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      Psychiatric comorbidity: fact or artifact?

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          Abstract

          The frequent occurrence of comorbidity has brought about an extensive theoretical debate in psychiatry. Why are the rates of psychiatric comorbidity so high and what are their implications for the ontological and epistemological status of comorbid psychiatric diseases? Current explanations focus either on classification choices or on causal ties between disorders. Based on empirical and philosophical arguments, we propose a conventionalist interpretation of psychiatric comorbidity instead. We argue that a conventionalist approach fits well with research and clinical practice and resolves two problems for psychiatric diseases: experimenter’s regress and arbitrariness.

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          Most cited references35

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          Diagnostic and statistical manual of mental disorders.

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            Science, Policy, and the Value-Free Ideal

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              Is Open Access

              Data-driven subtypes of major depressive disorder: a systematic review

              Background According to current classification systems, patients with major depressive disorder (MDD) may have very different combinations of symptoms. This symptomatic diversity hinders the progress of research into the causal mechanisms and treatment allocation. Theoretically founded subtypes of depression such as atypical, psychotic, and melancholic depression have limited clinical applicability. Data-driven analyses of symptom dimensions or subtypes of depression are scarce. In this systematic review, we examine the evidence for the existence of data-driven symptomatic subtypes of depression. Methods We undertook a systematic literature search of MEDLINE, PsycINFO and Embase in May 2012. We included studies analyzing the depression criteria of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) of adults with MDD in latent variable analyses. Results In total, 1176 articles were retrieved, of which 20 satisfied the inclusion criteria. These reports described a total of 34 latent variable analyses: 6 confirmatory factor analyses, 6 exploratory factor analyses, 12 principal component analyses, and 10 latent class analyses. The latent class techniques distinguished 2 to 5 classes, which mainly reflected subgroups with different overall severity: 62 of 71 significant differences on symptom level were congruent with a latent class solution reflecting severity. The latent class techniques did not consistently identify specific symptom clusters. Latent factor techniques mostly found a factor explaining the variance in the symptoms depressed mood and interest loss (11 of 13 analyses), often complemented by psychomotor retardation or fatigue (8 of 11 analyses). However, differences in found factors and classes were substantial. Conclusions The studies performed to date do not provide conclusive evidence for the existence of depressive symptom dimensions or symptomatic subtypes. The wide diversity of identified factors and classes might result either from the absence of patterns to be found, or from the theoretical and modeling choices preceding analysis.
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                Author and article information

                Contributors
                h.van.loo@umcg.nl
                j.w.romeijn@rug.nl
                Journal
                Theor Med Bioeth
                Theor Med Bioeth
                Theoretical Medicine and Bioethics
                Springer Netherlands (Dordrecht )
                1386-7415
                1573-0980
                1 February 2015
                1 February 2015
                2015
                : 36
                : 41-60
                Affiliations
                [ ]Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Department of Psychiatry, University Medical Center Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB Groningen, The Netherlands
                [ ]Faculty of Philosophy, University of Groningen, Oude Boteringestraat 52, 9712 GL Groningen, The Netherlands
                [ ]Philosophy Department, University of Johannesburg, Johannesburg, South Africa
                Article
                9321
                10.1007/s11017-015-9321-0
                4320768
                25636962
                68fd3486-4e6f-43c9-b8ea-7742b521f203
                © The Author(s) 2015

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

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                © Springer Science+Business Media Dordrecht 2015

                Applied ethics
                comorbidity,psychiatric disorders,dsm,disease classification,conventionalism
                Applied ethics
                comorbidity, psychiatric disorders, dsm, disease classification, conventionalism

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