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    Psychotic (delusional) major depression: should it be included as a distinct syndrome in DSM-IV

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    Authors
    Schatzberg, Alan F.
    Rothschild, Anthony J.
    UMass Chan Affiliations
    Department of Psychiatry
    Document Type
    Journal Article
    Publication Date
    1992-06-01
    Keywords
    Antidepressive Agents, Tricyclic
    Delusions
    Depressive Disorder
    Diagnosis, Differential
    Guilt
    Humans
    Placebos
    Psychiatric Status Rating Scales
    Psychomotor Disorders
    Sleep
    Terminology as Topic
    Psychiatry
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    Link to Full Text
    http://ajp.psychiatryonline.org/cgi/content/abstract/149/6/733
    Abstract
    To review data supporting or not supporting the designation of unipolar psychotic major depression as a distinct syndrome in DSM-IV, the authors used computerized literature searches to identify reports of studies that have directly compared the characteristics, biology, familial transmission, course/outcome, and response to treatment of psychotic and nonpsychotic major depression. The review showed that statistically significant differences between the two types of depression have been found on each of these dimensions. There are greater guilt feelings and psychomotor disturbance, among other features, in psychotic depression. Studies have found significant differences between patients with psychotic and nonpsychotic depression in glucocorticoid activity, dopamine beta-hydroxylase activity, levels of dopamine and serotonin metabolites, sleep measures, and ventricle-to-brain ratios. Family studies show higher rates of bipolar disorder in first-degree relatives of probands with psychotic major depression than of probands with nonpsychotic major depression. Greater morbidity and residual impairment have also been reported in patients with psychotic major depression, and they respond more poorly to placebo and to tricyclic antidepressants. Differences between patients with psychotic and nonpsychotic major depression on many of these measures were not due to differences in severity or endogenicity. Since the data indicate that psychotic and nonpsychotic major depression can be separated, the frequency with which the diagnosis of psychotic major depression is missed and its unique course and response to treatment point to the practical importance of a separate diagnosis for this disorder. However, further studies are needed to resolve important methodological issues and to develop an optimal set of operational criteria.
    Source
    Am J Psychiatry. 1992 Jun;149(6):733-45.
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/45810
    PubMed ID
    1590491
    Related Resources
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    UMass Chan Faculty and Researcher Publications

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