7 x 11 longassets.cambridge.org/97805211/31247/index/9780521131247_index.pdf · Addison’s disease diVerential diagnosis, 111 etiology, 111 ... apathy associated conditions, 264

Index

abnormal bereavement, 8, 9characteristics, 102classification issues, 347and cortisol levels, 36diagnostic criteria, 23diagnostic issues, 36and melancholia, 36–37, 46, 97

Abrams, R., 19, 27Accreditation Council of Graduate Medical

Education (ACGME) (USA), 352ACTH see adrenocorticotropic hormone (ACTH)AD see Alzheimer’s disease (AD)Addison’s disease

diVerential diagnosis, 111etiology, 111

adjustment disorder with depressed mood, 47, 97adolescents, 102diVerential diagnosis, 101–102and suicide risk, 102

adolescentsadjustment disorder with depressed mood, 102cognitive-behavior therapy, 245electroconvulsive therapy, 165–70case studies, 168–70eYcacy, 165–67, 244safety issues, 165manic-depressive illness, 245melancholia, 103–104comorbidity, 91–93, 103pharmacotherapy, 244–50prevalence, 103recommendations, 250sample heterogeneity, 245–46psychotherapy, 244–45

adrenalectomy, 62adrenal glands

atrophy, 62and stress, 62–63

adrenocorticotropic hormone (ACTH), 64and pregnancy, 33release, 64and stress responses, 309

adrenocorticotropin see adrenocorticotropichormone (ACTH)

AEPs see auditory evoked potentials (AEPs)

aVective disorders, convulsive therapy, 155aVective reactions, 8African-Americans, suicide rates, 126agitation

with melancholia, suicide risk assessment,135–36

symptoms, 16agomelatine, 290Akiskal, H. S., 21alcohol abuse

and depressive mood disorders, 255, 301and melancholia, 108–109pharmacotherapy, 255–56and sleep, 357and suicide risk, 137

alcoholism, genetic factors, 255Alzheimer’s disease (AD)

diVerential diagnosis, 106with melancholia, pharmacotherapy, 260–61and pseudodementia, 261diVerential diagnosis, 118, 158

American Academy of Child and AdolescentPsychiatry, 165

American College of Obstetricians andGynecologists, 291

American Journal of Psychiatry, 200, 288American Psychiatric Association (APA), 6, 8

classification issues, 365dexamethasone suppression test assessment, 70suicidal patient guidelines, 143Task Force on ECT, 167recommendations, 182see also Diagnostic and Statistical Manual ofMental Disorders (DSM)

amines, secondary vs tertiary, 199, 211Amish, suicide risk, 136amitriptyline, 50

eVectiveness, 202–203adolescents, 247eVects on suicide rates, 140studies, 141and electroconvulsive therapy compared, 157with haloperidol, 224melancholia treatment, 211studies, 54

522

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amobarbital, electroencephalographystudies, 323

amygdalametabolism, 318–19and stress responses, 308–11

Angst, J., 21animal studies

abnormal neuroplasticity, 314–15noradrenergic dysfunction, 314reward mechanisms, 315serotonin function, 312–13stress responses, 306, 308

anterior cingulate cortex, volume reduction,317–18, 319

anterior insular cortex, increased metabolism,319–20

anticonvulsantsapproved, 50diabetes with melancholia treatment, 264–65eVects on seizure, 188eYcacy, 24epilepsy with melancholia treatment, 260in mania treatment, 23manic-depressive illness treatment, 228–29neonatal issues, 242

antidepressants, 5–6Alzheimer’s disease with melancholia

treatment, 261with antipsychotics, 223–24approved, increase, 50comparisonsbiased, 197, 198, 199–01methodology issues, 200placebo eVects, 200–201unfavorable, 198controlled studiesbias, 198limitations, 197reviews, 199volunteer criteria, 198diabetes with melancholia treatment, 264–65dosing issues, 214, 247–48drug–drug interactions, 265drug-switching, 213–14, 217–18eVects on glucocorticoid receptors, 311eVects on suicide rates, 140–42meta-analyses, 140–41studies, 142eYcacy, tricyclics vs SSRIs, 201–204fetal safety issues, 243and glucose metabolism, 226mania induction, 22–23incidence, 22and manic-depressive illnessmood switch risk, 225–26treatment, 226–27marketing strategies, 51medical illness with melancholia treatment,

261–62meta-analyses, 197, 199–00, 201–204novel, and industry influences, 197–99overdose, lethality, 142–43postpartum depression treatment, 163

prescriptions, 50, 141–42selection criteria, 240side-eVects, 205simultaneous application, 217and suicide prevention, 132teratogenicity, 240–41thyroid disease with melancholia

treatment, 265use of term, 7–8vs electroconvulsive therapy, 156, 157, 158, 161,

188–90in pregnancy, 164suicide risk, 159see also monoamine oxidase inhibitors

(MAOIs); selective serotonin reuptakeinhibitors (SSRIs); tricyclic antidepressants(TCAs)

antipsychoticswith antidepressants, 223–24approved, 50drug augmentation, 217drug–drug interactions, 265fetal safety issues, 243indications, 223–24side-eVects, 223, 224use of term, 7–8

anxiety disordersdiVerential diagnosis, 109with melancholia, suicide risk assessment,

135–36anxious depression, 54–55APA see American Psychiatric Association (APA)apathetic syndromesdiVerential diagnosis, 109–13and neurologic diseases, 113–18

apathyassociated conditions, 264symptoms, 112

apolipoprotein E4 gene, and Alzheimer’sdisease, 106

approach–withdrawal theories, of hemispherespecialization, 322

Arateus, on melancholia, 3Archives of General Psychiatry, 200aripiprazole, 224Ashby, D., 141–42Asperger syndrome, with melancholia, 104atypical depression, 9, 54, 97age of onset, 98comorbidity, 98diVerential diagnosis, 98–99prevalence, 98symptoms, 98, 278treatment, 99see also seasonal aVective disorder (SAD)

auditory evoked potentials (AEPs), 323–24advantages, 324limitations, 324mood disorder studies, 324

Australiaantidepressant studies, 202electroconvulsive therapy studies, 166suicide rates, 126, 140–41

523 Index






autismwith melancholia, 104treatment, 104

avolitional syndromes, diVerential diagnosis,112–13

Baillarger, Jules-Gabriel-Francois, 4, 18Baltimore Epidemiologic Catchment Area

(USA), 252basal ganglia disease, diVerential

diagnosis, 291Baxter, Richard, on melancholia, 3BDI see Beck Depression Inventory

(BDI)BDNF see brain-derived neurotrophic factor

(BDNF)BDRS (Brief Depression Rating Scale), 94Bech–Rafaelsen Melancholia Scale

(BRMS), 94Beck Depression Inventory (BDI), 50, 93

applications, 94behavior disorders, classification, 1Benazzi, F., 21, 55Bennett, A. E., 153benzodiazepines

and breast-feeding, 244in catatonia diagnosis, 31, 161eVectiveness, elderly, 253eVects on seizure, 188and fetal safety, 239

bereavementuse of term, 46–47see also abnormal bereavement

Berger, Hans, 321, 323beta-blockers, eVects on seizure, 188Bethlem Hospital, 4bilateral electroconvulsive therapy

(BL-ECT), 184energy dosing, 186and right unilateral electroconvulsive therapycompared, 184

biological clock, 356bipolar depression, 8, 46

antidepressant-induced, 22–23early studies, 19electroconvulsive therapy, 172–74case studies, 173–74

bipolar disordersBipolar I, 8–9, 19studies, 21Bipolar II, 8–9, 19longitudinal studies, 20–21studies, 21case studies, 22diagnostic criteria, 8–9, 18psychopathologic studies, 20

bipolarity, lack of support for, 24bipolar–unipolar dichotomy

clinical studies, 20–22criticisms, 19, 20early studies, 19research issues, 21vs continuum model, 19–20

bipolar–unipolar overlap, 23issues, 24studies, 21twin studies, 23

BL-ECT see bilateral electroconvulsive therapy(BL-ECT)

borderline personality disorder, 99BPRS (Brief Psychotic Rating Scale), 166bradykinesia, 88bradykinetic syndromes, diVerential diagnosis,

112–13bradyphrenia, 88brain

feedback mechanisms, 63see also hemispheres

brain-derived neurotrophic factor (BDNF),315–16

abnormalities, 316and reward mechanisms, 315

brain injuryand depressive mood disorders, 317see also traumatic brain injury (TBI)

brain metabolism, abnormal, in melancholia,318–20, 332, 343

brain structureabnormalin melancholia, 317–18, 329, 346postmortem studies, 317–18

breast cancer, drug-induced, 224breast-feeding

melancholia in, pharmacotherapy, 239–44and psychotropic drugs, 243–44

brief depression, 46diVerential diagnosis, 101

Brief Depression Rating Scale (BDRS),applications, 94

Brief Psychotic Rating Scale (BPRS), 166brief recurrent depression, 9Bright, Timothy, on melancholia, 3Britain see United Kingdom (UK)British Journal of Psychiatry, 288BRMS (Bech–Rafaelsen Melancholia Scale), 94brofaromine, 290bromocriptine

drug augmentation, 216Parkinson’s disease with melancholiatreatment, 259

Brooklyn State Hospital (USA), 154bupropion, 225

eVectiveness, elderly, 253heart disease with melancholiatreatment, 262–63

mania induction, 23in smoking cessation therapy, 256trials data, 350

Burke, W. J., 203Burton, Robert, on melancholia, 3

California (USA)electroconvulsive therapy, adolescents, 165Medicaid, 270

cAMP see cyclic adenosine monophosphate(cAMP)

524 Index






Canada, electroconvulsive therapy studies, 166cancers

breast cancer, 224and depression risk, 111

Cannon, Walter, 62–63Capgras syndrome, and psychotic depression, 30carbamazepine

drug–drug interactions, 265in mania treatment, 23manic-depressive illness treatment, 229neonatal issues, 242

Cardiazol see pentylenetetrazolcardiovascular disease

and electroconvulsive therapy, 170with melancholia, pharmacotherapy, 262–64see also heart disease

Carroll, Bernard J., 64–65, 66, 68, 75on dexamethasone suppression test, 66, 69,

70–71Carroll Rating Scale (CRS), 94

applications, 94catalepsy, 30catatonia, 9, 46, 88

antidepressant treatment, 161case studies, 30–31, 32diagnosis, 31diagnostic criteria, 25diVerential diagnosis, 30, 161electroconvulsive therapy, 161–63case studies, 162–63eYcacy, 161malignant, 161and melancholia, 30, 32, 97pharmacotherapy, 224–25retarded, 162symptoms, 31, 161

CBT see cognitive-behavior therapy (CBT)CCKs (cholecystokinins), 317central nervous system (CNS), and

hypothalamic–pituitary–adrenal axis, 64cerebral hemispheric instability, and

manic-depressive illness, 329–30cerebrovascular disease, elderly, 105cerebrovascular stroke, diVerential diagnosis, 114CFS (chronic fatigue syndrome), 112characterological conditions, and

electroconvulsive therapy, 171–72characterological depression, 46Charney, D. S., 57chemical messengers, 63chemical neurotransmission, 62child abuse

identifying, 357stress responses, 306

Child and Adolescent Consortium (USA),electroconvulsive therapy studies, 165–66

childhood stress, and melancholia, 306children

cognitive-behavior therapy, 245of depressed mothers, 305–306electroconvulsive therapy, 165–70case studies, 168–70eYcacy, 167, 244

manic-depressive illness, 245marital conflict eVects on, 306melancholia, 103–104comorbidity, 91–93, 103pharmacotherapy, 244–50prevalence, 103prevention, 354–58recommendations, 250sample heterogeneity, 245–46psychotherapy, 244–45temperament, 302

Children’s Depression Rating Scale-Revised, 248China, suicide rates, 125chlordiazepoxide, eVectiveness, children and

adolescents, 249chlorpromazinedrug–drug interactions, 265mood disorder treatment studies, 7–8in postpartum depression treatment, 36

cholecystokinins (CCKs), roles, 317chromosome 12, 362chronic depression, diVerential diagnosis, 101chronic fatigue syndrome (CFS), and melancholia,

diVerential diagnosis, 112chronicity, prevention, 358chronic renal disease, and depression risk, 111cimetidine, drug–drug interactions, 265circadian cyclesand CLOCK genes, 361–62fetus, 356and melancholia, 310

citalopramand breast-feeding, 243–44eVectiveness, 203children and adolescents, 248eVects on suicide rates, 141heart disease with melancholia treatment,

263, 264Parkinson’s disease with melancholia

treatment, 259post-stroke depression treatment, 258

clinical examination, 85–95cognition, 90–91mood, 87, 441personality disorders, 91psychomotor functioning, 88for psychotic features, 89–90, 441strategies, 86–87, 446for suicidal thoughts, 90for vegatitive signs, 88–89

CLOCK genes, 361ethnic and racial diVerences, 361localization, 361mutations, 361

clomipramineeVectiveness, 203adolescents, 248epilepsy with melancholia treatment, 260

clonidine, in smoking cessation therapy, 256clozapine, 223–24drug–drug interactions, 265

CME (continuing medical education), 352CNS (central nervous system), 64

525 Index






cocaine, and depressive mood disorders, 256cocaine withdrawal

comorbidity, 109and melancholia, diVerential diagnosis, 109–10pharmacotherapy, 256

Cochrane Collaboration, 199, 203cognition, clinical examination, 90–91cognitive-behavior therapy (CBT)

in depression treatment, 218eVectivenessadolescents, 245children, 245, 248in postpartum depression treatment, 243

cognitive deficitsin melancholia, 327–28studies, 327–28

Colorado (USA), electroconvulsive therapy,adolescents, 165

comas, 30see also insulin coma

complicationsmelancholic patientsrecommendations, 266–68

consent issues, electroconvulsive therapy,162, 167

continuing medical education (CME),programs, 352

continuous positive airway pressure (CPAP), 269convulsive therapy, 6–7

aVective disorder treatment, 155early studies, 153–55, 161fear of treatment, 183manic-depressive illness treatment, earlystudies, 153–54

mechanisms, future studies, 353–54melancholia, 346mood disorder treatment, 154see also electroconvulsive therapy (ECT);pentylenetetrazol

Cook, L. C., 153CORE study, 158, 160, 171, 189corpus callosum

reduced volume, 306, 317–18and reduced metabolism, 319

corticotropin see adrenocorticotropichormone (ACTH)

corticotropin-releasing factor (CRF), 64corticotropin-releasing factor-1 receptor

antagonists, 363corticotropin-releasing hormone (CRH)

and pregnancy, 33release, 64and stress responses, 309–11

corticotropin-releasing hormoneantagonists, 363

cortisolassays, 66inhibition, 64levelsand abnormal bereavement, 15–36and depression, 65, 66and premenstrual dysphoric disorder, 102and stress, 302

and pregnancy, 33resistance, 311suppression, 354urinary free, 67

Cotard syndromecase studies, 29diagnostic criteria, 29electroconvulsive therapy, 30and psychotic depression, 29–30

CPAP (continuous positive airway pressure), 269CREB (cyclic AMP response element-binding

protein), 362CRF see corticotropin-releasing factor (CRF)CRH see corticotropin-releasing

hormone (CRH)Crohn’s disease, and depression, 111CRS see Carroll Rating Scale (CRS)crying, pathological, 116Culture and Depression, 51Cushing’s syndrome, 62

diVerential diagnosis, 111etiology, 111and hypercortisolemia, 64

cyclic adenosine monophosphate(cAMP), 360

abnormalities, 311cyclic AMP response element-binding protein

(CREB), 362cyclothymia, use of term, 18cyclothymic disorder, 8–9CYP2D6 gene, 359cytokines

abnormalities, and depression, 63in depressed patients, 364roles, 363–64

D2-receptor genes, 362D3-receptor genes, 362Danish University Antidepressant

Group, 203dawn simulation, 285DeCarolis, V., 157de Clerambault syndrome, and psychotic

depression, 30delirium

case studies, 128–29electroencephalography, 321

delivery, and postpartum blues, 33delusional depression

diagnostic criteria, 25–26see also psychotic depression

delusionsmood-congruent, 26–27nihilistic, 29see also mood-incongruent delusions

delusions of negation, case studies, 29dementia

diVerential diagnosis, 117–18electroencephalography, 321with melancholia, pharmacotherapy,260–61

see also Alzheimer’s disease (AD);pseudodementia

526 Index






dementia praecox, 4and catatonia, 161and manic-depressive illness compared, 18–19see also schizophrenia

demyelinating disease, diVerentialdiagnosis, 116

depressed mothers, 305–306studies, 354–58

depressed patientscompliance issues, 358cytokines in, 364electroencephalography studies, 321–23sleep disturbances, 73, 325suicide rates, 125see also melancholic patients

depressionanxious, 54–55chronic, 101classification, 46–51future trends, 346–49issues, 46–48cognitive-behavior therapy, 218concept of, expansion, 50and cortisol levels, 65, 66and Crohn’s disease, 111delusional, 25–26diagnostic criteria, 7, 46–51choices, 47in clinical practice, 47cross-sectional vs longitudinalapproaches, 55–56

industry influences, 50–51limitations, 48–50diagnostic issues, 62epidemic, 50–51genetic risk factors, 543geriatric, 9interpersonal therapy, 218involutional, 9irritable, 54and Lyme disease, 111and mania, 4, 18markers, 63, 66, 77, 325neurobiologic, 328mild, 51, 54non-nuclear, 57nuclear, 57and pancreatic carcinoma, 111post-schizophrenia, 106prevalence, 49–50psychotherapies, 2rating scales, 91–95reactive, 3, 8relapse, 73risk factors, 358seizure-related, 117sleep electroencephalography studies, 73–74,

75, 76subsyndromal, 46superimposed, 106and syphilis, 111and thyroid-stimulating hormone

levels, 72

and thyrotropin-releasing hormonelevels, 72

treatment, issues, 47twin studies, 49use of term, 15as buzzword, 51Meyer’s views, 6and vascular disease, 106vital, 8see also atypical depression; bipolar depression;

brief depression; depressive mood disorders;double depression; endogenomorphicdepression; endogenous depression;major depression; manic depression;melancholia; minor depression; neuroticdepression; non-melancholic depression;postpartum depression; post-psychoticdepression; post-stroke depression;prepartum depression; psychoticdepression; puerperal depression;treatment-resistant depression(TRD); unipolar depression;vascular depression

depression with catatonia or stupor, as severemelancholia, 30

Depression Interview and StructuredHamilton, 92

depression-like syndromes, and neurologicdiseases, 113–18

depressive mood disorders, 9and alcohol abuse, 255, 301and brain injury, 317classification issues, 25–26, 346–49diagnosis, 24, 85diVerential diagnosis, 5elderly, 105family studies, 299–01genetic factors, 255genetic studies, 348and lupus erythematosus, 111melancholia as, 45, 58mild, 46misdiagnosiscase studies, 130and suicide risk, 129–30and multiple sclerosis, 116and nicotine, 256non-melancholic, 97diVerential diagnosis, 98–03norepinephrine function, Table 14.3, 304pathophysiology, 298prevention, and sleep, 356–57as reactions, 6and reward mechanisms, 315risk factors, 111serotonin function, Table 14.2, 313and stress, 129–30misdiagnosis, 129and stroke, 317and substance abuse, 256and suicide risk, 125threshold model, 56treatment

527 Index






depressive mood disorders (cont.)algorithms, 47–48issues, 8, 47twin studies, 301, 303under-diagnosis, 126–29clinical ambiguities, 127studies, 127unrecognizedcase studies, 127, 128–29suicide risk, 126–29see also melancholia

depressive reactions, 46diagnostic criteria, 8

depressive spectrum disease, 19depressive stupor

electroconvulsive therapy, 161–63pharmacotherapy, 224–25

desipraminecomparative studies, 199–00eVectiveness, 202–203alcoholics, 255melancholia treatment, 211studies, 202

dexamethasone, 64in cortisol suppression, 65

dexamethasone/corticotropin-releasing-horm(DEX/CRH) test, 63

applications, 71sensitivity, 71–72

dexamethasone suppression test (DST), 26assessment studies, 69–71children and adolescents, 245development, 64–65diagnostic issues, 66–67, 108as diagnostic screening test, 68–69and electroconvulsive therapy, 68outcomes evaluation, 181limitations, 62, 63, 69, 109non-suppression, incidence, 69and Parkinson’s disease, 115and pregnancy, 33principles, 65–66prognostic value, 68re-examination, 63rejection, 71schizophrenia diagnosis, 107–108with sleep electroencephalography, 75studies, 67–69meta-analyses, 67and suicide risk, 68, 138–39technical issues, 66validation, 66

DEX/CRH test see dexamethasone/corticotropin-releasing-hormone(DEX/CRH) test

dextroamphetamine, drug augmentation, 216diabetes, with melancholia, pharmacotherapy,

264–65Diagnostic and Statistical Manual of Mental

Disorders (DSM)classification issues, future trends, 346–49, 365cross-sectional approach, criticisms, 55–56depression, 46–51

choices, 47, 536classification issues, 46–48diagnostic criteria limitations, 48–50future trends, 346–49limitations, 348validity issues, 49melancholia, future trends, 348–49

Diagnostic and Statistical Manual of MentalDisorders (DSM-I) (1952), 6

depressive reactions, 8Diagnostic and Statistical Manual of Mental

Disorders (DSM-II) (1968), 6, 8criticisms, 8depression, 7reliability issues, 8

Diagnostic and Statistical Manual of MentalDisorders (DSM-III) (1980), 8

bipolar disorder, 18major depression, 18melancholia, 55mood-congruence, 26–27mood disorders, 8psychotic disorders, 25

Diagnostic and Statistical Manual of MentalDisorders (DSM-IIIR) (1987), 8

mood disorders, 9Diagnostic and Statistical Manual of Mental

Disorders (DSM-IV) (1994)abnormal bereavement, 23depressive disorders, criticisms, 103limitations, 2, 9mood disorders, 9psychotic disorders, 25, 106

Diagnostic and Statistical Manual of MentalDisorders (DSM-V), proposals, 9

diVerential diagnosis, melancholia, 58, 97–18diphenhydramine, drug–drug interactions, 265Donovan, S., 141dopamine dysfunction

and melancholia, 315postmortem studies, 315

dopaminergic agents, 290dorsolateral prefrontal cortex, reduced

metabolism, 319dosing issues

antidepressants, 214, 247–48elderly, 250

double depression, 9, 100diVerential diagnosis, 101treatment resistance, 101

dramatic-emotional personality disorders,comorbidity, 109

Drevets, W. C., 312drug abuse, and melancholia, pharmacotherapy,

255, 256drug augmentation

limitations, 216limitation trials, 214–15options, 216–17see also lithium augmentation

drug–drug interactions, 265elderly, 250in melancholia treatment, 265, 650

528 Index






drug metabolismand pharmacogenetics, 359–60studies, 359

drug overdose, antidepressants, 142–43drug overuse, and melancholia, diVerential

diagnosis, 110drug-related depressive-like states, diVerential

diagnosis, 109–10drugs

in electroconvulsive therapy, 188mood disorder induction, 110, 655

drug-switchingantidepressants, 213–14, 217–18in melancholia treatment, 221trials, 214–15

DSM see Diagnostic and Statistical Manual ofMental Disorders (DSM)

DSM-I see Diagnostic and Statistical Manual ofMental Disorders (DSM-I) (1952)

DSM-II see Diagnostic and Statistical Manual ofMental Disorders (DSM-II) (1968)

DSM-III see Diagnostic and Statistical Manual ofMental Disorders (DSM-III) (1980)

DSM-IIIR see Diagnostic and Statistical Manual ofMental Disorders (DSM-IIIR) (1987)

DSM-IV see Diagnostic and Statistical Manual ofMental Disorders (DSM-IV) (1994)

DSM-V see Diagnostic and Statistical Manual ofMental Disorders (DSM-V)

DST see dexamethasone suppression test (DST)dysrhythmias, electroencephalography, 321dysthymia, 8, 46, 97

classification issues, 347diagnostic criteria, 100–101diVerential diagnosis, 100–101treatment, 101–10

ECT see electroconvulsive therapy (ECT)ECT Review Group (UK), 156Edinburgh Postnatal Depression Scale, 94EEG see electroencephalography (EEG)ego, 6Einheitspsychose, 4, 35elderly

antidepressants, meta-analyses, 200cerebrovascular disease, 105depressive mood disorders, 105dosing issues, 250drug–drug interactions, 250electroconvulsive therapy, 170–71case studies, 170–71manic-depressive illness, lithium treatment,

227–28melancholia, 104–106case studies, 170–71comorbidity, 105continuation treatment, 254maintenance treatment, 254mortality rates, 250pharmacotherapy, 250–54prevalence, 104–105recommendations, 254risk factors, 105

pharmacotherapyissues, 250–51responsiveness, 251suicide prevention errors, 126and vascular brain disease, 251vascular disease, 106

electroconvulsive therapy (ECT)adolescents, 165–70case studies, 168–70eYcacy, 165–67, 244safety issues, 165advantages, 182, 224applicability, 156–57availability, recommendations, 352barriers to, 174benefits, 187bipolar depression treatment, 172–74case studies, 173–74and cardiovascular disease, 170catatonia treatment, 161–63case studies, 162–63eYcacy, 161and characterological conditions, 171–72children, 165–70case studies, 168–70eYcacy, 167, 244concurrent medications, 188consent issues, 162, 167continuationstrategies, 188–90studies, 189contraindications, 184Cotard syndrome treatment, 30course design, 187–88current, AC vs square wave, 184depressive stupor treatment, 161–63and dexamethasone suppression test, 68early studies, 155eVectiveachieving, 181–90issues, 190eVective seizures, characterization, 185eYcacy, 24, 202optimal, 354elderly, 170–71case studies, 170–71electrode placement, 184bilateral, 184right unilateral, 184electrode selection, 186energy dosing, 186epilepsy with melancholia treatment, 260failure to administer, and suicide

risk, 134ineVective, studies, 187–88mechanisms, 353–54neuroendocrine hypothesis, 353neurohumoral theory, 353–54neurophysiologic hypotheses, 353melancholia treatment, 174, 221case studies, 157eVectiveness, 155–57, 211issues, 174

529 Index






electroconvulsive therapy (ECT) (cont.)mild/moderate melancholia treatment, 230and neurologic traits, 171–72case studies, 171–72outcomes, 181characteristics, 715, 716clinical criteria, 182laboratory tests, 181patient selection, 181–83and personality disorders, 172postpartum depression treatment, 36,163–65case studies, 164–65post-stroke depression treatment, 258and pregnancy, 163–65psychosis studies, 25psychotic depression treatment, 157–59, 223case studies, 158–59eYcacy, 157, 158relapse rates, 154, 188–89remission rates, 181age diVerences, 182issues, 187–88response issues, 182–83risk factors, 183, 184and schizophrenia treatment, 162seizuresduration, 185optimization, 185–86side-eVects, minimization, 101–84stigmatization, 156, 174and suicide prevention, 132and suicide risk, 159–61case studies, 160–61technical issues, 183–90training recommendations, 351–52and transcranial magnetic stimulationcompared, 286–87

treatment frequency, 186–87and treatment-resistant depression,272–73

unipolar depression treatment, 172–74vs antidepressants, 156, 157, 158, 161,188–90in pregnancy, 164suicide risk, 159vs pentylenetetrazol, 154see also bilateral electroconvulsive therapy(BL-ECT); right unilateral electroconvulsivetherapy (RUL-ECT)

electroencephalography (EEG), 63activated, 323–27medication induction, 323advantages, 320arousal issues, 323depressed patient studies, 321–23drug eVects, 322early applications, 321early studies, 321in electroconvulsive therapy, 185–86electrode placement issues, 322and melancholia, 321melancholia studies, 72–73

non-activated, 321see also sleep electroencephalography

electrophysiologic abnormalities, in melancholia,320–27

electrophysiologic measures, and melancholia,72–76

emotional incontinence, 116emotional lability, 116emotions

expressed, 358processing, hemispheric diVerences, 329regulation, 364

empirical approachlimitations, 52to syndromes, 52

endocrinology, historical background, 62endocrinopathies, and melancholia,

diVerential diagnosis, 111endogenomorphic depression, 9

concept of, 67endogenous depression, 8

use of term, 54see also melancholia

endophenotype, 331–32England and Wales, suicide rates, 126Enhancing Recovery in Coronary Heart Disease

(ENRICHD) trial, 263environmental factors

genetically influenced, 303interuterine, 304in melancholia, 303–307, 332–33and temperament, 302

epilepsycase studies, 116–17diVerential diagnosis, 116–17electroencephalography, 321with melancholia, pharmacotherapy, 260

epinephrine, isolation, 62episodic memory, impairment, 327eptapirone, 290estrogen

eVects on serotonin, 307, 313and melancholia, 307in melancholia treatment, 291

Euro-Americans, suicide rates, 125, 126Europe, depression, prevalence, 50examination (clinical) see clinical

examinationexcitatory amino acids, and melancholia, 316exorcism, 3expressed emotions, 358

facial expressions, and mood, 87Falret, Jean Pierre, 18

on melancholia, 4familial pure depressive disease, 19family background, and suicide risk, 135–36family studies, depressive mood disorders,

299–01fathers, depressed, and genetic vulnerability,

305–306Feighner criteria, 51Feinberg, M., 75

530 Index






fetuscircadian cycles, 356drug safety issues, 239–40, 243intrauterine stress responses, 304malformations, 240–41sleep and, 356–57

Fink, Max, 7–8Finland

depression studies, 354–55electroconvulsive therapy, and suicide risk,

159–60firearms

access removal, 145and suicide, 125–26, 133, 137case studies, 133

fluoxetineand breast-feeding, 243drug–drug interactions, 265eVectiveness, 202–203, 204adolescents, 249children, 248elderly, 253eVects on suicide rates, 140, 141heart disease with melancholia

treatment, 263neonatal issues, 241and placebo response, 201post-stroke depression treatment, 258side-eVects, 205studies, 202

flupenthixol, eVects on suicide rates, 140fluvoxamine

drug–drug interactions, 265eVects on suicide rates, 141

folate deficiency, and depression risk, 111folic acid, in pregnancy, 242follow-up studies, inadequate, and suicide risk,

132–33France

antidepressants, prescription increases, 50electroconvulsive therapy studies, 166–67

Freemantle, N., 199–00Freud, Siegmund, melancholia theories, 6frontal lobe disease

diVerential diagnosis, 113–14, 814symptoms, 113–14

GABAergic agents, 290GAF (Global Assessment of Function), 202Galen, 3Ganser syndrome, and psychotic depression, 30Geddes, J., 203genetic factors

alcoholism, 255and depression risk, 543depressive mood disorders, 255manic-depressive illness, 330melancholia, 298, 299–03,

331–32, 361temperament, 332see also heritability

genetic vulnerability, 299–01, 331–32depressed fathers, 305–306

depressed mothers, 305–306mechanisms, 362

gepirone, 290geriatric depression, 9Geriatric Depression Scale, 94Germany, St. John’s wort studies, 293Glasgow Depression Scale, 94Global Assessment of Function

(GAF), 202glucocorticoid receptors (GRs)abnormal functioning, 311antidepressant eVects, 311cortisol resistance, 311reduced, 310–11type I, 308type II, 308

glucocorticoidsadaptive eVects, 308–309animal studies, 308overexposure eVects, 309roles, 308synthetic, 64

glucocorticosteroid receptor agonists, inmelancholia treatment, 289–90

glucose metabolismand antidepressants, 226decrease, 319elevated, 318–19and sleep, 325

glutamate NMDA, 290glutamate signaling modifiers, 363Goodwin, F. K., 19–20on antidepressant-induced mania, 22

G-protein, 362Greenblatt, M., 156GRs see glucocorticoid receptors (GRs)Gunnell, D., 141–42guns see firearms

Hadzi-Pavlovic, D., 25–26, 53hallucinations, 89haloperidol, with amitriptyline, 224HAMD see Hamilton Rating Scale for

Depression (HRSD)Hamilton Rating Scale for Depression (HRSD),

91–93, 137, 171applications, 94–95in electroconvulsive therapy studies, 158, 160,

165, 171limitations, 92shorter versions, 93, 847

Harris, GeoVrey, 62Haslam, John, on melancholia, 4HD see Huntington’s disease (HD)health professionalsaccreditation, 351educationelectroconvulsive therapy training,351–52

in mood disorders, 351–52heart diseasewith melancholiamortality rates, 262

531 Index






heart disease (cont.)pharmacotherapy, 262–64see also cardiovascular disease

heart failure, risks, 262hemispheres

emotion-processing, 329specialization, approach–withdrawaltheories, 322

hemispheric instability, and manic-depressiveillness, 329–30

hemispheric sleep phase coherence, 326sex diVerences, 326

herbal remedies, for melancholia, 292–94heritability

estimates, 300melancholia, 346neurogenesis, 363and temperament, 302see also genetic factors

Hickie, I., 202Hill, Sir John Denis Nelson, 5–6hippocampus, neurogenesis, 363Hippocrates, on melancholia, 2–3histrionic personality disorder, 98Hoch, August, case studies, 32homeostatic functions, perturbations, 88–89HOPA gene, polymorphisms, 362Hopewell-Ash, Edwin Lancelot

on melancholia, 5Melancholia in Everyday Practice (1934),16, 17

hormonal changesduring pregnancy, 33and puerperal psychosis, 36

hormonesimbalance, 111and melancholia, 306–307in melancholia treatment, 291–92systemic eVects, 63therapeutic replacement, 62see also adrenocorticotropic hormone(ACTH); corticotropin-releasing hormone(CRH); thyroid-stimulating hormone(TSH); thyrotropin-releasing hormone(TRH)

hospitalizationfailurecase studies, 133and suicide risk, 133–34suicidal melancholic patients, 143–45guidelines, 143indications, 143and suicide risk, 135, 143–44

HPA axis see hypothalamic–pituitary–adrenal(HPA) axis

HPGH (hypothalamic–pituitary–growthhormone) system, 63

HPT axis see hypothalamic–pituitary–thyroid(HPT) axis

HRSD see Hamilton Rating Scale forDepression (HRSD)

5-HT1A (5-b-hydroxytryptamine receptor 1)agonists, 290

5-HT2A receptor gene, 359–605-HT see serotonin5-HTT gene, 303Huntington’s disease (HD)

diVerential diagnosis, 115–16with melancholia, pharmacotherapy, 259–60

Huston, P. E., 15517-hydroxycorticosteroids, and mood

disorders, 645-hydroxytryptamine (5-HT) see serotonin5-b-hydroxytryptamine receptor 1 (5-HT1A)

agonists, 2905-hydroxytryptamine receptors, 5HT1A,

310–11hyperadrenalism, and insomnia, 62hypercortisolemia, 64

as depression marker, 66, 77hyperglycemia, 264hypericum, in melancholia treatment, 292–93hyperparathyroidism

diVerential diagnosis, 111etiology, 111

hypnotics, and fetal safety, 239–40hypomania, 21hypothalamic hormones, in electroconvulsive

therapy evaluation, 186hypothalamic–pituitary–adrenal (HPA) axis, 63

abnormalities, 298diagnostic issues, 66–67, 78hyperactivity, 219and melancholia, 64–72overactivity, 364and stress response,307–308, 363mechanisms, 311suppression, 65targeting, 363use of term, 64

hypothalamic–pituitary–growth hormone(HPGH) system, 63

hypothalamic–pituitary–thyroid (HPT)axis, 63

evaluation, 72functions, 72and melancholia, 72

hypothalamusas biological clock, 356and stress responses, 309

hypothyroidismcomorbidity, 72with melancholia, pharmacotherapy, 265

hysteroid dysphoria, 98–99

ICD-8 see International Classification ofDiseases (ICD-8)

ICD-10 see International Classification ofDiseases (ICD-10)

id, 6imipramine, 50

drug-switching, 214eVectivenessalcoholics, 255children, 246, 247, 248

532 Index






eVects on electroconvulsive therapy, 188–89and electroconvulsive therapy compared, 157manic-depressive illness treatment, 227melancholia treatment, 211mood disorder treatment studies, 7–8psychosis studies, 25severe melancholia treatment, 230

immune response system, and melancholia,363–64

implicit memory, 327inflammatory markers

abnormalities, 63and depression, 63

inflammatory response, 363–64inpatient care, suicidal melancholic patients,

143–45insanity

circular, 4classification, 3–4

insomnia, and hyperadrenalism, 62insulin, discovery, 62insulin coma, 6–7

treatment, 62International Classification of Diseases

(ICD-8), 55psychotic disorders, 106reliability issues, 8

International Classification of Diseases(ICD-10)

limitations, 2melancholia, 26

interpersonal therapy, in depressiontreatment, 218

inter-rater reliability, 200interuterine factors, 304involuntary commitment

and suicide risk, 133–34case studies, 133

involutional depression, 9iproniazid, 50irritable depression, 54

Jamison, K. R., 19–20on antidepressant-induced mania, 22

Japan, depression, epidemic, 50–51Johns Hopkins Hospital (USA), Henry Phipps

Psychiatric Clinic, 154–55Journal of the American Medical Association,

The, 198

Kahlbaum, Karl, 18catatoniacase studies, 30–31research, 30

Kalinowsky, L. B., 155kava, side-eVects, 294Kayser–Fleischer rings, 116Kendell, R. E., 53

on structured interviews, 85two depression factors, 53, 54–55

Kendler, K. S., 27, 300ketoconazole, in melancholia

treatment, 290

Kirsch, I., 199Klein, D. F., 7–8, 98–99Kleinman, Arthur, 51Kraepelin, Emilon manic-depressive illness, 18–19melancholia theories, 4–5criticisms, 6

laboratory tests, and melancholiadefined, 62–78

lamotrigine, 225, 290manic-depressive illness treatment, 229severe melancholia treatment, 230

late-life depression see vascular depressionlaughing, pathological, 116left hippocampal cortex, reduced metabolism, 319Leonhard, Karl, 23manic-depressive illness theories, 19

lesopitron, 290leucotomy, 6–7Levinson, D. F., 300Lewis, Aubrey, on melancholia, 5lidocaine, eVects on seizure, 188light therapy (LT), 362dawn simulation, 285melancholia, 284–85

Linnaeus, Carolus, 1lithium, 50eVects on electroconvulsive therapy, 189eVects on suicide rates, 139–40eYcacy, 23, 24in electroconvulsive therapy, 188,

189–90manic-depressive illness treatment, 227in melancholia treatment, 211mild/moderate melancholia treatment, 230neonatal issues, 242severe melancholia treatment, 230

lithium augmentation, 215–16dose–response characteristics, 215eVectiveness, 215–16in melancholia treatment, 220–21side-eVects, 216

Locher, L. M., 155Loewi, Otto, 62London, Bethlem Hospital, 4lorazepamin catatonia diagnosis, 31in catatonia treatment, 225

LT see light therapy (LT)lupus erythematosus, and depressive mood

disorders, 111Lyme disease, and depression, 111

MADRS (Montgomery–Asberg DepressionRating Scale), 93

magnetic resonance imaging (MRI)in catatonia diagnosis, 31cerebrovascular disease studies, 105in epilepsy studies, 117

magnetic seizure therapy (MST)in melancholia treatment, 288safety issues, 288

533 Index






major depression, 3, 9case studies, 48–49comorbidity, 301diagnostic criteria, 8, 18, 48–49non-melancholic, 97diVerential diagnosis, 99–00treatment, issues, 51

major depression superimposed upondelusional disorder, 46

see also schizophreniamajor depressive disorder, 9

studies, 21malarial fevers, 6–7males, over 50 years of age, suicide risk, 136–37malignant catatonia (MC), electroconvulsive

therapy, 161mania

antidepressant-induced, 22–23incidence, 22classification issues, 347and depression, 4, 18early studies, 19and insanity, 3–4Kraepelin’s theories, 5use of term, 4

manic depression, 4case studies, 32and Cotard syndrome, 29

manic-depressive illness, 18–24, 46adolescents, 245antidepressant treatment, 226–27and cerebral hemispheric instability, 329–30children, 245convulsive therapy, early studies, 153–54and dementia praecox compared, 18–19early studies, 173electroconvulsive therapy, 172–74genetic factors, 330neurobiologic markers, 328pharmacotherapy, 225mood switch risk, 225–26and recurrent depressive illness, 23, 301sensitization model, 328singularity, 21suicide in, 136theoriesKraepelin’s, 18–19Leonhard’s, 19twin studies, 330see also bipolar disorders

manic episodes, in melancholia, 299,328–30

manisch-depressive Irresein, 4MAOIs see monoamine oxidase inhibitors

(MAOIs)maprotiline, epilepsy with melancholia

treatment, 260marital conflict, eVects on children, 306maternal care, 305–306Maudsley Hospital (UK), 53Mayo Clinic (USA), electroconvulsive therapy

studies, 166MC (malignant catatonia), 161

Mecholyl (methacholine) test, 181Medicaid (USA), 270medical illness

and melancholia, 110–12with melancholia, pharmacotherapy, 261–65and suicide risk, 137–38

medical practitioners see health professionalsmedications see drugsMedline

melancholia citations, 47trials data, 350

Meduna, Ladislas, 153melancholia

and abnormal bereavement, 36–37, 46, 97abnormal brain metabolism, 318–20, 332, 343abnormal brain structure, 317–18, 329, 346abnormal neurochemical functioning, 311–17in adolescents, 103–104pharmacotherapy, 244–50recommendations, 250with agitation, suicide risk assessment, 135–36and alcohol abuse, 108–109pharmacotherapy, 155–55, 256with anxiety, suicide risk assessment, 135–36with Asperger syndrome, 104with autism, 104behavioral characteristics, Table 3.4biological studies, issues, 299case studies, 16–18early, 16, 17and catatonia, 30, 32, 97characteristics, 15–16, 982, 346, 348and childhood stress, 306in children, 103–104pharmacotherapy, 244–50prevention, 354–58recommendations, 250and circadian cycles, 310classification, 16future trends, 346–49issues, 45simplified, 348clinical examination, 85–95strategies, 86–87, 446and cognition, 90–91cognitive deficits, 327–28studies, 327–28comorbiditychildren and adolescents, 91–93, 103elderly, 105concept of, 5criticisms, 53distinct, 51, 58origins, 2–9conceptual history, 9convulsive therapy, 346criteria, and psychotic depression, 27–29defined, 15–37by laboratory tests, 62–78by psychopathology, 59by specific event, 32–36definitions, 15, 97early, 15

534 Index






as depressive disorder, 45, 58diagnostic criteria, 62–78, 298future trends, 348–49proposals, 348–49diagnostic issues, 155diVerential diagnosis, 58, 97–18and dopamine dysfunction, 315and drug abuse, pharmacotherapy, 255, 256and drug-related depressive-like

states, 109–10early studies, 5in elderly, 104–106case studies, 253–54pharmacotherapy, 250–54recommendations, 254electroconvulsive therapy, 174, 221case studies, 157eVectiveness, 155–57, 211issues, 174outcomes, 181and electroencephalography, 321electroencephalography studies, 72–73electrophysiologic abnormalities, 320–27electrophysiologic measures, 72–76environmental factors, 303–307, 332–33genetically influenced, 303and estrogen, 307and excitatory amino acids, 316first episode, 358future trends, 365genetic factors, 298, 299–03,

331–32, 361vulnerability, 299–01glucocorticosteroid receptor agonist treatment,

289–90herbal remedies, 292–94heritability, 346historical perceptions, 45–46histories, 2and hormones, 306–307hormone therapy, 291–92and hypothalamic–pituitary–adrenal axis,

64–72and hypothalamic–pituitary–thyroid axis, 72and immune response system, 363–64and insanity, 3–4involutional, 4light therapy, 284–85magnetic seizure therapy, 288manic episodes, 299, 328–30with medical illness, 110–12pharmacotherapy, 261–65Medline citations, 47motor issues, 25–26nature of, 56–57neuroendocrine tests, 77–78with neurologic diseases, pharmacotherapy,

257–61and neuropeptides, 316–17and neurotrophic abnormalities, 316and noradrenergic dysfunction, 313–14observable features, 441and pain, 112

paradigms, 58–59pathophysiology, 298–33future trends, 360–64with personality disorders, pharmacotherapy,

265–66and personality traits, 91pharmacotherapy, 220–22, 346acute treatment, 220–21drug–drug interactions, 265, 650drug-switching, 221historical background, 196inpatient vs outpatient settings, 212long-term treatment, 211, 221–22randomized controlled trials, 196treatment recommendations, 229–30pharmacotherapy literature, validity,

196–07postmortem studies, 310, 317–18in pregnancycase studies, 240neonatal issues, 241–42pharmacotherapy, 239–44prevention, 355–56prevalencechildren and adolescents, 103elderly, 104–105early, 354–58future, 354–58and sleep, 356–57and pseudodementia, 90in psychiatric classification, 7–9and psychomotor disturbance, 55, 57, 88psychopathological validity, 53–56post-1980 literature, 54–56pre-1980 literature, 53–54and psychosis, 16, 55and psychotherapy, 218–19and psychotic depression, 24–30, 97with psychotic disorders, 106–108suicide risk assessment, 135–36and puerperal depression, 36, 97recognition, 348remission, 181goals, 349–50reviews, 2and schizophrenia, diVerential diagnosis,

106–108and serotonin dysfunction, 312–13and sleep apnea, 112, 269and sleep disturbances, 269sleep electroencephalography studies, 73–76,

325–26stress responsesabnormal, 307–11genetically influenced, 303mechanisms, 311subtypes, 97suicide in, 125–45as syndrome, 58targeted neurotransmitter system agent

treatment, 290temperamental risk factors, 302theories

535 Index






melancholia (cont.)Freud’s, 6Kraepelin’s, 4–5transcranial magnetic stimulation, 286–88treatmentalgorithms, 348, 364–65options, 346proposals, 284–94treatment trials, recommendations, 350tricyclic antidepressant treatment,206–207

and triiodothyronine, 307use of term, 1, 4advantages, 2, 16historical background, 45Meyer’s views, 6vagal nerve stimulation, 289vs psychodynamic theories, 6–7see also depression; endogenous depression;mild/moderate melancholia; severemelancholia

melancholia with psychosis see psychoticdepression

melancholic patientscognitive deficits, 327–28compliance issues, 358memory deficits, 327pharmacotherapy, 211–30acute treatment, 211–19augmentation limitation, 214–15continuation treatment, 211, 219–20, 254drug-switching trials, 214–15issues, 211lithium augmentation, 215–16maintenance treatment, 219–20, 254with psychotherapy, 218–19rapid response, 212–14recommendations, 266–68relapse rates, 219–20treatment recommendations, 229–30treatment resistance, 212–13psychotherapy, with pharmacotherapy,218–19

see also depressed patients; suicidalmelancholic patients

melancholy, definitions, 15memory deficits, melancholic patients, 327men, over 50 years of age, suicide risk,

136–37Mendel, Gregor Johann, 1mental disorders

natural vs unnatural, 3and witchcraft, 3

metabolismstress eVects on, 62–63see also brain metabolism; drugmetabolism; glucose metabolism

methacholine test, 181N-methyl-D-aspartate (NMDA), 363

binding, 316methylphenidate, drug augmentation, 216Metrazol see pentylenetetrazolMexicans, suicide rates, 126

Meyer, Adolf, 16on depressive disorders, 6

mianserin, eVects on suicide rates, 140mice, stress response studies, 303mifepristone, in melancholia treatment, 289–90mild depression, 51, 54mild/moderate melancholia

electroconvulsive therapy, 230treatment recommendations, 229–30

Miller, F. T., 202Mini-Mental State Examination (MMSE),

91, 252minor depression, 46

classification issues, 347–48diVerential diagnosis, 101

mirtazapineeVectiveness, 204melancholia treatment, 211overdose, 142

MMSE (Mini-Mental State Examination),91, 252

moclobemide, 290eVectiveness, elderly, 254manic-depressive illness treatment, 227

monoamine deficit theory, 312monoamine oxidase inhibitors (MAOIs)

approved, 50atypical depression treatment, 99drug augmentation, 217eVectiveness, 202children and adolescents, 249elderly, 254and electroconvulsive therapy compared, 156mania induction, 22manic-depressive illness treatment, 226overdose, lethality, 142–43

Montgomery–Asberg Depression Rating Scale(MADRS), 93

moodclinical examination, 87and facial expressions, 87screening questions, 87and sleep deprivation, 326–27

mood-congruence, of psychoticthoughts, 26–27

mood-congruent delusions, 26–27mood disorder due to a general medical

condition, 46mood disorders

classification, 1–2, 9, 18by treatment, 5–6issues, 347, 365simplification, 9convulsive therapy, 154diagnostic criteria, 8dichotomy issues, 21drug-induced, 655health professional education, 351–52neuroendocrine tests, 62–63not otherwise specified, 46pregnancy-related, 33–36psychotic, 25sensory evoked potentials studies, 324

536 Index






treatment, early, 357–58see also adjustment disorder with depressed

mood; depressive mood disorders; puerperalmood disorders

mood-incongruent delusions, 26–27as mood disorders, 27reviews, 27studies, 27

mood quality, and melancholia, 348mood stabilizers, 23, 227–29

drug–drug interactions, 265neonatal issues, 242–43severe melancholia treatment, 230

motherspsychotic, studies, 354see also depressed mothers

MRI see magnetic resonance imaging (MRI)MST see magnetic seizure therapy (MST)multiple sclerosis (MS), and depressive mood

disorders, 116Myerson, A., 154myxedema, 62

naltrexone, in alcoholism treatment, 255National Comorbidity Survey (USA), 300National Institute of Mental Health (NIMH)

(USA)antidepressant guidelines, 196depression studies, 56–57electroconvulsive therapy studies, 173and STEP-BD algorithm, 23

NE see norepinephrine (NE)NEDDI (Newcastle Endogenous Depression

Diagnostic Index), 94nefazodone

eVectiveness, 205, 224side-eVects, 205–206

Nelson, J. C., 57neonates

issues, 241–42premature, 304risk factors, 304

Netherlands, The, depression studies, 55neurobiologic markers, of manic-depressive

illness, 328neurochemical functioning, abnormal, in

melancholia, 311–17neurocognitive abnormalities, 26neuroendocrine abnormalities, 26

as markerslimitations, 63re-examination, 63and sleep electroencephalography studies, 63

neuroendocrine hypothesis, 353neuroendocrine tests, 24

advantages, 77–78as melancholia indices, 348in mood disorders, 62–63

neuroendocrine variables, and sleep variables,74–75

neurogenesisheritability, 363in hippocampus, 363

neurohumoral theory, 353–54neuroleptic malignant syndrome (NMS)diVerential diagnosis, 161–62electroconvulsive therapy, 162

neurologic diseasesand apathetic syndromes, 113–18and depression-like syndromes, 113–18with melancholia, pharmacotherapy, 257–61

neurologic illness, and suicide risk, 137–38neurologic traitsand electroconvulsive therapy, 171–72case studies, 171–72

neuropeptides, and melancholia, 316–17neuropeptide Y, roles, 317neurophysiologic hypotheses, 353neuroplasticityabnormal, animal studies, 314–15enhancement, 362–63impairment, 362

neurosyphilis, 1neurotic depression, 8Kendell’s studies, 53

neurotoxic eVectsprevention, 363reduction, 362–63

neurotrophic abnormalities, and melancholia, 316newborn see neonatesNewcastle Endogenous Depression Diagnostic

Index (NEDDI), 94New England Journal of Medicine, The, 198New Jersey Medicare (USA), 224New York City (USA)electroconvulsive therapyservices, 351–52studies, 187

nicotine, and depressive mood disorders, 256NIMH see National Institute of Mental Health

(NIMH) (USA)NMDA see N-methyl-D-aspartate (NMDA)NMS see neuroleptic malignant syndrome (NMS)non-melancholic depression, 54diagnostic criteria, 25–26diVerential diagnosis, 98–03

non-psychotic depression, diVerentialdiagnosis, 26

non-psychotic melancholia, diagnosticcriteria, 25–26

non-tricyclic antidepressants, vs selectiveserotonin reuptake inhibitors, 204–206

noradrenergic agents, 290noradrenergic dysfunctionanimal studies, 314and melancholia, 313–14

norepinephrine (NE)dysfunction, and melancholia, 313–14eVects on glucocorticoid receptor

functioning, 311function, in depressive mood

disorders, 313–14norepinephrine–serotonin interactions,

314–15nortriptylinecomparative studies, 199–00

537 Index






nortriptyline (cont.)eVectiveness, 203, 204, 313children, 246elderly, 251, 252, 253eVects on electroconvulsive therapy, 189in electroconvulsive therapy, 189–90heart disease with melancholiatreatment, 262–63, 264

in melancholia treatment, 211, 221with perphenazine, 224post-stroke depression treatment, 258studies, 202

NREM sleepand glucose metabolism, 325studies, 76

obsessive-compulsive disorder (OCD), diVerentialdiagnosis, 108

olanzapine, 225drug augmentation, 217drug–drug interactions, 265Huntington’s disease with melancholiatreatment, 260

side-eVects, 223–24olanzapine-fluoxetine, 23omega-3 fatty acids, in melancholia

treatment, 293oneiroid states, 107oneirophrenia, 34orbital cortex, volume reduction, 318organic solvent abuse, and melancholia,

diVerential diagnosis, 110Othello syndrome, and psychotic

depression, 30outpatients

inadequate follow-upcase studies, 133and suicide risk, 132–33suicidal melancholic patients, 144–45

over-the-counter drugs, and melancholia,diVerential diagnosis, 110

pain, and melancholia, 112pancreatic carcinoma, and depression, 111parenting issues, 305–306Parker, G., 25–26, 53, 68, 199, 202Parkinson’s disease (PD)

comorbidity, 115and dexamethasone suppression test, 115diVerential diagnosis, 115with melancholia, pharmacotherapy, 258–59

paroxetinedrug–drug interactions, 250eVectiveness, 203adolescents, 248children, 248eVects on electroconvulsive therapy, 188–89eVects on suicide rates, 140, 141studies, 141heart disease with melancholia treatment,262–63, 264

Parkinson’s disease with melancholiatreatment, 259

severe melancholia treatment, 230side-eVects, 205

paternal modulation, 305–306pathological mood, definition, 15patient non-compliance, 220

prevention strategies, 358patient selection, for electroconvulsive therapy,

181–83Paxil, usage, 50–51Paykel, E. S., 53–54pCREB (phosphorylated cyclic AMP response

element-binding protein), 360PD see Parkinson’s disease (PD)PDD see premenstrual dysphoric disorder (PDD)pentylenetetrazol, 153

aVective disorder treatment, 155early studies, 153–55seizure induction, 161vs electroconvulsive therapy, 154

perphenazine, with nortriptyline, 224Perris, C., 23personality disorders

borderline, 99clinical examination, 91and depression diagnosis, 55–56dramatic-emotional, 109and electroconvulsive therapy, 172histrionic, 98with melancholia, pharmacotherapy, 265–66premorbid, 265–66

personality traitsand melancholia, 91see also temperament

pharmaceutical industryconflict-of-interest issues, 198recommendations, 350–51influences, and novel antidepressants, 197–99and sponsor roles, 198treatment eYcacy standards, 199recommendations, 350–51

pharmacogenetics, future trends, 359–60pharmacotherapy

future research standards, 349–51inadequatecase studies, 132and suicide risk, 132, 141for melancholic patients, 211–30in complicating circumstances, 465with psychotherapy, 218–19

pharmacotherapy literature, in melancholia,validity, 196–07

phenelzine, 50eVectiveness, children and adolescents, 249

phenytoin, drug–drug interactions, 265phosphorylated cyclic AMP response

element-binding protein (pCREB), 360pindolol, drug augmentation, 216pituitary gland, hypothalamic control, 62PKA (protein kinase A), 360Plutarch, on melancholia, 3post-concussion syndrome, symptoms, 115posterior orbital cortex, increased metabolism,

319–20

538 Index






posterior ventrolateral prefrontal cortex, volumereduction, 318

postpartum blues, 33postpartum depression, 9, 46

antidepressant treatment, 163electroconvulsive therapy, 36, 163–65case studies, 164–65incidence, 33light therapy, 285and melancholia, 46pharmacotherapy, 243psychotherapy, 243risk factors, 35–36treatment outcomes, 36

postpartum non-psychotic melancholia,definition, 34

post-psychotic depression, 46diagnostic criteria, 106

post-schizophrenia depression, diagnosticcriteria, 106

post-stroke depressionpharmacotherapy, 257–58

post-traumatic stress disorder (PTSD), casestudies, 130

prednisolone, 64pregnancy

and electroconvulsive therapy, 163–65fetal monitoring, 164vs antidepressants, 164hormonal changes, 33melancholia incase studies, 240neonatal issues, 241–42pharmacotherapy, 239–44prevention, 355–56treatment-withholding eVects, 240and mood disorders, 33–36

premature births, 304premenstrual dysphoric disorder (PDD), 46

comorbidity, 102diVerential diagnosis, 102–103etiology, 102inheritance, 102treatment, 103twin studies, 102

prepartum depressionlight therapy, 285psychotherapy, 243risks, 240

prescription drugs, and melancholia,diVerential diagnosis, 110

Preskorn, S. H., 202procylidine, mood disorder treatment studies, 7–8progesterone

decrease, 36eVects on serotonin, 313in melancholia treatment, 291–92

protein kinase A (PKA), responses, 360Protheroe, C., 34protriptyline, melancholia treatment, 211pseudodementia

and Alzheimer’s disease, 261diVerential diagnosis, 118, 158

and melancholia, 90use of term, 90

Psychiatric Annals, 2psychiatric disorderscauses, single vs many, 4diagnostic issues, 62

psychoactive drugsdrug–drug interactions, 265studies, 197

psychodynamic theories, vs melancholia, 6–7psychoeducation, 23see also psychotherapy

psychological autopsies, 126psychomotor disturbancedefinition, 16factors, 57and melancholia, 55, 57, 88, 348

psychomotor functioning, clinicalexamination, 88

psychomotor retardation, 53, 55, 57psychopathologyand melancholiadefined, 59validity, 53–56

psychosis, 8case studies, 32detection issues, 26diagnostic criteria, 25and melancholia, 16, 55, 348and schizophrenia, 25see also puerperal psychosis

psychotherapyadolescents, 244–45children, 244–45eVects on suicide rates, 140and melancholia, 218–19with pharmacotherapy, 218–19postpartum depression, 243prepartum depression, 243psychoeducation, 23

psychotic depression, 8, 46, 54antidepressant/antipsychotic treatment,

223–24case studies, 28–29, 89–90, 223classification issues, 347comorbidity, 30and Cotard syndrome, 29–30diagnostic criteria, 25–26diVerential diagnosis, 26, 97–08electroconvulsive therapy, 157–59, 223case studies, 158–59eYcacy, 157, 158historical background, 24–26Kendell’s studies, 53and melancholia, 24–30, 97criteria, 27–29mortality rates, 222pharmacotherapy, 222–23relapse rates, 26studies, 26suicide rates, 223and suicide risk, 89treatment, 108

539 Index






psychotic disordersclassification, 106issues, 25clinical examination, 89–90diagnostic criteria, 25with melancholia, 106–108suicide risk assessment, 135–36prevention, 354

psychotic mood disorder, classificationissues, 25

psychotic thoughts, mood-congruence, 26–27psychotropic drugs

and breast-feeding, 243–44and fetal safety, 239–40, 243

PTSD (post-traumatic stress disorder), 243puberty, biological diVerences, 245–46puerperal depression, 33–36

case studies, 34classification issues, 35, 206incidence, 35and melancholia, 36, 97

puerperal mood disordersand melancholia, 36prevention, 357

puerperal psychosis, 34and hormonal changes, 36

puerperal psychotic depression, diagnosticcriteria, 33–34

Puerto Ricans, suicide rates, 126

quetiapine, 224Quitkin, F. M., 98–99

R121919, 363rapid cycling, 8–9rating scales, 91

applications, 94–95of depression, 91–95and diagnostic criteria, 85limitations, 85–86

RDC see Research Diagnostic Criteria (RDC)reactive depression, 3, 8recurrent depressive illness, and manic-depressive

illness, 23, 301remacemide, 290REM latency, 73, 205

as depression marker, 74, 325shortened, 326and suicide risk, 138

Research Diagnostic Criteria (RDC), 8, 51depression studies, 55

retardationand melancholia, 45–46psychomotor, 53, 55, 57symptoms, 16

reward mechanismsand depressive mood disorders, 315potentiation, 315

rheumatoid arthritis, and depression risk, 111right unilateral electroconvulsive therapy

(RUL-ECT), 184and bilateral electroconvulsive therapycompared, 184

disadvantages, 184energy dosing, 186

risperidonedrug augmentation, 217drug–drug interactions, 265eVectiveness, 224

risperidone/fluvoxamine, 217Rotterdam (Netherlands), 35RU486 (mifepristone), 289–90RUL-ECT see right unilateral electroconvulsive

therapy (RUL-ECT)Rush, A. J., 57

SAD see seasonal aVective disorder (SAD)SADHEART (Sertraline Antidepressant Heart

Attack Randomized Trial), 263–64SADS see Schedule for AVective Disorders and

Schizophrenia (SADS)St. John’s wort

in melancholia treatment, 292–93side-eVects, 293

Schedule for AVective Disorders andSchizophrenia (SADS), 50

depression studies, 55, 56–57schizoaVective disorders, 25schizophrenia, 46

and dexamethasone suppression test, 107–108diagnostic criteria, 25early studies, 24–25and electroconvulsive therapy, 162and melancholia, diVerential diagnosis,106–108

and psychosis, 25symptoms, 106–107transatlantic diVerences, 25see also dementia praecox

SCN (suprachiasmatic nucleus), 356seasonal aVective disorder (SAD), 97

comorbidity, 99concept of, 99–00diagnostic criteria, 100diVerential diagnosis, 99–00genetic factors, 361light therapy, 284–85

seasonal disorders, 9, 46seizures

drug eVects on, 188electroencephalography, 321pentylenetetrazol-induced, 161

selective serotonin reuptake inhibitors (SSRIs), 50development, 312eVectiveness, 202, 312children and adolescents, 244, 248–49elderly, 253–54issues, 312–13eVects on sleep, 357eVects on suicide rates, 140, 141studies, 141–42and electroconvulsive therapy compared, 156limitations, 197manic-depressive illness treatment, 226neonatal issues, 241–42overdose, lethality, 142–43

540 Index






Parkinson’s disease with melancholiatreatment, 259

and placebo response, 201vs non-tricyclic antidepressants, 204–206vs tricyclic antidepressants, 196, 198–00,

201–204, 206–207selegiline, Parkinson’s disease with melancholia

treatment, 259Selye, Hans, 62–63sensitization model, of manic-depressive

illness, 328sensory evoked potentials (SEPs), 323–26

mood disorder studies, 324serotonin

dysfunction, and melancholia, 312–13estrogen eVects on, 307, 313functionanimal studies, 313–12in depressive mooddisorders, 312–13

levels, and suicide risk, 138serotonin reuptake transporter

(SERT), 359–60sertraline

and breast-feeding, 244drug-switching, 214eVectiveness, 204adolescents, 248children, 248elderly, 251, 253eVects on suicide rates, 141heart disease with melancholia treatment,

263–64mania induction, 23Parkinson’s disease with melancholia treatment,

258–59post-stroke depression treatment, 258studies, 202

Sertraline Antidepressant Heart AttackRandomized Trial (SADHEART),263–64

SERT (serotonin reuptake transporter), 359–60serum prolactin, in electroconvulsive therapy

evaluation, 186severe melancholia

abnormal brain structure, 320depression with catatonia or stupor as, 30pharmacotherapy, 222–29treatment recommendations, 230

sex diVerencessleep electroencephalography, 76suicide rates, 125

SFBN (Stanley Foundation Bipolar Network),22–23

signal transduction, abnormalities, 360single photon emission computed tomography

(SPECT), 117sleep

and fetal development, 356–57and melancholia prevention, 356–57

sleep apneaand melancholia, 112, 269symptoms, 112

sleep deprivation, and mood, 326–27sleep disturbancesdepressed patients, 73, 325–27drug-induced, 205–206and melancholia, 269and relapse, 73and sleep electroencephalography, 326and suicide risk, 138see also hemispheric sleep phase coherence

sleep electroencephalographyadvantages, 78, 320depression studies, 73–74, 76sex diVerences, 76with dexamethasone suppression test, 75discriminant index scores, 73hemisphere coherence, 76as melancholia indices, 348melancholia studies, 73–76,

325–26and neuroendocrine abnormalities, 63and sleep disturbances, 326

sleep laboratory tests, 24sleep variables, and neuroendocrine

variables, 74–75smoking cessation, strategies, 256solvent abuse, and melancholia, diVerential

diagnosis, 110SPECT (single photon emission computed

tomography), 117sporadic pure depressive disease, 19SSRIs see selective serotonin reuptake inhibitors

(SSRIs)Stanley Foundation Bipolar Network

(SFBN), 22–23STEP-BD algorithm, 23stimulantsdrug augmentation, 216post-stroke depression treatment, 258

stresschildhood, 306cycles of, 332–33and depressive mood disorders, 129–30misdiagnosis, 129eVects on metabolism, 62–63

stress responsesabnormal, in melancholia, 307–11animal studies, 306, 308child abuse, 306genetically influenced, 303intrauterine, 304mechanisms, 307–11, 363murine studies, 303neurotoxic eVects, reduction, 362–63physiologic eVects, 308and sympathetic arousal, 309and temperament, 302

strokeantidepressant prophylaxis, 257–58cerebrovascular, 114and depressive mood disorders, 317with melancholia, pharmacotherapy,

257–58see also post-stroke depression

541 Index






structured interviewslimitations, 85procedures, 85

stuporcase studies, 32diVerential diagnosis, 30

Styron, William, and melancholia, 18sub-Saharan Africa, suicide rates, 125substance abuse

and depressive mood disorders, 256drugs, 255, 256solvents, 110and suicide risk, 137see also alcohol abuse

substance-induced mood disorder, 46substance P, roles, 317subsyndromal depression, 46succinylcholine, 183suicidal melancholic patients

case studies, 125contact schedules, 145hospitalization, 143–45guidelines, 143indications, Table 7.3, 143inpatient care, 143–45management, 143–45case studies, 145outpatient care, 144–45removal of lethal means, 145supervision, 145symptom relief, 145

suicidal thoughtsand alcohol use, 137case studies, 131clinical examination, 90communication, 131concealed, 131and decreased capacity, 127

suicideand firearms, 125–26, 133, 137case studies, 133in manic-depressive illness, 136in melancholia, 125–45

suicide preventionand antidepressants, 132errors in, 126–31measures for, 138

suicide ratesage diVerences, 125, 126antidepressant treatment eVects, 140–42depressed patients, 125ethnic and racial diVerences, 126global estimates, 125lithium treatment eVects, 139–40psychotic depression, 223sex diVerences, 125and treatment type, 139–43

suicide riskand adjustment disorder with depressedmood, 102

and alcohol abuse, 137antidepressants vs electroconvulsivetherapy, 159

case studies, 132, 133, 137and depressive mood disorders, 125and dexamethasone suppression test,68, 138–39

and electroconvulsive therapy, 159–61case studies, 160–61and failure to administer electroconvulsivetherapy, 134

and failure to hospitalize, 133–34and failure to recognize depressive mooddisorders, 126–29

familial, 135–36and hospitalization, 135, 143–44guidelines, 143inadequate outpatient follow-up, 132–33inadequate pharmacotherapy, 132, 141studies, 132and involuntary commitment, 133–34laboratory measures, 138–39males, over 50 years of age, 136–37and medical illness, 137–38and neurological illness, 137–38and psychotic depression, 89and serotonin levels, 138and sleep disturbances, 138and substance abuse, 137twin studies, 135–36under-diagnosis, 126–29studies, 127

suicide risk assessment, 134–36factors, 1298inadequate, 130–31case studies, 131long-term, 131training, 134–35

super-ego, 6superimposed depression, diagnostic

criteria, 106suprachiasmatic nucleus (SCN), 356Sweden, depression, prevalence, 49Swedish Birth Registry, 241sympathetic arousal, and stress

responses, 309syndromes

Asperger, 104avolitional, 113bradykinetic, 113Capgras, 30de Clerambault, 30definitions, 51–52empirical, 52expert consensus, 51–52Ganser, 30melancholia as, 58Othello, 30post-concussion, 115see also apathetic syndromes; Cotard syndrome;Cushing’s syndrome; neuroleptic malignantsyndrome (NMS)

syphiliscerebral, 4and depression, 111serological identification, 62

542 Index






T3 see triiodothyronine (T3)T4 (thyroxine), 72tachycardia, risk factors, 262TADS (Treatment for Adolescents with

Depression Study), 249targeted neurotransmitter system agents, in

melancholia treatment, 290Taylor, Michael Alan, 19, 27TBI see traumatic brain injury (TBI)TCAs see tricyclic antidepressants (TCAs)temperament

children, 302and environmental factors, 302genetic factors, 332and heritability, 302and melancholia risk, 302personality traits, 91and stress responses, 302unstable, 330use of term, 302

Tennessee (USA), electroconvulsive therapy,adolescents, 165

teratogenicity, antidepressants, 240–41testosterone, in melancholia

treatment, 292Texas (USA), electroconvulsive therapy,

adolescents, 165thalamus, and stress responses,

308, 309–11theophylline, eVects on seizure, 188thioridazine, drug–drug interactions, 265threshold model, 56, 57thrombosis, risk factors, 262thyroid, functions, 72thyroid disease

diVerential diagnosis, 111etiology, 111with melancholia, pharmacotherapy, 265

thyroid dysfunction, and treatment-resistantdepression, 272

thyroid function tests, 63thyroid-stimulating hormone (TSH), 72

levelsand depression, 72and mania, 330and melancholia, 307

thyrotropin-releasing hormone(TRH), 72

levels, and depression, 72and melancholia, 307

thyroxine (T4), release, 72TMS see transcranial magnetic

stimulation (TMS)topiramate, 290transcranial magnetic stimulation (TMS)

eVectiveness, 287–88and electroconvulsive therapy compared,

286–87in melancholia treatment, 286–88

transcription cascades, 360transcription factors, 360tranylcypromine, 50

eVectiveness, children and adolescents, 249

traumatic brain injury (TBI)diVerential diagnosis, 115with melancholia, pharmacotherapy, 261

trazodone, side-eVects, 205–206TRD see treatment-resistant depression (TRD)Treatment for Adolescents with Depression Study

(TADS), 249treatment algorithms, 47–48, 348, 364–65STEP-BD, 23

treatment guidelines, recommendations, 351treatment resistance, 212–13treatment-resistant depression (TRD)case studies, 270comorbidity, 270–72and electroconvulsive therapy, failure to

provide, 272–73inadequate treatment, 270incorrect diagnosis, 268–70pharmacotherapy, 268–73prevention, 273and thyroid dysfunction, 272

treatment trials, recommendations, 349–51treatment type, and suicide rates, 139–43TRH see thyrotropin-releasing hormone (TRH)tricyclic antidepressants (TCAs)advantages, 197, 202approved, 50and breast-feeding, 244dosing issues, 247–48drug augmentation, 217eVectiveness, 202children, 244, 246–48elderly, 252eVects on suicide rates, 140and electroconvulsive therapy

compared, 156, 157epilepsy with melancholia treatment, 260heart disease with melancholia

treatment, 262–63mania induction, 22manic-depressive illness treatment, 226melancholia treatment, 206–207neonatal issues, 241, 242overdose, lethality, 142–43Parkinson’s disease with melancholia treatment,

258–59psychosis studies, 25secondary vs tertiary amines, 199, 211side-eVects, 205, 252, 260treatment resistance, 103vs selective serotonin reuptake inhibitors, 196,

198–00, 201–204, 206–207triiodothyronine (T3)drug augmentation, 216and melancholia, 307release, 72

tryptophan hydroxylase, 360TSH see thyroid-stimulating hormone (TSH)twin studiesbipolar–unipolar overlap, 23depression, 49depressive mood disorders, 301, 303manic-depressive illness, 330

543 Index






twin studies (cont.)premenstrual dysphoric disorder, 102suicide risk, 135–36

two depression factors, Kendell’s, 53,54–55

UFC (urinary free cortisol), 67unipolar depression, 46

early studies, 19electroconvulsive therapy, 172–74recurrent, 21subtypes, 19

unipolar disorder, psychopathologic studies, 20unitary model, 5United Kingdom (UK)

antidepressantsprescriptions issued, 141–42regulations, 141and suicide rates, 141–42

United States of America (USA)antidepressantsstudies, 142and suicide risk, 141electroconvulsive therapy, adolescents, 165St. John’s wort studies, 293suicide rates, 125, 126ethnic and racial diVerences, 126suicide risk assessment, training, 134–35

University of Melbourne (Australia), 64–65University of Michigan (USA), 64–65

electroconvulsive therapy studies, 166urinary free cortisol (UFC), 67urine copper assays, 116

vagal nerve stimulation (VNS)in melancholia treatment, 289recommendations, 289

valproic aciddrug–drug interactions, 265manic-depressive illness treatment, 228, 229severe melancholia treatment, 230

vascular brain disease, elderly, 251vascular depression

age of onset, 105use of term, 105

vascular disease, and depression, 106vasoactive intestinal polypeptide (VIP),

roles, 317

vasopressin, roles, 316–17vegetative functions, and melancholia, 16vegetative signs

clinical examination, 88–89and melancholia, 348

venlafaxinediabetes with melancholiatreatment, 264–65

eVectiveness, 202, 203, 205, 224eVects on suicide rates, 141heart disease with melancholiatreatment, 263

Huntington’s disease with melancholiatreatment, 260

mania induction, 23melancholia treatment, 211Parkinson’s disease with melancholiatreatment, 259

severe melancholia treatment, 230side-eVects, 263toxicity, 142

ventrolateral cortex, increased metabolism,319–20

VEPs see visual evoked potentials (VEPs)Veraguth’s folds, 87verbal memory, impairment, 327Verblodungsprocesse, 4VIP (vasoactive intestinal polypeptide), 317visual evoked potentials (VEPs), 323–24

mood disorder studies, 324visual memory, impairment, 327vital depression, 8VNS see vagal nerve stimulation (VNS)

warfarin, drug–drug interactions, 265Washington state (USA), 241Weissenburger, J. E. 57white matter, 116

changes, 105, 106Wilson’s disease, diVerential diagnosis, 116witchcraft, and mental disorders, 3Witzelsucht (shallow humor), 113–14World Health Organization (WHO), depression

studies, 351

ziprasidone, 224Ziskind, E., 154, 155Zung Self-rating Depression Scale (ZSDS), 94

544 Index






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7 x 11 longassets.cambridge.org/97805211/31247/index/9780521131247_index.pdf · Addison’s disease diVerential diagnosis, 111 etiology, 111 ... apathy associated conditions, 264