Hudson and Pope's Affective Spectrum Disorder-Does Antidepressant Response Identify a Family of Diso

Hudson and Pope's Affective Spectrum Disorder-Does Antidepressant Response Identify a Family of Diso

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Unformatted text preview: Affective Spectrum Disorder: 552 Am J Psychiatry 147:5, May 1990 Does Antidepressant Response Identify a Family of Disorders With a Common Pathophysiology? James I. Hudson, M.D., and Harrison G. Pope, Jr., M.D. Response to pharmacologic treatments may identify groups of disorders with a common pathophysiology. The authors applied a treatment-response model, based on four classes ofantidepressants (tricyclic types, mon- oamine oxidase inhibitors, serotonin uptake inhibitors, and atypicalagents), to the medicalliterature. The mod- el identified eight disorders that may share a patho- physiologic abnormality: major depression, bulimia, panic disorder, obsessive-compulsive disorder, atten- tion deficit disorder with hyperactivity, cataplexy, mi- graine, and irritable bowel syndrome. Phenomenologic and family studies support this grouping. If the model is validated, this family ofdisorders, which the authors term “affective spectrum disorder, “ would represent one of the most prevalent diseases in the population. (Am J Psychiatry 1990; 147:552-564) M any psychiatric and medical disorders respond to antidepressant medications. Because these disorders may respond fully to antidepressants from several unrelated chemical classes, it follows that they may share a pathophysiologic “step” in the etiologic chain of steps required for their expression. We de- scribe the development and application of a model de- signed to identify members of this proposed family of disorders, here termed “affective spectrum disorder.” The disorders identified include major depression, bu- limia, panic disorder, obsessive-compulsive disorder, attention deficit disorder with hyperactivity, cataplexy, Received April 21, 1989; revision receivedjuly 28, 1989; accepted Aug. 10, 1989. From the Biological Psychiatry Laboratory, Labora- tories for Psychiatric Research, and Psychosis Program, McLean Hospital; and the Department of Psychiatry, Harvard Medical School, Boston. Address reprint requests to Dr. Hudson, McLean Hospital, 115 Mill St., Belmont, MA 02178. Supported in part by NIMH Clinical Research Center grant MH- 36224. The authors thank Drs. R. Baldessarini, B. Cohen, F. Franken- burg, R. Gutierrez-Esteinou, P. Holzman, M. Hudson, E. Hundert, P. Keck, Jr., D. Klein, J. Lipinski, S. Matthysse, S. McElroy, A. Pope, A. Satlin, R. Spitzer, G. Steketee, K. White, and D. Wilson for their comments on this manuscript and Mses. L. Sullivan and K. Zierk for their assistance. Copyright © 1990 American Psychiatric Association. migraine, and irritable bowel syndrome. Several other disorders, such as posttraumatic stress disorder and atypical facial pain, nearly meet the criteria of the model as well....
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Hudson and Pope's Affective Spectrum Disorder-Does Antidepressant Response Identify a Family of Diso

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