ICD-10 or DSM-IV? Anhedonia, fatigue and depressed mood as screening symptoms for diagnosing a current depressive episode in physically ill patients in general hospital

• Published in: Journal of affective disorders Vol. 126; no. 1; pp. 245 - 251
• Main Authors: Sibitz, Ingrid, Berger, Peter, Freidl, Marion, Topitz, Andrea, Krautgartner, Monika, Spiegel, Wolfgang, Katschnig, Heinz
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier B.V 01.10.2010; Elsevier
• Subjects: Adolescent; Adult; Adult and adolescent clinical studies; Aged; Aged, 80 and over; Anhedonia; Biological and medical sciences; Comorbidity; Depression; Depression - diagnosis; Depression - psychology; Depressive Disorder - diagnosis; Depressive Disorder - psychology; Diagnostic and Statistical Manual of Mental Disorders; Fatigue - psychology; Female; Hospitals, General; Humans; Inpatients - psychology; International Classification of Diseases; Male; Medical sciences; Middle Aged; Mood disorders; Moods; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; ROC Curve; Screening; Sensitivity and Specificity; Sick people; Surveys and Questionnaires; Symptoms; Young Adult; Screening; Depression; Anhedonia; Comorbidity; Mood disorder; Human; Affect affectivity; General hospital; Fatigue; Medical screening; Symptomatology; Concomitant disease; International Classification of Diseases 10; Diagnostic and Statistical Manual IV
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2010.03.023

Abstract Objective To explore the usefulness of “anhedonia”, “fatigue” and “depressed mood” as screening symptoms for predicting a depressive episode in physically ill patients. Method 290 patients filled in a modified version of the Patient Questionnaire and were subsequently assessed by psychiatrists with the Composite International Diagnostic Interview (CIDI; ICD-10 version). Results 63 patients suffered from a current depressive episode according to the CIDI. If at least two of the three symptoms were used for screening positively (ICD-10 algorithm), the sensitivity was 93.2% and the specificity 72.7%, while the simpler algorithm of DSM-IV – requiring depressed mood or anhedonia to be present – yielded a slightly higher sensitivity (95.2%) and a slightly lower specificity (66.5%). One in five patients with a depressive episode did not report “depressed mood”. Limitation It remains unclear how relevant the three core symptoms of depression are for the diagnosis of an ICD-10 depression in people who are not physically ill. Conclusion The fact that both diagnostic algorithms yielded comparable results suggests that the more parsimonious DSM-IV algorithm is preferable and “fatigue” could be left out as a screening symptom. Since “depressed mood” was absent in a substantial proportion of patients, special attention has to be paid to “anhedonia”. Medical students and non-psychiatric clinicians should be especially trained to ask for anhedonia, so that cases of depression will not be overlooked.