Ten-year outcomes in first episode psychotic major depression patients compared with schizophrenia and bipolar patients

M Heslin,J.M Lappin,K Donoghue,B Lomas,U Reininghaus,A Onyejiaka,T Croudace,P.B Jones,R.M Murray,P Fearon,G.A Doody,P Dazzan,T.J Craig,C Morgan

doi:10.1016/j.schres.2016.04.049

Abstract

We aimed to investigate long-term outcomes in psychotic major depression patients compared to schizophrenia and bipolar/manic psychosis patients, in an incidence sample, while accounting for diagnostic change.Based on Aetiology and Ethnicity in Schizophrenia and Other Psychoses (ÆSOP and ÆSOP-10), a first episode psychosis cohort was followed-up 10years after first presentation. The Schedules for Clinical Assessment in Neuropsychiatry, WHO Life Chart and Global Assessment of Functioning were used to assess clinical, social and service use outcomes.Seventy-two PMD patients, 218 schizophrenia patients and 70 psychotic bipolar disorder/mania patients were identified at baseline. Differences in outcome between PMD and bipolar patients based on baseline and lifetime diagnosis were minimal. Differences in clinical, social and service use outcomes between PMD and schizophrenia were more substantial with PMD patients showing better outcomes on most variables. However, there was some weak evidence (albeit not quite statistically significant at p<0.05) based on lifetime diagnoses that PMD patients were more likely to attempt suicide (OR 2.31, CI 0.98–5.42, p0.055) and self-harm (OR 2.34, CI 0.97–5.68, p0.060).PMD patients have better social and service use outcomes compared to people with schizophrenia, but may be more likely to attempt suicide or self-harm. This unique profile is important for clinicians to consider in any risk assessment.

Highlights

Major depression with psychotic features, known as Psychotic Major Depression (PMD), is defined by ICD–10 (WHO, 1993) as a depressive disorder with the addition of delusions, hallucinations or depressive stupor
Given the paucity of information on long-term outcomes for PMD patients in less biased samples, we aimed to examine long term (10 year) outcomes in people with PMD, while improving on the methodological limitations of previous research by studying an incidence sample, and accounting for diagnostic change
This paper is based on the ÆSOP-10 study which is fully described in Morgan et al (2014) In brief, ÆSOP-10 is a 10 year follow-up of a cohort of people with a first episode of psychosis

Summary

Introduction

Major depression with psychotic features, known as Psychotic Major Depression (PMD), is defined by ICD–10 (WHO, 1993) as a depressive disorder with the addition of delusions, hallucinations or depressive stupor. A systematic review and meta-analysis by Kirkbride et al (2012) reported a pooled incidence for PMD in England of 5.3 (95% CI 3.7–7.6) per 100,000 person years. This was compared with 3.7 per 100,000 person years (95% CI 3–4.5) for bipolar with psychotic. Symptoms and 15.2 per 100,000 person years (95% CI 11.9–19.5) for schizophrenia These results suggest that PMD is less common than schizophrenia, but more common than bipolar disorder. Despite these incidence rates, PMD is a largely under-researched disorder (Crebbin et al, 2008). Heslin et al / Schizophrenia Research 176 (2016) 417–422 illness (Cohen and Cohen, 1984) and may give a distorted picture of long-term prognosis

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Conclusion