Depression and anxiety secondary to medical illness.

Mind and body remain stubbornly one. The distinction between primary and secondary disorders respects this unity. The distinction between "reactive" and "induced" carry causal implications and suggest the former is psychogenic and the latter organic--both of which are probably premature conclusions. The diagnostician, free of the demands on the pathologist, can pursue the correct nosology committed to demonstrating, not the pathophysiology, but the presence of adequate diagnostic criteria. Whenever a secondary disorder meets full criteria it may warrant the same treatment accorded to the primary disorder. Whether the disease is major or minor may also be of clinical significance. Only further application of psychiatric nosology to medically ill patients can resolve these issues. Karajgi et al recently found that the lifetime prevalence of panic disorder in a sample of patients with chronic obstructive pulmonary disease was 8%. The only respectable offspring of neurotic depression in DSM-III-R is dysthymia. As with neurotic depression, dysthymia is not a condition thought appropriate for or responsive to antidepressant drugs. Clinicians dealing with depression in the medically ill think of depression itself as "serious," that is, major.