The Continuum Hypothesis of Mood Disorders

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Sir: The recent (November 2007) article by Laursen et al. tested the continuum between mood and psychotic disorders. The authors state that, using “selected risk factors” (i.e., some family, environmental, and birth variables), “differences between the phenotypes were quantitative rather than qualitative” but that differences between genders and between “age-specific incidences” favored instead the Kraepelinian dichotomy (between “manic-depressive insanity,” including most DSM-IV-TR mood disorders, and “dementia praecox,” including several DSM-IV-TR psychotic disorders). The variables chosen are questionable. Among classic diagnostic validators, age at onset, boundaries between syndromes (i.e., bimodal distribution of distinguishing features), course, psychometric (multivariate) analyses, and, most of all, psychiatric family history (in this case, of bipolar, unipolar, psychotic disorders) figure prominently.​

J Clin Psychiatry 2008;69(7):1187-1188 [letter]