4. Discussion
Use of the complete clinician-rated 24-item SMPI measure (and
applying the cut-off of four or more A items being affirmed than B
items) has been demonstrated as having impressive properties in
differentiating those with clinically diagnosed melancholic and nonmelancholic
depression in both unipolar and bipolar depressed
patients. In this study we sought to determine which items contribute
most to such sub-typing of unipolar depressive disorders and therefore
might be weighted by clinicians who in effect operate to a
Bayesian or decision tree model, seeking to prioritise or weight some
features above others in differentiating melancholic from nonmelancholic
depression. We analysed A and B items separately but
judged that the combined analysis (of both A and B refined items)
addressed the study question most appropriately. In summary, 91% of
those whose depression was “disproportionately severe” (i.e. more
severe than warranted by any antecedent life event stressor) received
a diagnosis melancholia, with no further items required. If the
depression was not disproportionately severe, but the patient was
anergic and not reacting to support, melancholia was diagnosed in 73%
of cases. Finally, if the depression was not disproportionately severe
nor anergic, but the depression had emerged “out of the blue”,
melancholia was diagnosed in 63% of cases. That analysis generated
two important findings in addition to providing quantification. First,
only five of the 24 items were required to allow a reasonably succinct
and efficient decision tree to be derived. Second, three of the five
refined items contributing to the decision tree were non-symptom
items. This reinforces the earlier suggestion that the clinical differentiation
of melancholic and non-melancholic conditions is likely to be
enhanced by a greater emphasis on illness course and contextual
variables, as opposed to relying only on symptoms to discriminate
melancholic and non-melancholic depression. Interestingly,
psychomotor disturbance appeared to have less of a discriminatory
4. DiscussionUse of the complete clinician-rated 24-item SMPI measure (andapplying the cut-off of four or more A items being affirmed than Bitems) has been demonstrated as having impressive properties indifferentiating those with clinically diagnosed melancholic and nonmelancholicdepression in both unipolar and bipolar depressedpatients. In this study we sought to determine which items contributemost to such sub-typing of unipolar depressive disorders and thereforemight be weighted by clinicians who in effect operate to aBayesian or decision tree model, seeking to prioritise or weight somefeatures above others in differentiating melancholic from nonmelancholicdepression. We analysed A and B items separately butjudged that the combined analysis (of both A and B refined items)addressed the study question most appropriately. In summary, 91% ofthose whose depression was “disproportionately severe” (i.e. moresevere than warranted by any antecedent life event stressor) receiveda diagnosis melancholia, with no further items required. If thedepression was not disproportionately severe, but the patient wasanergic and not reacting to support, melancholia was diagnosed in 73%of cases. Finally, if the depression was not disproportionately severenor anergic, but the depression had emerged “out of the blue”,melancholia was diagnosed in 63% of cases. That analysis generatedtwo important findings in addition to providing quantification. First,ห้าเท่าของสินค้า 24 เป็นต่อให้รวบรัดสมเหตุสมผลและต้นไม้การตัดสินใจที่มีประสิทธิภาพได้มา ที่สอง สาม 5สนับสนุนต้นไม้ตัดสินใจสินค้ารับได้ไม่มีอาการสินค้า นี้ reinforces แนะนำก่อนหน้านี้ที่สร้างความแตกต่างทางคลินิกคับอกคับ และไม่ใช่คับอกคับสภาพเป็นแนวโน้มที่จะขั้นสูง โดยเน้นหลักสูตรการเจ็บป่วยมากขึ้น และบริบทตัวแปร จำกัดอาศัยอาการถือเขาถือเราเท่านั้นภาวะซึมเศร้าคับอกคับ และไม่ใช่คับอกคับ เป็นเรื่องน่าสนใจรบกวน psychomotor ปรากฏมีน้อยของการประมงทะเล
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