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Neurological, Psychiatric, and Developmental Disorders: Meeting the Challenge in the Developing World
While criteria for diagnosis have been standardized by the American Psychiatric Association  and the International Classification of Disease, 10th revision, their criteria are often of limited applicability in non-psychiatric settings, especially by primary care physicians, who often see patients with significant physical comorbidity. The accurate and timely diagnosis of depression is also complicated by the reluctance of patients to seek help because of the stigma associated with mental illness and by the nature of the complaints, which may often be thought to have a physical origin.
There have been continuing studies on the reliability and validity of various methods of assessing depression, and in parallel there has been continuing work on evolving the classification systems and criteria used for these disorders. Current standardized classification systems used for depression appear in Table 9-1 and Table 9-2.
TABLE 9-1 DSM-IV Criteria for Major Depressive Episode
Five (or more) of the following symptoms have been present duringthe same 2-week period and represent a change from previous functioning:at least one of the symptoms is either (1) depressed mood or (2)loss of interest or pleasure.
Depressed mood most of the day, nearly every day, as indicated by either subjective report or observation made by others;
Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day;
Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day;
Insomnia or hypersomnia nearly every day;
Psychomotor agitation or retardation nearly every day;
Fatigue or loss of energy nearly every day;
Feelings of worthlessness or excessive or inappropriate guilt nearly every day;
Diminished ability to think or concentrate, or indecisiveness, nearly every day;
Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
The symptoms do not meet criteria for a Mixed Episode (see Table F).
The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The symptoms are not due to the direct physiological effects of a substance or a general medical condition.
The symptoms are not better accounted for by bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.