Major depression with psychotic features (MD-Psy), a disorder with considerable morbidity and mortality, is more common than is generally realized and is encountered frequently in clinical practice. Although studies conducted in both inpatient and outpatient settings have estimated that 16% to 54% of adults with depression are also psychotic, MD-Psy often is not diagnosed accurately because the psychosis may be subtle, intermittent, or concealed leading to a misdiagnosis of nonpsychotic depression.