Evaluation of the DSM-III Criteria for Melancholia

The DSM-III criteria for melancholia are intended to define an endogenomorphic subcategory of major depressive episode for which somatic treatment is usually required. One hundred twenty-three inpatients having a major depressive episode were examined retrospectively to determine the ability of the melancholia criteria to identify patients observed to have an autonomous syndrome during the first week of hospitalization and to distinguish them from patients observed to be responsive to psychosocial intervention without drug treatment. The melancholia criteria correctly classified 77% of the sample. In comparison with the primary affective disorder criteria, the melancholia criteria appeared to be more selective; fewer responsive patients were falsely identified. The predictive values of individual symptom criteria were examined. Of the current symptom criteria, two observed signs, lack of reactivity and psychomotor change, were most useful for making the autonomous-responsive distinction.