At 09:48 PM 8/18/98 +0100, you wrote:
>In article <[log in to unmask]>, Ahmad Risk
><[log in to unmask]> writes
>>I have a term for the kind of depression referred to in vrious messages
>>as 'mild'.
>>
>>I call it 'Acopia' and the patient is 'acopic'.
>
George said
>I'll go even further and suggest that there is only one kind of
>depression. If it can be alleviated by a change of circumstance,
>environment or any singular event (not ECT) then it is no longer
>clinical depression but unhappiness. The two may co-exist or interact
>but differ in aetiology. As to whether it is severe or mild depends upon
>the criteria you relate it to, which will probably differ from person to
>person - so that the management sub-class is probably the best way to
>describe it but rename it type 1,11 or 111 to code it.
Back to old endogenous / exogenous depression????
My acopic patients are more likely to be depressed but are recognisably a
different group and include many patients who aren't depressed at all.
Equally I have treated some apparently acopics for their obvious clinical
depression and guess what? They start coping again. Funny that.
Equally can't agree that patients who become ill with depression because of
grief (death / loss of partner / child / parent / job), or as a result of
physical illness (e.g. CA, Parkinsons, MS etc.) are the same as those who
are just unhappy because of those events.
Unhappy people are naturally more likely to get depressed, and depressed
people are more likely to be unhappy.
Doesn't make the two things the same - seem to remember you can even have
smiling depression.
As to diagnosis by management - it is a pragmatic approach, and I believe
it reflects how GPs label many conditions. The problem is that it doesn't
provide a basis for comparing how two different doctors manage the same
condition, or arguing for resource changes so that patients can be managed
differently - that can only be done if you have a patient based diagnosis
of some kind, not a management implied diagnosis.
If we're going to have "quick and dirty" diagnostic labels we need to
understand what they're going to be used for. If shorthand for describing
how patients are managed - management cats fine, if audit, resource
management etc can't see how we can use that system.
JB
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