DSM-III and Affective Pathology in Hospitalized Adolescents

Abstract

Charts of 76 adolescents, who had been recently discharged from a psychiatric hospital, were reviewed by a research team for evidence of DSM-III axis I and axis II disorders. Research diagnoses were assigned to patients on the basis of documented symptomatology and irrespective of the discharge diagnosis of the clinical staff. Forty-five patients met criteria for an affective disorder. Of these, 15 were diagnosed major depression and 24 dysthymia or atypical depression (i.e., dysthymia of briefer duration than 1 year). Two patients were manic, one was bipolar depressed, one was schizoaffective, and two were atypical depressed with psychotic features. No patient with dysthymia had a past history of major depression as the earliest manifestation of psychiatric disorder. Four patients with major depression, however, had past histories of dysthymia as the earliest manifestation of psychiatric disorder. Forty per cent of patients with major depression had parents with depression. Excepting one schizophrenic, every patient who had ever attempted suicide met criteria for a depressive disorder. Twelve patients fulfilled DSM-III criteria for borderline personality disorder (BPD). Each of these patients manifested a concurrent axis I depressive disorder, and each had a history of attempted suicide. Patients with major depression co-existing with BPD had histories of more frequent and more lethal attempts than other patients. Most depressed borderline patients were female. Sex differences were not found in prevalence of affective disorder occurring alone without the co-existence of BPD. Of the 12 patients with depression plus BPD, all those patients (N = 5) with major depression and BPD had at least one parent who had been treated for depression. In each of these five cases, axis I affective disorder occurred earlier in development than did axis II BPD. Our findings indicate that depression may have an earlier onset in the life cycle than generally appreciated. Dysthymia may in itself be a serious disorder during adolescence and may progress to major depression. The co-existence of a depressive disorder with BPD would appear to be of particular clinical significance during adolescence. More specifically, it appears that adolescents who manifest major depression and BPD actually suffer from a particularly severe variant of affective disorder.