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Tijdschrift voor Psychiatrie 50 (2008) 3, 159 - 170

Essay

A multidimensional description and validation of two subtypes in the field of endogenous and melancholic depression

J.G. Goekoop

summary
background
It should be possible to improve the diagnosis of endogenous or melancholic depression by applying Jaspers' multidimensional model of clinical symptoms, by considering the role of vasopressinergic activity in dysregulated stress reactions and by referring to Cloninger's personality model.
method The strategy of Robins and Guze is used to develop diagnostic concepts. Melancholic depression according to dsm-iv criteria is converted into a mixture of basic symptom dimensions and this mixture is investigated for its possible links with familial depression, time needed for complete recovery, plasma vasopressin-concentration, correlated plasma vasopressin- and cortisolconcentrations, and features of temperament and character.
results Two subtypes were found. One is a highly anxious-retarded subtype, with slow recovery, a correlation between vasopressin and cortisol, low pre-morbid self-directedness and a positive family history of depression; the other is a subtype with an above-normal plasma vasopressin concentration, an anxious-retarded phenotype without an intensity threshold, correlated vasopressin- and cortisol-concentration, low pre-morbid cooperativeness and a positive family history of depression.
conclusion
A multidimensional description of clinical symptoms and personality makes it possible to integrate pathophysiological aspects into new diagnostic concepts.

keywords melancholia, anxiety, retardation, vasopressin, cortisol, family history, personality