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Am J Psychiatry 1992; 149:733-745
Copyright © 1992 by American Psychiatric Association
Psychotic (delusional) major depression: should it be included as a distinct syndrome in DSM-IV?
AF Schatzberg and AJ Rothschild
Department of Psychiatry, Harvard Medical School, Boston, Mass.
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.
This article has been cited by other articles:
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