Depressive and adjustment disorders – some questions about the differential diagnosis: case studies

A Presicci¹, P Lecce¹, P Ventura¹, F Margari², S Tafuri³, L Margari<sup>1

1</sup>Child Neuropsychiatric Unit, Department of Neurologic and Psychiatric Science, Aldo Moro University of Bari, Bari, Italy; ²Psychiatric Unit, Department of Neurologic and Psychiatric Science, Aldo Moro University of Bari, Bari, Italy; ³Hygiene Section, Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy

Background: Diagnosis and treatment of mood disorders in youth are still problematic because in this age the clinical presentation is atypical, and the diagnostic tools and the therapies are the same as that used for the adults. Mood disorders are categorically divided into unipolar disorders (major depressive disorder and dysthymic disorder) and bipolar disorder in Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision), but mood symptoms are also comprised in the diagnostic criteria of the adjustment disorder (AD), which occur in many different psychiatric disorders, and may also be found in some physical conditions. The differential diagnosis is not much addressed in the midst of clinical ­investigation and so remains the major problem in the clinical practice.

Aims: The associations between some variables and the depressive disorder and AD were analyzed to make considerations about differential diagnosis.

Patients and methods: We reported a retrospective study of 60 patients affected by ­depressive disorder and AD. The analysis has evaluated the association between some variables and the single diagnostic categories. We have considered 10 variables, of which 6 are specific to the ­disorders, and 4 have been considered related problems.

Results: The statistical analysis showed significant results for the associations of 3 variables (prevalent symptoms, treatment, and family history) with the single diagnostic categories.

Conclusion: The discriminate analysis resulted in statistically significant differences between patients with depressive disorders and those with AD on 3 variables, of which 2 are specific to the disorders, and 1 is included in the related problems. The other variables were weakly associated with the single diagnostic categories without any statistically significant differences. The 3 variables that were associated with the single diagnostic categories support the distinct construct validity of the 2 diagnostic categories, but, to date, it is difficult to establish if these variables can be considered diagnostic predictors. On the other hand, the other variables did not support the distinct construct validity of the 2 diagnostic categories, which suggest an ­overlapping and ­dimensional concept. The spectrum approach could unify categorical ­classification that is ­essential with a dimensional view. Combination of dimensional and categorical principles for classifying mood disorders may help to reduce the problems of underdiagnosis and undertreatment.

Keywords: depressive disorder, bipolar disorder, spectrum