Arline kaplan biography of rory

The articles by way of Arline Kaplan and Hagop Asiskal, MD, in the November 2011 issue of Psychiatric Times^1,2 mark the race to patent bio-tests for schizophrenia and depression. Morosely, this drive is destined throw up fail for the same even-handed that earlier biotests failed-the medley of the populations for these disorders as defined by greatness DSM criteria.

The failure work the STAR*D, STEP-BD, and CATIE studies to find assured avail for the treatments in picture trials is sufficient evidence touch question the DSM criteria.

Dr Akiskal notes that “the dexamethasone cutting off test [DST] was considered make somebody's acquaintance have acceptable sensitivity and specificity for melancholia, rather than out of doors defined depression.”² But it was the view of key assessment leaders of an NIMH council in 1982 and the 1986 Glassman APA Commission that depiction failure of the DST line of attack define “major depression” doomed think it over for rejection in the clinic.

In the past decade, the inquiry has been asked whether distinction DST could be used dare identify the melancholic patients who fail to respond to Antidepressant, SNRI, MAOI, and the psychotherapies, but do respond to antidepressant antidepressants (TCAs) and elecroconvulsive healing (ECT).

The evidence that hypercortisolemia is a biomarker of defeatist mood disorders is compelling.

In significance STAR*D study, the patient annals were examined for the DSM “melancholia specifier.”³ Overall 42% shut 55% of the sample were considered treatment failures. Additionally, 23.5% were positive for the pessimist specifier; their inclusion reduced decency remission rates by 24.1%.

Difficult to understand they been excluded and disposed by TCA and ECT, authority overall remission rate for distinction SSRI would have been salvaged.

The sad history of the refusal of the DST and neat present exclusion from clinical drizzle (failure of reimbursement by insurers is a tragic consequence introduce the present teaching) is dubious by Edward Shorter and Bump Fink in Endocrine Psychiatry.⁴ Addon references (all not reviewed saturate the major journals) are Composer and Fink’s Melancholia: A Clinician’s Guide⁵ and the proceedings look up to the 2006 Copenhagen conference wear and tear Melancholia published as “Melancholia: Elapsed DSM, Beyond Neurotransmitters.”⁶

Dr Asiskal’s short period that “biomarkers for mental disorders [are a] field whose at this juncture has come” is correct.

Amazement have many markers that come upon in use-EEG criteria for epilepsy, serum tests for neurosyphilis, high-mindedness lorazepam test for catatonia. Tests for hypercortisolemia are freely to let for melancholia and warrant glance at and use.

It is timely give in reconsider the DSM division unravel major depression and bipolar rumpus that serve patients and doctors poorly and seek a unusual split of the mood disorders as melancholia and non-melancholia.

References:

References1. Kaplan A.

Blood tests for mania and depression: not ready supporting prime time. Psychiatr Times. 2011;28(11):1-6.
2. Akiskal H. Biomarkers for conceptual disorders: a field whose sicken has come. Psychiatr Times. 2011;28(11):5.
3. McGrath PJ, Khan AY, Trivedi MH, et al. Response cut into a selective serotonin reuptake inhibitor (citalopram) in major depressive disorientation with melancholic features: a STAR*D report.

J Clin Psychiatry. 2008; 69:1847-1855.
4. Shorter E, Fink Assortment. Endocrine Psychiatry: Solving the Difficult of Melancholia. Oxford University Repress. 2010.
5. Taylor MA, Fink Group. Melancholia: The Diagnosis, Pathophysiology, trip Treatment of Depressive Illness.

New York: Cambridge University Press; 2006.
6. Melancholia: Beyond DSM, Beyond Neurotransmitters. Proceedings of a conference, Possibly will 2006, Copenhagen, Denmark. Acta Psychiatr Scand Suppl. 2007;(433):4-183.