ABSTRACT
THE FOLLOW ING examination of the clinical features of depressive states is based on the detailed study of 61 cases examined and treated by the writer at the Maudsley Hospital, London.
The diagnosis o f ‘depressive state’ had been made finally after the discharge of the patient; each of them had been seen first either in the out-patient department, or in private by a competent psychiatrist, the case had been presented at a clinical conference, and a diagnosis reached after discussion; in many cases the patient had been presented on more than one occasion, the ultimate diagnosis representing the considered view of the medical staff of the hospital. By ‘depressive state’ has been understood a condition in which the clinical picture is dominated by an unpleasant affect, not transitory, without evidence of schizophrenic disorder (other than slight or subordinate) or organic disorder of the brain, and in which, moreover, the affective change appears primary, not secondary to other symptoms of ill-health. It was therefore in part diagnosis by exclusion; in so much as symptomatic depressive states, occurring in the course of such disorders as general paralysis of the insane, present no positive characters, qua depressive, to distinguish them from the depressive reactions here considered, it seemed preferable to limit the inquiry to those in which the disorder seemed primary.
