Fifty (50) major depressive patients (15 males and 35 females) aged 41.0 ± 11.4 (range 21–60) years [9
], took part in the study. All provided written informed consent. Fourteen of them fulfilled criteria for atypical features, 16 for melancholic features (according to DSM-IV) and 32 for somatic syndrome (according to ICD-10). Nine patients did not fulfil criteria for any specific syndrome according either classification system.
Patients were in- or outpatients of the 3rd department of psychiatry, Aristotle University of Thessaloniki, Greece. They constituted consecutive cases that fulfilled the inclusion criteria and no systemic bias exists.
The SCAN v 2.0 [11
] was used for the diagnosis of depression and its subtypes and the IPDE [12
] was used for the diagnosis of personality disorders.
Seventeen patients (34%) suffered from a personality disorder (PD). Ten of them (20%) had a cluster B PD. Concerning depressive subtypes, 5 (out of 16) melancholics (26.32%), 7 (out of 14) atypicals (50%), 9 (out of 32) patients with somatic syndrome (28.13%), and 3 (out of 9) 'undifferentiated' patients (33.33%), fulfilled criteria for PD (note: patients with PD are not 5 + 7 + 9 + 3 = 24, but only 17 as mentioned above, because there is ovelapping between depressive syndromes). No patient suffered from a paranoid, schizotypal, antisocial, dissocial, narcissistic, and avoidant PD, although individual criteria were met. No criteria belonging to the schizotypal or antisocial PDs were met.
No patient fulfilled criteria for catatonic or psychotic features or for seasonal affective disorder. No patient fulfilled criteria for another DSM-IV axis-I disorder, excepting generalized anxiety disorder (N = 10) and panic disorder (N = 7). Another 5 patients had both generalized anxiety disorder and panic disorder (totally 22 patients that is 44% had some anxiety disorder).
The present study did not include a normal controls group, since the aim of the study was to compare depressive subtypes between each other.
Laboratory Testing included blood and biochemical testing, test for pregnancy, T3, T4, TSH, B12 and folic acid.
The Psychometric Assessment
included the Hamilton Depression Rating Scale (HDRS), the Hamilton Anxiety Scale (HAS), the 1965 and 1971 Newcastle Depression Diagnostic Scale (1965 and 1971-NDDS) and the Diagnostic Melancholia Scale (DMS) [15
] and the General Assessment of Functioning Scale (GAF) [16
]. An attempt was made to assess the direction of aggression of the depressed patients, with the use of the Personality Deviance Scale (PDS) [17
]. This was done mainly because the direction of aggression is considered to be a core feature for the etiopathogenesis of depression according to psychodynamic theories, but also is related to personality traits.
The PDS consists from the following subscales:
a. Extrapunitive Scale (ES) which consists of 1. HT: Hostile Thoughts and 2. DO: Denigratory Attitudes Toward other People. All these scales and subscales are scored in such a way that high scores denote lack of the characteristic.
b. Intropunitive Scale (IS), which consists of 1. LSC: Lack of Self-Confidence and DEP: Overdependency on Others. All these scales and subscales are scored in such a way that high scores denote presence of the characteristic.
c. Dominance Scale (DS) which consists of 1. MIN: Domineering Social Attitude and 2. HA: Uninhibited Hostile Acts. The MIN is scored in such a way that high scores denotes presence of the characteristic, while HA has opposite properties.
Data concerning personal and family history and stressful life events
a. age of onset b. presence of a recent suicide attempt c. history of such attempts d. The questionnaire of Holmes [18
] was used to search for stressful life events during the last 6 months before the onset of the symptomatology.
The 1 mg Dexamethasone Suppression Test (DST) protocol demands the administration of 1 mg dexamethasone per os at 23.00 of the first day, and determination of cortisol serum levels simultaneously and the next day at 16.00 and 23.00. Cortisol levels expressed in μg/dl were measured with Luminance Immunoassay (intra-essay reliability: 4.9%; inter-essay: 7.5%). Non-suppression cut-off level: 5 μg/dl.
Multiple Analysis of Variance (MANOVA) was performed with DST (suppression vs. non suppression) and Personality Disorder (present vs. absent) as factors. The dependent variables list included: Age, Age of Onset, Number of previous episodes, Number of DSM-IV Criteria, Number of atypical features, Number of melancholic features, GAF, NDDS 1965, NDDS 1971, Endogenous axis of DMS, Reactive axis of DMS, Number of stressful life events, HDRS-17, HDRS-21, HDRS Depressive index, HDRS Anxiety index, HDRS Sleep index, HDRS non-specific index, HAS, HAS Somatic subscale, HAS Psychic subscale, PDS-Hostile Thoughts Scale, PDS-Denigratory Attitude Scale, PDS-Extrapunitive Scale, PDS-Low Self Confidence Scale, PDS-Overdependency by others Scale, PDS-Intropunitive Scale, PDS-Domineering Social Attitude Scale, PDS-Uninhibited Hostile Acts Scale and PDS-Dominance Scale.
Afterwards, Analysis of Variance (ANOVA) with Least Significance Difference (LSD) test as post-hoc test was performed.
Finally, Chi-square test was performed. PD and DST were independently placed in cross-tabulation with the presence or absence of Recent Suicide Attempt, History of Suicide Attempt, Generalized Anxiety or Panic Disorder, Melancholic Features, Atypical Features, Somatic Syndrome, 'Undifferentiated' symptomatology, Full and sustained remission, With Relapsing circumscribed episodes, Chronic Depression without full remission, Presence of Stressful life events, Family history of any mental disorder, Family history of depression in 1st degree relatives, and Family history of depression in 2nd degree relatives.