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September 1991, Vol 48, No. 9 >
Article | September 1991

Conceptualization and Rationale for Consensus Definitions of Terms in Major Depressive Disorder: Title and subTitle BreakRemission, Recovery, Relapse, and Recurrence

Ellen Frank, PhD; Robert F. Prien, PhD; Robin B. Jarrett, PhD; Martin B. Keller, MD; David J. Kupfer, MD; Philip W. Lavori, PhD; A. John Rush, MD; Myrna M. Weissman, PhD
[+] Author Affiliations

Accepted for publication September 20, 1990.

Reprint requests to Western Psychiatric Institute and Clinic, 3811 O'Hara St, Pittsburgh, PA 15213 (Dr Frank).


Arch Gen Psychiatry. 1991;48(9):851-855. doi:10.1001/archpsyc.1991.01810330075011
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• In 1988, the MacArthur Foundation Research Network on the Psychobiology of Depression convened a task force to examine the ways in which change points in the course of depressive illness had been described and the extent to which inconsistency in these descriptions might be impeding research on this disorder. We found considerable inconsistency across and even within research reports and concluded that research on depressive illness would be well served by greater consistency in the definition change points in the course of illness. We propose an internally consistent, empirically defined conceptual scheme for the terms remission, recovery, relapse, and recurrence. In addition, we propose tentative operational criteria for each term. Finally, we discuss ways to assess the usefulness of such operational criteria through reanalysis of existing data and the design and conduct of new experiments.

REFERENCES

1 +
Prien RF, Carpenter LL, Kupfer DJ.  The definition and operational criteria for treatment outcome of major depressive disorder: a review of the current research literature . Arch Gen Psychiatry . 1991;;48:796-800.
2 +
Spitzer RL, Endicott J, Robins E.  Research Diagnostic Criteria: rationale and reliability . Arch Gen Psychiatry . 1978;;35:773-782.
3 +
Hamilton M.  A rating scale for depression . J Neurol Neurosurg Psychiatry . 1960;;23:56-62.
4 +
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J.  An inventory for measuring depression . Arch Gen Psychiatry . 1961;;4:561-571.
5 +
Keller MB, Lavori PW, Friedman B, Nielsen E, Endicott J, McDonald Scott P, Andreason NC.  Longitudinal Interval Follow-up Evaluation: a comprehensive method for assessing outcome in longitudinal studies . Arch Gen Psychiatry . 1987;;44:540-548.
6 +
Guy W, Cleary PA, Close JH, Conners CK, Covi L, Derogatis LR, Fish B, Gershon S, Gittelman-Klein R, Hamilton M, Honigfeld G, Klein DF, Lipman RS, McGlashan T, Overall JE, Sprague RL, Werry J, Wittenborn JR, Yang K, Zung WW. ECDEU Assessment Manual for Psychopharmacology . Washington, DC: US Dept of Health, Education, and Welfare;1976;. DHEW publication (ADM) 76-338.
7 +
Rush AJ, Giles DE, Schlesser MA, Fulton CL, Weissenburger J, Burns C.  The Inventory for Depressive Symptomatology (IDS): preliminary findings . Psychiatry Res . 1985;;18:65-87.
8 +
Metz CE.  Basic principles of ROC analysis . Semin Nucl Med . 1978;;8:283-298.
9 +
Mossman D, Somoza E.  Maximizing diagnostic information from the dexamethasone suppression test: an approach to criterion selection using receiver operating characteristic analysis . Arch Gen Psychiatry . 1989;;46:653-659.
10 +
Hsiao JK, Bartko JJ, Potter WZ.  Diagnosing diagnoses: receiver operating characteristic methods and psychiatry . Arch Gen Psychiatry . 1989;;46:664-667.
11 +
Keller MB, Lavori PW, Lewis CE, Klerman GL.  Predictors of relapse in major depressive disorder . JAMA . 1983;;250:3299-3304.

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1 +
Prien RF, Carpenter LL, Kupfer DJ.  The definition and operational criteria for treatment outcome of major depressive disorder: a review of the current research literature . Arch Gen Psychiatry . 1991;;48:796-800.
2 +
Spitzer RL, Endicott J, Robins E.  Research Diagnostic Criteria: rationale and reliability . Arch Gen Psychiatry . 1978;;35:773-782.
3 +
Hamilton M.  A rating scale for depression . J Neurol Neurosurg Psychiatry . 1960;;23:56-62.
4 +
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J.  An inventory for measuring depression . Arch Gen Psychiatry . 1961;;4:561-571.
5 +
Keller MB, Lavori PW, Friedman B, Nielsen E, Endicott J, McDonald Scott P, Andreason NC.  Longitudinal Interval Follow-up Evaluation: a comprehensive method for assessing outcome in longitudinal studies . Arch Gen Psychiatry . 1987;;44:540-548.
6 +
Guy W, Cleary PA, Close JH, Conners CK, Covi L, Derogatis LR, Fish B, Gershon S, Gittelman-Klein R, Hamilton M, Honigfeld G, Klein DF, Lipman RS, McGlashan T, Overall JE, Sprague RL, Werry J, Wittenborn JR, Yang K, Zung WW. ECDEU Assessment Manual for Psychopharmacology . Washington, DC: US Dept of Health, Education, and Welfare;1976;. DHEW publication (ADM) 76-338.
7 +
Rush AJ, Giles DE, Schlesser MA, Fulton CL, Weissenburger J, Burns C.  The Inventory for Depressive Symptomatology (IDS): preliminary findings . Psychiatry Res . 1985;;18:65-87.
8 +
Metz CE.  Basic principles of ROC analysis . Semin Nucl Med . 1978;;8:283-298.
9 +
Mossman D, Somoza E.  Maximizing diagnostic information from the dexamethasone suppression test: an approach to criterion selection using receiver operating characteristic analysis . Arch Gen Psychiatry . 1989;;46:653-659.
10 +
Hsiao JK, Bartko JJ, Potter WZ.  Diagnosing diagnoses: receiver operating characteristic methods and psychiatry . Arch Gen Psychiatry . 1989;;46:664-667.
11 +
Keller MB, Lavori PW, Lewis CE, Klerman GL.  Predictors of relapse in major depressive disorder . JAMA . 1983;;250:3299-3304.

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