Department of Psychiatry, Umea University, S-901 85 Umea, Sweden
Over time, our knowledge has increased about the classification and delineation of the affective psychoses. A distinction between unipolar affective disorders and bipolar affective disorders has been suggested by Perris (12) and Angst (3). Di­agnostic criteria for major depression and bipolar disorders have been presented in DSM-III (2). As concerns the nonpsychotic depressive disorders, there are still many un­solved problems, and there are no generally accepted diagnostic criteria delin­eating specific diagnostic subgroups. At the Department of Psychiatry at Umea University, we have used an op­erational definition of a subgroup called neurotic-reactive depression. The di­agnostic criteria have been used in a series of studies over the last 15 years. According to the diagnostic definition, the patients must have shown a clear-cut depressive symptomatology of a neurotic, nonpsychotic dimension, i.e., with unimpaired evaluation of reality during the whole course of the depressive dis­order. Furthermore, the condition must have arisen as a reaction to external events or represent an acute breakdown in patients with unstable personalities and a tendency to react with depressive, anxious, or psychosomatic symptoms under the influence of stress in relatively ordinary life situations (5). This definition somewhat resembles the definition of neurotic depression used by the World Health Organization (23). A neurotic disorder characterized by disproportionate depression which has usually recognizably ensued on a distressing experience; it does not include among its features delusions or hallucinations, and there is often preoccupation with the psychic trauma Which preceded the illness, e.g., loss of a cherished person or possession. Anxiety is also frequently present and mixed states of anxiety and depression should be included ere. The distinction between depressive neuroses and psychosis should be made ot only upon the degree of depression but also on the presence or absence of other eurotic and psychotic characteristics and upon the degree of disturbance of the patient’s behaviour.

Although the two definitions have certain similarities, it must be kept in mind that the definitions do not delineate identical groups of patients (Table 1).

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