The impact of therapeutic advances in widening the nosologic boundaries of affective disorders: clinical and research implications.

Abstract

The clinical boundaries of affective disorders have been considerably broadened in the past few years, in part due to therapeutic advances. Many psychotic patients who were formerly considered schizophrenic are now being treated with thymoleptic agents. Clinicians as well as researchers are seeing many patient with mood disturbance in ambulatory settings where anxious, intermittent, masked, and characterological presentations are common. Mood disorders are also being increasingly diagnosed in children, the elderly and in patients in primary care settings. Do these changes in diagnostic practice reflect therapeutic fashion? Are there external validating criteria by which the affective origin of these diverse conditions can be ascertained? In discussing the clinical and research dimensions of these questions, we provide a framework for resolving the methodologic issues involved.