MELANCHOLIA - PRESENT PSYCHIATRIC MODELS

Historically, melancholia has given place to depression, to become a p articular sub-type of the latter, characterized by pay chomotor retard ation, symptomatic severity, importance of the somatic and vegetative disorders, presence of psychotic symptoms, possible biological (mainly neuro-endocrinian) abnormalities, and good response to the biological treatment. A personal study on 30 patients considered as typical conf irms the diagnostic stereotypes of the French clinicians. However, the critiera selected by the DSM-III and -IV of the APA are more problema tic (for the CIM-10 of the WHO, melancholia is a vestigial synonym of ''severe depression''). Accepting cases of medium severity, they turn melancholia into a more frequent pathology (two-thirds of the patients hospitalized for depression), synonym of ''endogenous'' or ''psychoti c'' depression. This model of relatively severe, episodic pathology di ffers from the psychodynamic conception of melancholia, which might co rrespond to the inter-critical mental state, likely comparable to the ''typus melancholicus'' of the unipolar forms of depression. Here rema ins the problem of the accessibility to the rather little documented p sychotherapies, whether they are of psychoanalytical or cognitive insp iration.