OBJECTIVE: The current research was designed to investigate the
relationship between affective disruption and psychosis in unipolar major
depressive disorder and to evaluate whether some depressed patients are
particularly vulnerable to subsequent psychosis. METHOD: A group of 31
psychotic and 63 nonpsychotic inpatients with unipolar depression were
assessed during hospitalization and then prospectively assessed for
depressive and psychotic symptoms 2.4 years after hospital discharge.
RESULTS: The psychotic depressed inpatients had significantly higher rates
of psychosis during the posthospital period, 2.4 years later, than the
originally nonpsychotic depressed inpatients. However, they did not have
higher rates of depressive syndromes during the posthospital period.
Psychosis during the posthospital period was significantly related to
recurrent or persistent affective disruption. The posthospital depressive
syndromes of the initially psychotic depressed inpatients tended to be
slightly more severe than those of the initially nonpsychotic depressed
inpatients. Despite this, psychosis during the inpatient period was more
predictive of posthospital psychosis than the severity of the posthospital
depressive syndrome. CONCLUSIONS: The interaction of the following two
factors was proposed to be central to psychotic depression: 1) a
vulnerability to psychosis, and 2) concurrent affective disruption.