[Remissions in affective disorders: epidemiology, psychopathology, clinical and social prognosis, treatment].

OBJECTIVE: Although there is some evidence on heterogeneity of remissions in affective disorders (partial and full), many aspects of their comparative epidemiology, psychopathology, comorbidity and treatment are still unclear. According to our hypothesis, partial/symptomatic and full/syndromal remissions are not just consecutive stages of disease with spontaneous or treatment related interchange, but independent clinical entities with different essence. The distinction reflects a predominant pattern of disease development, based on interaction of two comorbid axes -- recurrent depression and personality disorder (PD). METHODS: A random epidemiological sample of 450 subjects (314 women and 136 men) with affective disorders was examined cross-sectionally and retrospectively. RESULTS: In the epidemiological sample, the prevalence was distributed as follows: verified remissions -- 36.2% (n=163): partial -- 27.5% (n=124), full - 8.7% (n=39). It has been shown that partial remission is a result of overlapping of recurrent depression and PD with affective diathesis (cycloid, hyperthymic, borderline) or PD prone to close interrelations with affective disorders (avoidant, obsessive-compulsive, narcissistic, histrionic). Thus, most residual symptoms (RS) reflect the association and are heterogeneous -- combined, affective, personal. Combined RS (dysthymic, phobic/anxious, somatoform) are "joint" presentations of depression and PD. Affective RS are depressive "blips" or brief depressive flares. Personal RS are pathological postdepressive personality traits (depressive, hypochondriacal, avoidant, dependent, histrionic), emerged or enhanced after depression. Full remission develops in "dissociation" of recurrent depression and PD without affective diathesis (schizotypal, schizoid, obsessive-compulsive, histrionic). Some common personality dimensions are relevant here: perfectionism, work addiction, hyperactivity, and psychological detachment from vital depressive symptoms ("alexithymia for depression"). CONCLUSIONS: The discussed remissions division suggests different prognosis and treatment approach.