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Nosographie des états dépressifs: tendances actuelles

Published online by Cambridge University Press:  28 April 2020

JD Guelfi*
Affiliation:
Service du Pr B Samuel-Lajeunesse, Clinique des maladie mentales et de l'encéphale, 100, rue de la Santé, 75674 Paris Cedex 14, France
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Résumé

La distinction entre deux principales catégories de dépression sur des bases essentiellement étio-pathogéniques a largement dominé la littérature internationale jusqu’aux années 1970. La validité de cette dichotomie: dépression «endogène» dépression «névrotique” n’a cependant jamais pu être démontrée de façon indiscutable. Selon l’école unitaire de Londres, les troubles affectifs, anxieux et dépressifs, représentent même des troubles pour lesquels les variations interindividuelles observées sont des modifications purement quantitatives au sein d’un continuum. L’utilisation aux États-Unis de critères diagnostiques pour délimiter les différentes catégories nosologiques s’est considérablement développée depuis 1972. Cette tendance a abouti à la généralisation des critères diagnostiques pour l’ensemble des troubles mentaux et au DSM III en 1980, révisé en 1987. Les principales originalités de la forme révisée du DSM III par rapport à la première version du manuel sont les critères de la mélancolie, l’utilisation d’un cinquième chiffre pour préciser l’intensité du trouble actuel et l’individualisation des troubles de l’humeur à caractère saisonnier. La dixième révision de la classification internationale des maladies élaborée par l’OMS est actuellement en préparation. Cette classification a assez largement accepté les principes généraux du DSM III. La confrontation de ces deux modèles de classification montre que la distinction classique endogène-non endogène est progressivement remplacée par la distinction bipolaire-non bipolaire. Au sein des dépressions non bipolaires, la valeur du modèle unitaire reste une question d’actualité, toujours controversée. Une autre tendance de la nosographie actuelle des troubles dépressifs est représentée par des classifications essentiellement fondées sur une réactivité thérapeutique différentielle. Ces modèles classent les syndromes dépressifs essentiellement en fonction de manifestations dont dépendent en grande partie l’accessibilité à la thérapeutique et la qualité du résultat obtenu sous traitement comme l’anxiété et certaines caractéristiques de la personnalité.

Summary

Summary

The distinction between the main categories of depression based on etiopathogenic bases was prevalent in international literature up to the 1970's. Nevertheless, it has never been possible to clearly substantiate the validity of this dichotomy, which differentiates between “endogenous” and “neurotic” depression. Moreover, according to the London “Unitarian ” school, affective, anxious and depressive disorders represent disorders for which the observed inter-individual variations are purely quantitative modifications within a single continuum. Since 1972, the use in the United States of diagnostic criteria to define the various nosological categories has developed considerably; these descriptive, mainly symptomatic criteria do not refer to non-demonstrated etiopathogenic hypotheses. This is the case for Feighner's St-Louis criteria (which opposes primary and secondary depression) and Spitzer's Research Diagnostic Criteria which, amongst other categories, isolate the major depressive episode. This tendency has led to the generalization of diagnostic criteria for mental disorders as a whole, and to the DSM III in 19S0, revised in 1987. The various diagnostic categories of depression in the DSM III-R are reviewed here and commented on. The basic distinction henceforth opposes bipolar and purely depressive disorders. The main new elements in the revised edition compared with the first edition of the DSM III are the criteria for melancholy, the use of a fifth digit to specify severity of the current disorder, and the individualization of mood disorders with a seasonal pattern. The tenth revised edition of the International Classification of Diseases, drawn up by WHO, is currently being prepared. The definitive version will be completed in 1992 and applicable in 1992-1993. A draft version is being used for field studies at present. This classification has broadly accepted the general principles of the DSM III. The ICD-10 will nevertheless differ from the revised DSM III classification with regard to several items. The confrontation of these 2 classification models shows that the traditional endogenous – non-endogenous distinction is gradually being replaced by the bipolar – non-bipolar distinction. Within the non-bipolar depression context, the value of the unitary model remains a topical and controversial issue. Another tendency in the current nosography of depressive disorders is that represented by classifications essentially based on differential therapeutic reactivity. These models seem to have a heuristic value. They classify depressive syndromes mainly as a function of the manifestations which often accompany the depressive syndrome, and on which therapeutic accessibility and the quality of results obtained during treatment is largely dependent. This is the case for anxiety and certain personality characteristics.

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Revue
Copyright
Copyright © European Psychiatric Association

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