Affective disorder in the neurological patient.

An index sample of neurological patients diagnosed as clinically depressed (83) was compared with a "major depression" sample (43) and a "neurological sample" (44) who were free from psychiatric disorder. There was no difference in global Hamilton Scores between the index and the major depression sample. The latter, however, more often exhibited family and personal history of psychiatric illness, early awakening, guilt, suicidal ideas, shorter index episodes of depression, and better response to treatment. The three samples were followed up for a period of up to 5 years. The index sample did worse on follow-up than did the depressed and the neurological samples. The disease profiles of both the index and neurological samples were similar, but there were more cases of epilepsy in the former. The index sample responded badly to conventional antidepressant treatment. It is concluded that the presence of chronic affective disorder in the neurological patient has an adverse effect on prognosis.