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Emotional status: diagnosis and treatment for severe psychiatric disorders

European Archives of Psychiatry and Clinical Neuroscience
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DOI: 10.1007/s00406-011-0284-5
  • Editorial
  • Medicine


EDITORIAL Emotional status: diagnosis and treatment for severe psychiatric disorders P. Falkai • H.-J. Mo¨ller Published online: 28 December 2011 � The Author(s) 2011. This article is published with open access at This edition focuses on the emotional status that is affected in a variety of psychiatric disorders, ranging from affective disorders to schizophrenia and patients with drug abuse. In patients with major depressive disorders, hypomania is a common cluster of symptoms that is derived from diagnostic DSM-IV criteria. To assess the clinical validity of these criteria in an international sample, Angst et al. [1] analyzed clinical data including family history, course, and clinical characteristics in 5,635 patients with major depressive episodes. Items for hypomania, irritability, elevated mood, and increased activity could be shown to be valid and confirm symptom threshold in DSM-IV. How- ever, brief hypomanic episodes over only a few days were also valid for which reason DSM-IV durational require- ments should be altered. Additionally, exclusion criteria like hypomania due to antidepressant treatment should be revised in the face of the exclusion of patients with bipolar disorder. During the last years, the usage of antidepressants in treating acute depression and its efficacy were under debate. In a review of randomized clinical trials and meta- analyses, Baghai et al. [2] summarize methodological issues of these studies and confirm efficacy and clinical effectiveness of antidepressants in the treatment of depressive disorder. Additionally, they allocate individu- alized antidepressant treatment to be safe and well tolerated in most patients and assert that it should be combined with psychotherapy. In patients with affective disorders and schizophrenia, improved diagnostic criteria are needed and might be developed by neuroimaging tools. A glutamate hypothesis has been linked to both syndromes, and t

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