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Mélancolie délirante: caractéristiques épidémiologiques, cliniques, biologiques et thérapeutiques

Published online by Cambridge University Press:  28 April 2020

C Epelbaum  and
P Hardy
C Epelbaum
Affiliation:
Service de psychiatrie adulte, CHU de Bicêtre, 78, avenue du Général-Leclerc, 94275, Le Kremlin-Bicêtre Cedex, France
P Hardy
Affiliation:
Service de psychiatrie adulte, CHU de Bicêtre, 78, avenue du Général-Leclerc, 94275, Le Kremlin-Bicêtre Cedex, France
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Résumé

Les spécificités des mélancolies délirantes en regard des autres types de dépression ont fait l’objet de nombreuses recherches dont les résultats apparaissent parfois contradictoires. Sur un plan épidémiologique, les mélancolies délirantes se distinguent peu des autres types de dépression quant au sex-ratio, à l’âge de début, au nombre d’épisodes antérieurs, à l’existence d’antécédents familiaux de troubles thymiques ou quant à la prédominance des formes unipolaires ou bipolaires. Du point de vue clinique, un certain nombre d’éléments paraissent caractériser le tableau des mélancolies délirantes (importance du ralentissement psychomoteur, culpabilité accrue, humeur dépressive et agitation plus intense). D’autres paramètres sont signalés par certains auteurs, mais non par tous, comme plus particuliers à cette entité. Sur un plan biologique, certains marqueurs de la mélancolie délirante ont été isolés (MHPG-HVA plus faible, dosage de β-décarboxylase, etc). Mais aucun de ces indices, en particulier la positivité du test à la dexaméthasone n’est réellement spécifique de cette pathologie. Le traitement des mélancolies délirantes apparaît en revanche bien établi et diffère de celui des autres formes de dépression; supériorité de l’association neuroleptiques-antidépresseurs tricycliques par rapport à la monothérapie antidépressive et surtout l’électro-convulsivo-thérapie qui est fréquemment indiquée d’emblée en raison de la gravité de l’état de ces patients. Il apparaît toutefois que certaines particularités cliniques, évolutives et thérapeutiques confèrent au cadre des mélancolies délirantes une homogénéité et une spécificité suffisantes pour le distinguer du groupe des autres dépressions. Ces caractéristiques, qui sont pour la plupart des variables continues, sont de nature à situer les mélancolies délirantes dans un gradient de sévérité accru en regard des autres dépressions, plutôt que dans une dichotomie. Ces divergences de résultats observés à propos d’autres paramètres pourraient résulter d’insuffisances méthodologiques mais également de l’hétérogénéité du groupe des mélancolies délirantes. Cette dernière hypothèse paraît ouvrir les voies de recherche les plus prometteuses.

Summary

Summary

The specificities of the delusional depression as compared to other forms of depression have been the subject of a large number of contradictory results. From an epidemiological point of view, delusional depression is similar to other forms of depression for sex ratio, age of onset, number of previous episodes, family history of depression or predominance of unipolar or bipolar forms. From a clinical point of view, the delusional depressions are characterized by a few items (increased guilt, agitation, etc), but there is no general agreement on this subject. Specific biological parameters for delusional depression (lowered MHPG/HVA, β-decarboxylase level) have been put forward, none of which, particularly positivity to the dexamethasone-test, is specific for this pathology. The treatment of delusional depression is usually based on neuroleptic plus antidepressant medication and electroconvulsive therapy is often the first treatment proposed, due to the severity of symptoms presented by the patient. Some clinical, evolutional and therapeutic particularities nevertheless give delusional depression some homogeneity and specificity. We interpret them as fitting with a dimensional model. Other elements show a heterogeneity of the group of delusional depression, and research in this direction is still needed.

Keywords

mélancolie délirantedépressionassociation neuroleptiqueantidépresseursdelusional depressiondepressionneuroleptic-antidepressantassociation
Type
Revue
Information
Psychiatry and Psychobiology , Volume 5 , Issue 5 , 1990 , pp. 309 - 318
Copyright
Copyright © European Psychiatric Association 1990

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