Psychotic depression: a review and clinical experience

Aust N Z J Psychiatry. 1991 Jun;25(2):169-80. doi: 10.1080/00048679109077732.

Abstract

We review research literature on psychotic (delusional) depression, including demographic, illness pattern, clinical, biological marker and treatment issues. Secondly, we report a study of a consecutive sample of 137 patients meeting criteria for DSM-III melancholia, RDC definite endogenous depression and our "clinical" criteria for endogenous depression, of whom there were 35 "psychotic depressives" (PDs). The PDs were contrasted with the remaining 76 depressives (EDs) and with an age and sex-matched subset (MEDs). The PDs were distinctly older than the EDs at assessment and at initial onset of any affective disorder. Compared to the MEDs, they tended to have longer illnesses, were more likely to be hospitalised (and to have longer stays), to receive (in the past and for the current episode) combination antipsychotic/antidepressant medication and/or ECT, and to have a poorer course over the following year. They were no more likely to have a bipolar pattern, a family history of depressive disorder, schizophrenia or alcoholism, or vegetative depressive features. Developmental psychosocial stressors and antecedent life event stressors were not over-represented. Most of the PDs had delusions, one-fifth reported hallucinations and psychomotor disturbance was marked. Other differential clinical findings were sustained mood disturbance, constipation, and the absence of a diurnal variation in mood and energy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Affective Disorders, Psychotic / diagnosis
  • Affective Disorders, Psychotic / psychology
  • Affective Disorders, Psychotic / therapy
  • Antidepressive Agents / therapeutic use
  • Antipsychotic Agents / therapeutic use
  • Bipolar Disorder / diagnosis
  • Bipolar Disorder / psychology
  • Bipolar Disorder / therapy
  • Chronic Disease
  • Combined Modality Therapy
  • Delusions / diagnosis
  • Delusions / psychology
  • Delusions / therapy
  • Depressive Disorder / diagnosis*
  • Depressive Disorder / psychology
  • Depressive Disorder / therapy
  • Electroconvulsive Therapy
  • Female
  • Follow-Up Studies
  • Hallucinations / diagnosis
  • Hallucinations / psychology
  • Hallucinations / therapy
  • Hospitalization
  • Humans
  • Longitudinal Studies
  • Male
  • Neurocognitive Disorders / diagnosis
  • Neurocognitive Disorders / psychology
  • Neurocognitive Disorders / therapy
  • Personality Tests / statistics & numerical data
  • Psychiatric Status Rating Scales / statistics & numerical data
  • Psychotic Disorders / diagnosis*
  • Psychotic Disorders / psychology
  • Psychotic Disorders / therapy
  • Risk Factors

Substances

  • Antidepressive Agents
  • Antipsychotic Agents