Kalmár S.
Private practice, Kecskemét, Hungary
Neuropsychopharmacol Hung. 2009 Dec;11(4):227-34.

Introduction: Disturbances of perception play a considerable role in depressed patients’ symptoms. These symptoms are mostly secondary in the daily practice, however, the disturbances of perception of a mild degree lead to cognitive distortions, and they make the recognition of the depression significantly more difficult. Purpose: To review several systems of diagnostic criteria, five developed in Europe, ten in the area of the United Kingdom, five in the United States and five other diagnostic systems with respect to the kind of significance they ascribe to the disturbances of perception in the presence of the depression.

Results: The author establishes that the diagnostic systems examined in case of the patients suffering from depression ascribe different significances to the disturbances of perception despite the fact that all depressed patients suffer from these symptoms. In case of the 23 examined disturbances of perception, out of the 25 systems 20 ascribe significance to fewer than ten symptoms, 11 systems ascribe significance to five or fewer symptoms. In the process of the simplification of the diagnostic systems these symptoms do not obtain emphasis, which makes the establishment of the accurate diagnosis difficult. The author emphasizes that in the background of disturbances of perception the detection of the misshapen reality hides, from which the patients suffer the most. Out of the examined diagnostic systems the European and the complex diagnostic systems ascribe a more considerable emphasis to the disturbances of perception. In Kielholz’s system there are 14, while in the CODE system there are 19 kinds of disturbances of perception. Conclusion: The author establishes that the disturbances of perception and the symptoms developed by the consequences of the disturbances of perception have a greater significance in patients suffering from depressive disorders than it is known in the common knowledge. In fact most of the psychiatric signs and symptoms may be attributable to some kind of disturbance of perception. Out of the examined diagnostic systems Paul Kielholz’s and Thomas Ban’s complex diagnostic system, the CODE-DD takes the significance of the disturbances of perception into consideration in the largest degree. It is necessary to keep in mind that patients suffering from depression with disturbances of perception also present have difficulty in recovery. In the process of the simplification of the diagnostic systems these symptoms may evade the doctors’ attention making the recognition of the illness more difficult and weaken the efficiency of the therapy. It would be justified to indicate the disturbances of perception as a diagnostic criterion in the ICD-11 and in the DSM-V among the illnesses related to depression. Paying attention to the disturbances of perception may transform the system of psychiatric classifications and the research of psychiatric illnesses not only in case of affective disorders but also in case of psychoses. Especially the genetic research concerning the disturbances of perception may support the objective judgement of the psychiatric disorders, its biological tenability could stabilize the situation of psychiatry among medical sciences.