Dysphoria from a transnosological perspective

The objective of our psychopathological analyses is to shed light on the po sition of irritable mood (dysphoria) in psychiatric diagnostics and nosolog y. In today's most commonly applied classification systems, the ICD-10 and the DSM-IV, dysphoria is mentioned mostly in the context of diagnostic crit eria of personality and affective disorders. Other authors have emphasized the importance of dysphoric states in organic psychoses and delusional diso rders. Summarizing the various publications on the nosological position, dy sphoria is a nosological nonspecific syndrome which may occur in the course of all psychiatric disorders and illnesses. According to the results of ou r psychopathological analyses, the pathogenesis of dysphoria has to be cons idered as a multidimensional circular process in which various mental, phys ical and social factors act as predisposing, triggering and disorder-mainta ining factors. Stressors induced by particular experiences and perceptions and by impaired health may lead to a dysphoric state if adequate coping mec hanisms are missing. Dysphoria itself usually leads to a deterioration in t he mental and physical state of the patient, and shows a clear impact on th e patient's social network. The reactions of people close to the patient co mbined with the impaired mental and physical conditions of the patient caus e the circle to restart. As contemporary diagnostic entities do not refer t o pathogenesis, classical categorical diagnostics cannot provide the basis for effective pathogenesis-oriented therapy. A change of paradigm in diagno stics from a categorical to a dimensional approach thus becomes necessary. Following a dimensional diagnostic approach based on a dynamic model of vul nerability, a precise differential diagnosis of the complex constellation o f conditions and their interactions becomes necessary in order to develop e ffective treatment strategies. Disorder-maintaining factors determine the t reatment of the acute symptomatology, whereas predisposing and triggering f actors serve as the basis for the prophylactic treatment. Copyright (C) 200 0 S. Karger AG, Basel.