No CrossRef data available.
Article contents
Mélancolie délirante: caractéristiques épidémiologiques, cliniques, biologiques et thérapeutiques
Published online by Cambridge University Press: 28 April 2020
Résumé
Les spécificités des mélancolies délirantes en regard des autres types de dépression ont fait l’objet de nombreuses recherches dont les résultats apparaissent parfois contradictoires. Sur un plan épidémiologique, les mélancolies délirantes se distinguent peu des autres types de dépression quant au sex-ratio, à l’âge de début, au nombre d’épisodes antérieurs, à l’existence d’antécédents familiaux de troubles thymiques ou quant à la prédominance des formes unipolaires ou bipolaires. Du point de vue clinique, un certain nombre d’éléments paraissent caractériser le tableau des mélancolies délirantes (importance du ralentissement psychomoteur, culpabilité accrue, humeur dépressive et agitation plus intense). D’autres paramètres sont signalés par certains auteurs, mais non par tous, comme plus particuliers à cette entité. Sur un plan biologique, certains marqueurs de la mélancolie délirante ont été isolés (MHPG-HVA plus faible, dosage de β-décarboxylase, etc). Mais aucun de ces indices, en particulier la positivité du test à la dexaméthasone n’est réellement spécifique de cette pathologie. Le traitement des mélancolies délirantes apparaît en revanche bien établi et diffère de celui des autres formes de dépression; supériorité de l’association neuroleptiques-antidépresseurs tricycliques par rapport à la monothérapie antidépressive et surtout l’électro-convulsivo-thérapie qui est fréquemment indiquée d’emblée en raison de la gravité de l’état de ces patients. Il apparaît toutefois que certaines particularités cliniques, évolutives et thérapeutiques confèrent au cadre des mélancolies délirantes une homogénéité et une spécificité suffisantes pour le distinguer du groupe des autres dépressions. Ces caractéristiques, qui sont pour la plupart des variables continues, sont de nature à situer les mélancolies délirantes dans un gradient de sévérité accru en regard des autres dépressions, plutôt que dans une dichotomie. Ces divergences de résultats observés à propos d’autres paramètres pourraient résulter d’insuffisances méthodologiques mais également de l’hétérogénéité du groupe des mélancolies délirantes. Cette dernière hypothèse paraît ouvrir les voies de recherche les plus prometteuses.
Summary
The specificities of the delusional depression as compared to other forms of depression have been the subject of a large number of contradictory results. From an epidemiological point of view, delusional depression is similar to other forms of depression for sex ratio, age of onset, number of previous episodes, family history of depression or predominance of unipolar or bipolar forms. From a clinical point of view, the delusional depressions are characterized by a few items (increased guilt, agitation, etc), but there is no general agreement on this subject. Specific biological parameters for delusional depression (lowered MHPG/HVA, β-decarboxylase level) have been put forward, none of which, particularly positivity to the dexamethasone-test, is specific for this pathology. The treatment of delusional depression is usually based on neuroleptic plus antidepressant medication and electroconvulsive therapy is often the first treatment proposed, due to the severity of symptoms presented by the patient. Some clinical, evolutional and therapeutic particularities nevertheless give delusional depression some homogeneity and specificity. We interpret them as fitting with a dimensional model. Other elements show a heterogeneity of the group of delusional depression, and research in this direction is still needed.
Keywords
- Type
- Revue
- Information
- Copyright
- Copyright © European Psychiatric Association 1990
References
Références
Akiskal, HS, Bitar, AH, Puzatian, VR (1978) The nosologie status of neurotic depression. Arch Gen Psychiatry 35, 756-766CrossRefGoogle Scholar
Akistal, HS, Puzatian, VR (1979) Psychotic forms of depression and mania. Psychiatr Clin Am 2, 419-439CrossRefGoogle Scholar
The APA task force on laboratory tests in psychiatry (1987) The dexamethasone suppression test: an Overview of its current status in psychiatry. Am J Psychiatry 144, 1253-1262CrossRefGoogle Scholar
Arana, GW, Baldessarini, RJ, Ornsteen, M (1985) The dexamethasone suppression test for diagnosis and prognosis in psychiatry. Arch Gen Psychiatry 42, 1193-1204CrossRefGoogle Scholar
Arana, GW, Baldessarini, RJ (1987) Clinical use of the DXM suppression test in psychiatry. In: Psychopharmacology: The Third Generation in Progress. (Meltzer, H Y, éd) Raven Press, New York, 609–615Google Scholar
Ayuso-Gutierrez, JL, Garcia-Camba, JE, Olmo, J (1982) Dexamethasone suppression test in patients with delusional and non delusional endogenous depression. XIIIe congres du CINP, JérusalemGoogle Scholar
Aronson, T, Sheekla, S, Hoff, A, Cook, B (1988) Proposed delusional depression subtype : preliminary evidence from a retrospective study of phenomenology and treatment course. J Affective Disor 14, 69-74CrossRefGoogle Scholar
Avery, D, Winokur, G (1977) The efficacy of electroconvulsive therapy and antidepressants in depression. Biol Psychiatry 12, 507-524Google ScholarPubMed
Avery, D, Lubrano, A (1979) Depression treated with imipramine and ECT : The De Carolis study reconsidered. Am J Psychiatry 136, 559-562CrossRefGoogle Scholar
Benadon-Barreau, V (1989) Traitement des mélancolies délirantes. Ann Psychiatr A, 266–271Google Scholar
Brockington, IF, Kendell, RE, Kellett, JM, Curry, SH, Wainright, S (1978) Trials of lithium, chlorpromazine and amitriptyline in schizo-affective patients. Br J Psychiatry 133, 162-168CrossRefGoogle Scholar
Brown, WA, Shuey, I (1980) Response to dexamethasone and subtype of depression. Arch Gen Psychiatry 37, 745-751CrossRefGoogle ScholarPubMed
Brown, R, Fances, A, Kocsis, J, Mann, J (1982a) Psychotic vs non psychotic depression : Comparison of treatment response. J Nerv Ment Dis 170, 635-637CrossRefGoogle Scholar
Brown, R, Kocsis, J, Cohen, SK (1982b) Delusional depression and inappropriate antidiuretic hormone secretion. Biol Psychiatry 18, 1059-1063Google Scholar
Carroll, BJ, Curtis, G, Mendels, J (1976a) Neuroendocrine regulation in depression : 1. Limbic System adrenocortical dysfunction. Arch Gen Psychiatry 33, 1039—1044CrossRefGoogle Scholar
Carroll, BJ, Curtis, GC, Mendels, J (1976b) Neuroendocrine regulation in depression: 2. Discrimination of depressed from non depressed patients. Arch Gen Psychiatry 33, 1051-1058CrossRefGoogle Scholar
Carroll, BJ, Greden, JF, Feinberg, M, James, N, Haskett, RF, Steiner, M, Tarika, J (1980) Neuroendocrine dysfunction in genetic subtype of primary unipolar depression. Psychiatr Res 2, 251-258CrossRefGoogle Scholar
Carroll, BJ, Feinberg, M, Greden, JF (1981) A specifie laboratory test for the diagnosis of melancolia. Arch Gen Psychiatry 38, 15-22CrossRefGoogle Scholar
Charney, DS, Nelson, JC (1981) Delusional and non delusional depression. Further evidence for distinct subtypes. Am J Psychiatry 138, 328-333Google Scholar
Cooper, JE, Kendeli, RF, Gurland, BJ (1972) Psychiatrie diagnosis in New York and London: a comparative study of mental hospital admissions. In: Mandsley Monograph Series No 20, Oxford University Press, LondonGoogle Scholar
Coryell, W, Tsuang, MT (1982a) Primary unipolar depression and the pronostic importance of delusions. Arch Gen Psychiatry 39, 1181-1184CrossRefGoogle Scholar
Corryel, W, Gaffney, G, Burkhardt, PE (1982b) The dexamethasone suppression test and familial subtypes of depression. A naturalistic replication. Biol Psychiatr 17, 33-40Google Scholar
Coryell, W, Pfohl, B, Zimmerman, M (1984) The clinical and neuro-endocrine features of psychotic depression. J Nerv Ment Disord 172, 521-528CrossRefGoogle Scholar
Coryell, W, Endicott, J, Keller, M, Andreasen, N (1985a) Phenomenology and family history in DSM III psychotic depression. J Affective Disord 9, 13-18CrossRefGoogle Scholar
Coryell, W, Zimmerman, M, Pfohl, B (1985b) Short term prognosis in primary and secondary major depression. J Affective Disora 9, 265-270CrossRefGoogle Scholar
Davidson, JRT, McLeod, M, Kurland, AA, White, HL (1977) Antidepressant drug therapy in psychotic depression. Br J Psychiatry 131, 493-496CrossRefGoogle ScholarPubMed
De, Carolis M (1987) ECT : A last resort treatment for resistant depression? In: Treating resistant depression, Zohar, J, Belmaker, RH, RMA publishing crp, New York, 163–174Google Scholar
D’Elia, G, Ohoson, JO, Stromgren, LS (1983) Present practice of electro-convulsive therapy in Scandinavia. Arch Gen Psychiatry 40, 577-581CrossRefGoogle Scholar
Evans, DL, Nemeroff, CB (1983) Use of the dexamethasone suppression test using DSM III criteria on an inpatient psychiatrie unit. Biol Psychiatry 18, 505-511Google Scholar
Fanget, F, Bissuel, Y, Marie-Cardine, M (1986) Intérêt des faibles doses de Dogmatil dans le traitement des états dépressifs. Sem Hôp Paris 62, 69-72Google Scholar
Fink, M (1987) Convulsive therapy in affective disorders: A decade of understanding and acceptance. In: Psychopharmacology : The Third Generation of Progress (Herbert, Y, Meltzer, M, eds), Raven Press, New York, 1071–1076Google Scholar
Frances, A, Brown, RP, Kocsis, JH, Mann, JJ (1981) Psychotic depression: a separate entity? Am J Psychiatry 138, 831-833Google ScholarPubMed
Frangos, E, Athanassenas, G, Tsitourides, S, Psilolignos, P, Katsanou, N (1983) Psychotic depressive disorder. A separate entity? J Affective Disord 5, 259-265CrossRefGoogle ScholarPubMed
Gerhson, E, Hamovitt, J, Guroff, J, Dibble, E, Lerckx-Man, J, Sceery, W, Targum, S, Nurenberger, J, Goldin, I, Bunney, W (1982) A family history of schizo-affective, bipolar I, bipolar II, unipolar and normal control probands. Arch Gen Psychiatry 39, 1157-1167CrossRefGoogle Scholar
Glassman, A, Kantor, S, Shostak, M (1975) Depression, delusions and drug response. Am J Psychiatry 132, 716-719Google ScholarPubMed
Glassman, A, Roose, SP (1981) Delusional depression: a distinct clinical entity? Arch Gen Psychiatry 38, 424-427CrossRefGoogle ScholarPubMed
Goldberg, IK (1980) Dexamethasone suppression test as indicator of safe with drawal of antidepressant therapy. Lancet i, 81–61Google Scholar
Granier, F, Schmitt, L, Girard, M, Escande, M, Chap, H (1985) Intérêt et limites du test à la dexaméthasone dans les troubles de l’humeur. Sem Hôp Paris 14, 915-919Google Scholar
Helms, P, Smith, R (1983) Recurrent psychotic depression evidence of diagnostic stability. J Affective Disord 5, 51-54CrossRefGoogle ScholarPubMed
Hodern, A, Holt, HF, Burt, CG, Gordon, WF (1963) Amitryptyline in dépressive cases. Br J Psychiatry 109, 815-825Google Scholar
Hollister, LE, Overall, JE, Pokony, AD, Shelton, J (1971) Acetophenazine and diazepam in anxious depressions. Arch Gen Psychiatry 24, 273-278CrossRefGoogle ScholarPubMed
Homans, S, Lachenbruch, PA, Winokur, G, Clayton, P (1982) An efficacy study of electroconvulsive therapy and antidepressants in the treatment of primary depression. Psychol Med 12, 615-624CrossRefGoogle Scholar
Howarth, B, Grace, M, Eng, P (1985) Depression, drugs and delusions. Arch Gen Psychiatry 42, 1145-1147CrossRefGoogle ScholarPubMed
Jouvent, R (1985) Critiques d’une approche nosologique des mélancolies délirantes. In: Les séminaires du GIRAD 1983-1984. Euthérapie éditeur, Paris, 25–32Google Scholar
Kantor, SJ, Glassman, AF (1977) Delusional depressions: natural history and responses to treatment. Br J Psychiatry 131, 351-360CrossRefGoogle Scholar
Kaskey, GB, Nasr, S, Meltzer, HY (1980) Drug treatment in delusional depression. Psychiatr Res 1, 267-277CrossRefGoogle Scholar
Kathol, R, Winokur, G (1977) “Organic” and “Psychotic” symptoms in unipolar (UP) versus bipolar (BP) depressions. Compr Psychiatry 18, 251-253CrossRefGoogle Scholar
Kendell, RE (1981) L’échec des méthodes statistiques multivariées à résoudre nos difficultés de classification. In: La symptomatologie dépressive (Pichot, P, Pull, C, éds), Ciba Geigy, Paris131–134Google Scholar
Kettering, RL, Harrow, M, Grossman, L, Maltzer, HY (1987) The prognostic relevance of delusion in depression: a follow-up study. Am J Psychiatry 144, 1154-1160Google ScholarPubMed
Kocsis, JH, Croughan, JI, Katz, MM (1990) Response to treatment with antidepressants of patients with severe or moderate non psychotic dépression and of patients with psychotic dépression. Am J Psychiatry 147, 621-624Google ScholarPubMed
Kroessler, D (1985) Relative efficacity rates for therapies of delusional depression. Convulsive Ther 1, 173-182Google Scholar
Lépine, JP, Lempériere, T, Rodière, C (1983) Le test à la dexaméthasone : une aide au diagnostic dans les mélancolies délirantes. Ann Méd Psychol 1, 218-223Google Scholar
Lépine, JP, Rodière, C, Rouillon, F, Lempériere, T (1985) Particularités cliniques et neuro-endocriniennes des mélancolies délirantes. Sem Hôp Paris 61, 3179-3186Google Scholar
Linnoila, M, Karoum, F, Potter, WZ (1984) Phenylethylamine and tyramine outputs in patients with affective disorders: behavioral and biochimical correlates. In: Frontiers in Biochemical and Pharmacological Research in Depression (Usdine, et al, eds). Raven Press, New York224–227Google Scholar
Loo, H, Colonna, L, Petit, M, Benyacoue, A, Boulanger, JP (1979) Électrochoc. Encycl Méd Chir Psychiatr 11, 37, 820 E 10Google Scholar
Lykouras, E, Malliaras, D, Christodoulou, GN, Papakostas, Y, Voulgari, A, Tzonou, A, Stefanis, C (1986) Delusional depression: phenomenology and response to treatment. A prospective study. Act Psychiatr Scand 73, 324-329CrossRefGoogle ScholarPubMed
Meltzer, HY, Cho, HW, Carrol, BJ (1976) Serum dopamine beta hydroxylase activity in the affective psychoses and schizophrenia: decreased activity in unipolar psychotically depressed patients. Arch Gen Psychiatry 33, 585-591CrossRefGoogle ScholarPubMed
Meyers, BS, Kalayam, B, Mei-Tal, V (1984) Late onset delusional depression: a distinct clinical entity? J Clin Psychiatry 45, 347-349Google ScholarPubMed
Minter, RE, Mandel, MR (1979) A prospective study of treatment of psychotic depression. Am J Psychiatry 136, 1470-1472Google ScholarPubMed
Ndetei, DM, Vadher, A (1984) A cross-cultural study of patterns of depression in a hospital-based population. Acta Psychiatr Scand 70, 62-68CrossRefGoogle Scholar
Nelson, JC (1987) The use of antipsychotic drugs in treatment of depression. In: Treating Resistant Depression (Zohar, J, RH Bel Maker, RMA publishing corp). New York131–146Google Scholar
Nelson, JC, Bowers, MB (1978) Delusional unipolar depression. Arch Gen Psychiatry 35, 1321-1328CrossRefGoogle ScholarPubMed
Pande, A, Grunhaus, RF, Haskett, RF, Greden, JF (1990) Electroconvulsive therapy in delusional and non delusional depressive disorder. J Affective Disord 19, 215-219CrossRefGoogle ScholarPubMed
Perry, PJ, Morgan, DE, Smith, RE, Tsuang, MT (1982) Treatment of unipolar depression accompanied by delusions. J Affective Disord 4, 195-200CrossRefGoogle ScholarPubMed
Petit, M, Dolfus, S (1989) Place actuelle de l’électrochoc. Confront Psychiatr (numéro spé) 219-239Google Scholar
Price, LH, Conwell, Y, Nelson, JC (1983) Lithium augmentation of combined neuroleptic-tricyclic treatment in delusional depression. Am J Psychiatry 140, 318-322Google ScholarPubMed
Price, LH, Nelson, JC, Charney, DS, Quilan, DM (1984) Family history in delusional depression. J Affective Disord 6, 109-114CrossRefGoogle ScholarPubMed
Pull, CB (1988) La classification des troubles dépressifs dans le DSM III et le DSM 1II-R Psychiatr Psychobiol 3, 5s–9sGoogle Scholar
Quitkin, F, Rifkin, A, Klein, DF (1978) Imipramine response in deluded depressive patients. Am J Psychiatry 135, 806-811Google ScholarPubMed
Rao, UAR, Coppen, A (1979) Classification of depression and response to amitriptyline therapy. Psychol Med 9, 321-325CrossRefGoogle ScholarPubMed
Raskin, A, Schulterbrandt, JG, Reating, N, McKeon, JJ (1970) Differential response to chlorpromazine, imipramine, and placebo. Arch Gen Psychiatry 23, 164-173CrossRefGoogle ScholarPubMed
Rhimer, Z, Arato, M, Szadoczyk, E, Revai, K, Demeter, E, Gyorgy, S, Udvarhelyi, P (1984) The dexamethasone suppression test in psychotic versus non-psychotic endogenous depression. Br J Psychiatry 145, 508-511CrossRefGoogle Scholar
Rich, CL, Spiker, DG, Jewell, SW (1986) ECT response in psychotic versus non psychotic unipolar depressives. J Clin Psychiatry 47, 123-125Google ScholarPubMed
Robertson, M, Trimblel, M (1982) Major tranquillisers used as antidepressants. J Affective Disord 4, 173-193CrossRefGoogle ScholarPubMed
Rothschild, AJ, Schatzberg, AF (1988) Biochemical and neuroendocrine studies in psychotic depressions. In: The Hypothalamic-Pituitary-Adrenal Axis: Physiology, Pathophysiology and Psychiatrie Implications (Schatzberg, AF, Nemeroff, CB, eds) Raven Press, New York, 187–200Google Scholar
Roth, M, Mountjoy, C (1981) Quelques problèmes dans la classification et le choix du traitement dans les troubles affectifs. In: La symptomatologie dépressive (Pichot, P, Pull, C, éds). Ciba Geigy, Paris, 119–129Google Scholar
Rudorfer, MV, Hwu, HG, Clayton, PJ (1982) Dexamethasone suppression test in primary depression : signifiance of family history and psychosis. Biol Psychiatry 17, 41-48Google Scholar
Schatzberg, AF, Rothschild, AJ, Stahl, JB, Bond, TC, Rosenbaum, AH, Lofgren, SB, McLaughlin, RA, Sullivan, MA, Cole, JO (1983) The dexamethasone suppression test : identification of subtypes of depression. Am J Psychiatry 140, 88-91Google ScholarPubMed
Schlesser, MA, Winokur, G, Sherman, BM (1980) Hypothalamic-pituitary-adrenal axis activity in depressive illness. Its relationship to classification. Arch Gen Psychiatry 37, 737-743CrossRefGoogle ScholarPubMed
Scotto, JC (1985) Les délires systématisés sensibles aux antidépresseurs. Sem Hôp Paris 61, 2669-2670Google Scholar
Shrivasta, RK, Goldman, A, Winters, R, Kaitz, R, Previtt, B (1983) Clinical study of the dexamethasone suppression test in major depressive episode with psychotic features (delusional depression). VIIe congrès mondial de psychiatrie. Vienne, 259Google Scholar
Simpson, GM, Leel, HL, Cuculic, A (1977) Two doses of imipramine in hospitalized endogenous and neurotic depression. Arch Gen Psychiatry 33, 1093-1102CrossRefGoogle Scholar
Solan, WJ, Khan, A, Avery, D (1988) Psychotic and non psychotic depression: contparison of response to ECT. J Clin Psychiatry 49, 97-99Google Scholar
Spiker, DG, Cofsky-Weiss, J, Dealy, RS, Griffin, SJ, Hanin, I, Neil, JF, Perel, JM, Rossi, AJ, Soloff, PH (1985) The pharmacological treatment of delusional depression. Am J Psychiatry 142, 430-436Google ScholarPubMed
Spiker, DG, Perel, JM, Hunin, I, Dealy, RS, Griffin, SHJ, Soloff, PH, Weiss, JC (1986) The pharmacological treatment of delusional depression : part II. J Clin Psychopharmacol 6, 339-342CrossRefGoogle ScholarPubMed
Sweeney, D, Nelson, O, Bowers, M, Maas, J, Heninger, G (1978) Delusional versus non-delusional depression: neurochemical differences. Lancet ii, 100–101CrossRefGoogle Scholar
Ulett, G (1975) Mere on the treatment of delusional depressed patients. Am J Psychiatry 132, 1332CrossRefGoogle Scholar
Vanelle, JM (1989) Alternatives médicamenteuses aux antidépresseurs. Confront Psychiatr (numéro spé) 173-187Google Scholar
Waziri, R, Wilson, P, Sherman, A (1983) Plasma serine/cysteine ratio as a biological marker for psychosis. Br J Psychiatry 143, 69-73CrossRefGoogle Scholar
Weissman, M, Prusoff, BA, Merikangas, K (1984) Is delusional depression related to bipolar disorder? Am J Psychiatry 141, 892-893Google ScholarPubMed
Weissman, MM, Boyd, JH (1985) Affective disorders: epidemiology. In: Comprehensive Textbook of Psychiatry vol I (Kaplan, HI, Jadock, BJ, Williams Wilkins, eds). Baltimore-London764–769Google Scholar
Widlôcher, D, Deslauriers, A (1983) Le ralentissement, symptôme privilégié de la symptomatologie dépressive. In: La maladie dépressive. Ciba Geigy, Paris, 71 —74Google Scholar
Winokur, G (1984) Psychosis in hipolar and unipolar affective illness with special reference to schizoaffective disorder. Br J Psychiatry 145, 236-242CrossRefGoogle Scholar
Wolfersdorf, M, Keller, F, Steiner, B, Holf, G (1987) Delusional depression and suicide. Act Psychiatr Scand 76, 359-363CrossRefGoogle ScholarPubMed
Zohar, J, Bel-Maker, RH (1987) Treating resistant depression. PMA Publishing Corp, New York, 165–169Google Scholar
Comments
No Comments have been published for this article.