Background: Investigations of unipolar major depressive disorder (MDD) have focused primarily on major depressive episode remission/recovery and relapse/ recurrence. This is the first prospective, naturalistic, longterm study of the weekly symptomatic course of MDD.

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Background: The goal of this study was to investigate psychosocial disability in relation to depressive symptom severity during the long-term course of unipolar major depressive disorder (MDD).

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Dzflerential diagnosis of patients whose course of illness includes substantial psychotic and mood syndromes is among the most challenging in psychiatry. The relative temporal preponderance of one or the other of these syndromes over course of illness forms the basis for distinctions among DSM-III-R diagnoses of schizoaflective disorder (SA), bipolar disorder (BPD), and schizophrenia (SZ); and such temporal assesmnents may be especially diflcult to make reliably. Elsewhere we report relatively low reliability of SA and a tendency for it be "con.ed" with SZ and BPD. I n this paper, we identi3 clinical variables that increase diagnostic diflerentiation. Data are fiom a Diagnostic Interview for Genetic Studies (DIGS) reliability study in which patients with independently assessed DSM-III-R lifetime diagnoses of SA-bipolar subtype,(SA-BP), BPD, and SZ were also clinically assessed and diagnosed by the DIGS on two occasions by t w o diflerent interviewers blind to entry diagnoses. The relative strength of DIGS-based DSM-III-R diagnoses and individual DIGS clinical variables in predicting entry diagnoses is shown in a series of logistic regression analyses. Models incorporating DIGS variables are more predictive of entry diagnoses than models using DIGS diagnoses alone. Based o n DIGS information, the SA-BP group is more clearly diflerentiated fiom the BPD group than fiom the SZ group. Dzflerent proJiles of DIGS variables distinguish the groups. Findings are discussed in terms of their implications for nosologic research. Depression 3:309-315 (1 99511 996). 0 1996 Wiley-Liss, Inc. *