatr Res 1971;;8:73-90.
33 +
Rosenthal SH, Klerman GL:  Content and consistency in the endogenous depressive pattern . Br J Psychiatry 1966;;112:471-484.
34 +
Rosenthal SH, Gudeman JE:  The endogenous depressive pattern: An empirical investigation . Arch Gen Psychiatry 1967;;16:241-249.
35 +
Kupfer DJ:  REM latency: A psychobiologic marker for primary depressive disease . Biol Psychiatry 1976;;11:159-174.
36 +
Spiker DG, Coble PA, Cofsky J, Foster FG, Kupfer DJ:  EEG sleep and severity of depression . Biol Psychiatry 1978;;13:485-488.
37 +
Pollitt J, Young J:  Anxiety or masked depression? A study based on the action of monoamine oxidase inhibitors . Br J Psychiatry 1971;;119:143-149.
38 +
Foulds MA:  Psychotic depression and age . J Ment Sci 1960;;106:1394-1397.
39 +
Ulrich RF, Shaw DH, Kupfer DJ:  Effects of aging on EEG sleep in depression . Sleep 1980;;3:31-40.
40 +
McGuire A, Russell SM:  Subjective sleep disturbances in the normal population . J Ment Sci 1962;;108:642-654.
41 +
Tune GS:  Sleep and wakefulness in normal human adults . Br Med J 1968;;2:269-271.
42 +
Williams RL, Karacan I, Hursch CJ: EEG of Human Sleep: Clinical Applications . New York, John Wiley & Sons Inc, 1974;.
43 +
Mendelson WF, Gillin JG, Wyatt RJ: Human Sleep and Its Disorders . New York, Plenum Press, 1977;, pp 157-158.
44 +
Dirlich G, Kammerloher A, Schulz H, Lund R, Doerr P, von Zerssen D:  Temporal coordination of rest-activity cycle, body temperature, urinary free cortisol, and mood in a patient with 48-hour unipolar-depressive cycles in clinical and time-cue-free environments . Biol Psychiatry 1981;;16:163-179.
45 +
Beigel A, Murphy DL:  Unipolar and bipolar affective illness . Arch Gen Psychiatry 1971;;24:215-220.
46 +
Nelson JC, Charney DS:  The symptoms of major depressive illness . Am J Psychiatry 1981;;138:1-12.
47 +
Nelson JC, Charney DS, Quinlan DM:  Evaluation of the DSM-III criteria for melancholia . Arch Gen Psychiatry 1981;;38:555-559.
48 +
Feighner JP, Robins E, Guze SB, Woodruff RA, Winokur G, Munoz R:  Diagnostic criteria for use in psychiatric research . Arch Gen Psychiatry 1972;;26:57-63.
49 +
Feinberg M, Carroll BJ, Steiner M, Commorato AJ:  Misdiagnoses of endogenous depression with Research Diagnostic Criteria . Lancet 1979;;1:267.
50 +
Michaelis R:  Depressive Verstimmung und Schlafsucht . Arch Psychiatr Nervenkr 1964;;206:345-355.
51 +
Kraines SH: Mental Depressions and Their Treatment . New York, Macmillan Publishing Co Inc, 1957;.
52 +
Kupfer DJ, Bulik CM, Grochocinski V:  Relationship between EEG sleep measures and clinical ratings of depression: A revisit . J Affective Disord , in press.
53 +
Klein DF:  Endogenomorphic depression . Arch Gen Psychiatry 1974;; 31:447-454.

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