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How Shall I Diagnose Thee? Let Me Count the Ways

  • Boadie W. Dunlop
    Correspondence
    Address correspondence to Boadie W. Dunlop, M.D., M.S., Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, 12 Executive Park Drive NE, 3rd Floor, Atlanta, GA 30329.
    Affiliations
    Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
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      The development of objective methods to accurately diagnose major depressive disorder (MDD) is an area of great current interest in psychiatry. The diversity of methods being evaluated to distinguish MDD patients from healthy control subjects (HCs) is remarkable and includes questionnaires, computerized adaptive tests, cell phone usage data, multiplex serum assays, urine and plasma metabolomics, G protein subunit distribution in red blood cell membranes, and neuroimaging. Presumably, this interest in using tests to improve diagnostic accuracy derives from the high error rates in identifying MDD among primary care providers (
      • Mitchell A.J.
      • Vaze A.
      • Rao S.
      Clinical diagnosis of depression in primary care: A meta-analysis.
      ), who are often dealing with patients presenting with a multitude of somatic complaints and are not themselves necessarily receptive to a primary psychiatric diagnosis. While psychiatrists generally do not struggle with identifying a current major depressive episode during an initial evaluation, the low interrater agreement for the presence of MDD from the DSM-5 field trials suggest that even psychiatrists’ diagnostic consistency may be unsatisfactory (
      • Regier D.A.
      • Narrow W.E.
      • Clarke D.E.
      DSM-5 field trials in the United States and Canada, Part II: Test-retest reliability of selected categorical diagnoses.
      ).
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      Linked Article

      • Detecting Neuroimaging Biomarkers for Depression: A Meta-analysis of Multivariate Pattern Recognition Studies
        Biological PsychiatryVol. 82Issue 5
        • Preview
          Multiple studies have examined functional and structural brain alteration in patients diagnosed with major depressive disorder (MDD). The introduction of multivariate statistical methods allows investigators to utilize data concerning these brain alterations to generate diagnostic models that accurately differentiate patients with MDD from healthy control subjects (HCs). However, there is substantial heterogeneity in the reported results, the methodological approaches, and the clinical characteristics of participants in these studies.
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