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Old data, new interpretation: a re-analysis of Sir Aubrey Lewis' M.D. thesis

Published online by Cambridge University Press:  09 July 2009

Gordon Parker*
Affiliation:
School of Psychiatry, University of New South Wales; Mood Disorders Unit, Prince Henry Hospital, Sydney, Australia
Dusan Hadzi-Pavlovic
Affiliation:
School of Psychiatry, University of New South Wales; Mood Disorders Unit, Prince Henry Hospital, Sydney, Australia
*
1Address for correspondence: Professor Gordon Parker, Psychiatry Unit, Prince of Wales Hospital, Randwick 2031, Sydney, NSW, Australia.

Synopsis

Sir Aubrey Lewis studied 61 depressives in considerable detail, principally cross-sectionally but also by reviewing progress. He concluded that he could find no qualitative distinctions between the depressed patients and thus established himself as a strong and influential advocate of the unitary view of depression (i.e. that depression varies dimensionally, not categorically). Subsequently, Kiloh & Garside (proponents of the binary view of two depressive ‘types’) coded the Lewis data and undertook a principal components analysis. They claimed success in distinguishing ‘endogenous’ and ‘neurotic’ depressive types within Lewis' sample. In this paper we re-analyse the data set using both a latent class categorical approach and mixture analyses. We suggest that any demonstration of sub-types was limited by relative homogeneity of the sample (in that up to 80% had probable or possible psychotic conditions), and by Lewis rating a number of important features (e.g. delusions) dimensionally rather than categorically. Nevertheless, we identify one categorical class (essentially an agitated psychotic depressive condition) and a residual (presumably heterogeneous) class. The presence of those two classes was supported by demonstrating bimodality in composite scores derived from the fourteen differentiating clinical features (and not evident when all clinical features were considered), and formally confirmed by mixture analyses. Membership of the categorical class was determined principally by psychotic features (delusions and hallucinations) and by objectively-judged psychomotor disturbance, and we consider the nature of that ‘class’. Lewis' data set is unusual (in having self-report and observationally rated data), and historically important in demonstrating that conclusions may depend on the choice of variables examined and analytical approaches.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 1993

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References

American Psychiatric Association (1968). Diagnostic and Statistical Manual of Mental Disorders, 2nd edn (DSM-II). APA: Washington.Google Scholar
American Psychiatric Association (1980). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn (DSM-III). APA: Washington.Google Scholar
Andreasen, N. C., Flaum, M. & Arndt, S. (1992). The comprehensive assessment of symptoms and history (CASH). An instrument for assessing diagnosis and psychopathology. Archives of General Psychiatry 49, 615623.CrossRefGoogle ScholarPubMed
Bartholomew, D. J. (1981). Latent Variable Models and Factor Analysis. Charles Griffin: London.Google Scholar
Duggan, C. F., Lee, A. S. & Murray, R. M. (1991). Do different subtypes of hospitalized depressives have different long-term outcomes? Archives of General Psychiatry 48, 308312.CrossRefGoogle ScholarPubMed
Golden, R. R. (1982). A taxometric model for the detection of a conjectured latent taxon. Multivariate Behavioral Research 17, 389416.CrossRefGoogle ScholarPubMed
Hasselblad, V. (1966). Estimation of parameters for a mixture of normal distributions. Technometrics 8, 431444.CrossRefGoogle Scholar
Kantor, S. J. & Glassmann, A. H. (1977). Delusional depressions: natural history and response to treatment. British Journal of Psychiatry 131, 351360.CrossRefGoogle ScholarPubMed
Kendell, R. E. (1976). The classifications of depression: a review of contemporary confusion. British Journal of Psychiatry 129, 1528.CrossRefGoogle ScholarPubMed
Kendell, R. E. (1989). Clinical validity. In The Validity of Psychiatric Diagnosis (ed. Robins, L. N. and Barrett, J. E.), pp. 305323. Raven Press: New York.Google Scholar
Kendler, K. (1991). Mood-incongruent psychotic effective illness: a historical and empirical review. Archives of General Psychiatry 48, 362369.CrossRefGoogle Scholar
Kiloh, L. G. & Garside, R. F. (1977). Depression: a multivariate study of Sir Aubrey Lewis's data on melancholia. Australian and New Zealand Journal of Psychiatry 11, 149156.CrossRefGoogle ScholarPubMed
Kiloh, L. G., Andrews, G., Neilson, M. & Bianchi, G. N. (1972). The relationship of the syndromes called endogenous and neurotic depression. British Journal of Psychiatry 121, 183196.CrossRefGoogle ScholarPubMed
Lewis, A. J. (1931). A Clinical and Historical Survey of Depressive States Based on the Study of 61 Cases. M.D. thesis. University of Adelaide: Adelaide.Google Scholar
Lewis, A. J. (1934 a). Melancholia: a historical review. Journal of Mental Science 80, 142.CrossRefGoogle Scholar
Lewis, A. J. (1934 b). Melancholia: a clinical survey of depressive states. Journal of Mental Science 80, 277378.CrossRefGoogle Scholar
Lewis, A. J. (1936). Melancholia: prognostic studies and case-material. Journal of Mental Science 82, 488558.CrossRefGoogle Scholar
Maxwell, A. E. (1971). Multivariate statistical methods and classification problems. British Journal of Psychiatry 119, 121127.CrossRefGoogle ScholarPubMed
Minter, R. E. & Mandel, M. R. (1979). The treatment of psychotic major depressive disorder with drugs and electroconvulsive therapy. Journal of Nervous and Mental Disease 167, 726733.CrossRefGoogle ScholarPubMed
Nelson, J. C. & Charney, D. S. (1981). The symptoms of major depressive illness. American Journal of Psychiatry 138, 113.Google ScholarPubMed
Parker, G., Hadzi-Pavlovic, D., Boyce, P., Wilhelm, K., Brodaty, H., Mitchell, P., Hickie, I. & Eyers, K. (1990). Classifying depression by mental state signs. British Journal of Psychiatry 157, 5565.CrossRefGoogle ScholarPubMed
Parker, G., Hall, W., Boyce, P., Hadzi-Pavlovic, D., Mitchell, P., Wilhelm, K., Brodaty, H., Hickie, I. & Eyers, K. (1991 a). Depression sub-typing: unitary, binary or arbitrary? Australian and New Zealand Journal of Psychiatry 25, 6376.CrossRefGoogle ScholarPubMed
Parker, G., Hadzi-Pavlovic, D., Hickie, I., Boyce, P., Mitchell, P., Wilhelm, K., Brodaty, H., Eyers, K. & Pedic, F. (1991 b). Psychotic depression: a review and clinical experience. Australian and New Zealand Journal of Psychiatry 25, 169180.CrossRefGoogle ScholarPubMed
Parker, G., Hadzi-Pavlovic, D., Hickie, I., Boyce, P., Mitchell, P., Wilhelm, K. & Brodaty, H. (1991 c). Distinguishing psychotic and non-psychotic melancholia. Journal of Affective Disorders 25, 135148.CrossRefGoogle Scholar
Parker, G., Hadzi-Pavlovic, D., Mitchell, P., Hickie, I., Wilhelm, K., Brodaty, H., Boyce, P. & Roy, K. (1992 a). Psychosocial risk factors distinguishing melancholia and non-melancholic depression: a comparison of six systems. Psychiatry Research 39, 211226.CrossRefGoogle Scholar
Parker, G., Hadzi-Pavlovic, D., Brodaty, H., Boyce, P., Mitchell, P., Wilhelm, K. & Hickie, I. (1992 b). Predicting the course of melancholic and non-melancholic depression: a naturalistic comparison study. Journal of Nervous and Mental Disease 180, 693702.CrossRefGoogle Scholar
Paykel, E. S. (1971). Classification of depressed patients: a cluster analysis derived grouping. British Journal of Psychiatry 118, 275288.CrossRefGoogle ScholarPubMed
Robins, E. & Guze, S. B. (1970). Establishment of diagnostic validity in psychiatric illness: its application to schizophrenia. American Journal of Psychiatry 126, 107111.CrossRefGoogle ScholarPubMed
Rush, A. J. & Weissenger, J. E. (1993). Melancholic symptom features. In DSM-IV Source Book (ed. Task Force on DSM-IV). APA Press: Washington. (In the press.)Google Scholar
Schatzberg, A. F. & Rothschild, A. J. (1992). Psychotic (delusional) major depression: should it be included as a distinct syndrome in DSM-IV? American Journal of Psychiatry 149, 733745.Google ScholarPubMed
Spiker, D. G., Weiss, J. C., Dealy, R. S., Griffin, S. J., Hanin, I., Neil, J. F., Perel, J. M., Rossi, A. J. & Soloff, P. H. (1985). The pharmacological treatment of delusional depression. American Journal of Psychiatry 142, 430435.Google ScholarPubMed