Studies in the Classification of Affective Disorders

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Abstract
This is the first report in a series concerned with the classification of affective disorders. A sample of 145 patients suffering from a primary mood change of anxiety and/or depression was examined by means of a structured clinical interview and the administration of the Maudsley Personality Inventory. The patients were categorized into an \`anxiety state' group a \`depressive illness' group and a `doubtful' group, on the basis of the predominant mood change during illness. Systematic comparison of the patients with anxiety states and depressive illness indicated that, with the aid of a wide range of items drawn from an adequate span of early life, personality and clinical features, a satisfactory degree of separation between the two groups could be achieved. The first component extracted from a principal components analysis of the data was bipolar, with anxiety symptoms at one pole and depressive symptoms at the other; maladaptive personality traits were mainly associated with anxiety symptoms. This finding confirms that within an affective material there are two distinct syndromes corresponding to anxiety and depression. Two further principal components analyses were performed on the anxiety and depressive items separately. The correlation between the patients' scores along the general components obtained from each of these analyses was negative. This indicates that, within an affective population, the presence of an anxiety syndrome diminishes the likelihood that there is also a depressive syndrome. The distribution of patient scores along the bipolar component did not depart significantly from normality. However, when the clinical diagnoses were re-applied, the anxiety states and the depressive states were seen to occupy different halves of the distribution and the difference between their mean scores was highly significant. The high degree of association between the clinical diagnostic groups and the two halves of the distribution separated at their mean supports the initial diagnostic differentiation into anxiety states and depressive states and justifies the use of the original clinical groups in further attempts to improve discrimination between them.