Major depression with psychotic features in adolescence

Abstract

Major Depression with psychotic features remains a poorly-defined entity in adolescents. The diagnostic differentiation from schizophrenia can be difficult and the implications for treatment have not been studied. Of 81 hospitalized adolescents studied with semistructured interviews GADS), 12 had schizophrenia and six had major depression with psychotic features (MD-psychotic; DSM-III). Analysis of SADS results, dexamethasone suppression test results, and hospital course suggests that those with MD-psychotic were differentiated from those with schizophrenia by better premorbid function, family history of affective disorder, more acute onset, onset with nondelusional depression, more severe guilt, worthlessness and hopelessness, more severe psychomotor retardation and delayed insomnia, and more suicidal ideation and behavior. Consistent with studies in adults, cross-sectional mental status parameters did not differentiate well between groups and were heterogeneous within the MD-psychotic group. Dexamethasone nonsuppression appeared to distinguish the two groups. Implications for diagnostic dilemmas, treatment, and the design of prospective studies are discussed.