Psychotic versus non-psychotic major depressive disorder: A comparative naturalistic study

Objective: Psychotic depressed patients were found to have more severe cognitive deficits, poorer treatment response and higher suicidal risk respect to non-psychotic depressives. Aim of the present research was to compare clinical variables and outcome between psychotic and non-psychotic major depressive patients. Method: A sample of 36 major depressed patients was divided into two groups according to the presence of psychotic symptoms. Structured Clinical Interview for DSM (SCID-I) and Hamilton Depression Rating Scale (HAM-D) were administered to the patients at baseline by trained raters. One-way analysis of variance (ANOVAs) and chi-square tests were performed to compare the two groups. Binary logistic regression was performed to assess the risk of lack of response/remission in patients with psychotic symptoms and the risk of developing psychotic symptoms in major depressives with a family history of schizophrenia or bipolar disorder. Results: Psychotic major depressives presented more severe illness as showed by HAM-D baseline scores (F = 17.20, p < 0.001), a longer duration of hospitalization (F = 7.64, p = 0.009) and they were more frequently treated with clomipramine (chi(2) = 16.22, p = 0.027). Psychotic symptoms were predictive of lack of remission (OR = 4.09, p = 0.05) and family history of schizophrenia/ psychotic bipolar disorder was associated with psychotic major depression (OR = 10.81, p = 0.04). Conclusions: Patients with psychotic symptoms present a more severe course of illness as showed by long hospitalizations and lower rates of remission. Psychotic depressives show more frequently a family history of "major psychoses'' suggesting a continuum in psychotic disorders and a genetic association of major psychotic depression with bipolar disorder and schizophrenia. (C) 2013 Elsevier B.V. All rights reserved.