Nonpsychotic Depressed Patients Research Articles

Association between thyroid function and psychotic symptoms in adolescents with major depressive disorder: A large sample sized cross-sectional study in China

BackgroundsThyroid function was associated with depression and psychotic symptoms; however, little research has focused on its role in coexisting psychotic symptoms in adolescents with depressive disorder. This study aimed to explore the association between thyroid function and psychotic symptoms among depression adolescents. MethodsA total of 679 adolescent patients (aged 12–18) diagnosed as depressive disorder were recruited. Their socio-demographic, clinical data and thyroid function parameters were collected. The severity of psychotic symptoms was measured according to the assessment measure in DSM-5. Based on the severity of psychotic symptoms, patients were distributed into psychotic depression (PD) and non-psychotic depression (NPD) subgroups, respectively. ResultsThe prevalence rate of PD was 52.7% among adolescents with depressive disorder in this study. PD patients were younger (p < 0.01), with more female (p < 0.001) and non-Han nationality (p < 0.01), and presented serum FT4 level decrease (p < 0.01). PD patients displayed a higher rate of abnormal thyroid relevant parameters (p < 0.05). 35.2% of PD patients presented at least one abnormal parameter among all five parameters tested (TSH, TT3, FT3, TT4, and FT4), compared to 27.4% among NPD patients. Further logistic regression analysis indicated that increased serum FT4 level was a protective effect of PD with an adjusted odds ratio (OR) of 0.615. We did not find a statistically significant difference in the family history of mental disorders, serum TSH, TT3, FT3, and TT4 levels. ConclusionsOur results suggested a high prevalence of PD among depression adolescents, associated with younger age, female, non-Han nationality, and decreased serum FT4 level. We recommend that adolescents with depressive disorder regularly screen their serum FT4 levels for better clinical outcomes.

Factors associated with antipsychotic use in non-psychotic depressed patients: results from a clinical multicenter survey

BackgroundThe combination of antipsychotics is not well studied among non-psychotic major depressive disorder (MDD). This study aims to explore the antipsychotics use in this population and its associated factors.MethodsThis cross-sectional and multi-site study was conducted in 11 sites of China. one Thousand five hundred three eligible MDD patients after 8–12 weeks of antidepressant treatment were included consecutively. A structured questionnaire was used to obtain socio-demographic data and medical histories. The Chinese version of the Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR), the Patient Health Questionnaire-15 (PHQ-15) and the Sheehan Disability Scale (SDS) were used for patient self-rating. Logistic regression model was used to explore the associated factors that could potentially be influential for the use antipsychotic augmentation.ResultsOverall, quetiapine (43.4%) was the most commonly used as an adjunct to antidepressants, followed by olanzapine (38.8%). And antipsychotics were commonly combined with escitalopram (23.1%), venlafaxine (21.7%), sertraline (14.8%). The factors influencing the combination of antipsychotics in non-psychotic depressed patients included service setting (OR = 0.444; p < 0.001; 95%CI = 0.338–0.583), comorbidity of physical illness (OR = 1.704; p < 0.001; 95%CI = 1.274–2.278), PHQ level (OR = 0.680; p < 0.001; 95%CI = 0.548–0.844), SDS level (OR = 1.627; p < 0.001; 95%CI = 1.371–1.930) and antidepressants co-treatment (OR = 2.606; p < 0.001; 95%CI = 1.949–3.485).ConclusionsAntipsychotics use is common among non-psychotic MDD patient. Service setting, comorbidity of physical illness, somatic symptoms, social functioning and engagement, and antidepressants co-treatment could be the factors associated with the antipsychotics use in MDD patients.

Non-psychotic depression and the social burden of illness

The burden of depression is increasing worldwide, caregivers are seen as a psychologically vulnerable group, and the social burden of non-psychotic depression remains unexplored.&#x0D; The aim of the study was to examine the clinical and functional characteristics of non-psychotic depression and the burden of family members of patients most involved in the interaction with patients. The study objectives included analysis of quality of life and co-occurring behavior of patients relatives as characteristics of their psychosocial adaptation.&#x0D; Methods. We used clinical and scales assessment of depression level, quality of life, subjective distress level, and coping behavior features.&#x0D; Results. Nonpsychotic depression was detected approximately half a year after the onset of symptoms, and in more than 40% of cases not by psychiatrists, self-treatment was typical. Impairments in social functioning in non-psychotic depression patients affected more in the areas of socially useful activities and social relationships, predominantly in non-working patients. 62.96% of patients rated relationships with loved ones as good, and 82.6% rated support from relatives in connection with the illness as adequate. In 60.87% of cases, there were psycho-traumatic microsocial factors. Spouses (45.5%) prevailed among supportive relatives, of whom 60% were employed, and limitation of labor activity due to the relatives illness was not characteristic, and material losses were insignificant. Supportive relatives more often than their sick relatives assessed the relationship with the sick as good (81.8%). In about 91% of cases, the attitude toward the mental illness of the relative was adequate, which exceeds the subjective assessment of patients with non-psychotic depression. The close relatives of the patients had decreased quality of life, which was mediated by severity of depression, higher than average level of distress related to mental disorder of the loved one (64,59,34 VAS scores). The structure of coping in supportive relatives is characterized on the whole by prevalence of constructive and relatively constructive coping-strategies, the most problematic being the emotional sphere of coping behavior.&#x0D; Conclusion. Even mild to moderate non-psychotic depression is associated with the presence of social burden of illness, covering not only the patients themselves, but also their family members, which necessitates psychologically corrective work with supportive relatives.

Sex differences in psychotic and non-psychotic major depressive disorder in a Chinese Han population

BackgroundSex differences between psychotic depression (PD) and non-psychotic depression (NPD) have received little systematic study. This study was conducted to investigate sex difference in patients with psychotic and non-psychotic major depressive disorder in a Chinese Han population. MethodsIn this cross-sectional study, a total of 1718 first-episode and drug-naïve outpatients with major depressive disorder were recruited. Demographic and clinical characteristics were collected. All subjects were rated on the Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA) and the Positive and Negative Syndrome Scale (PANSS). ResultsThe prevalence of PD in female patients (10.97%) was higher than that in male patients (7.99%). Analysis of variance (ANOVA) showed that female patients were older compared with male patients in NPD group, but there were no significant differences in demographic and clinical variables between female and male PD patients. Further, there were no sex differences in the scores of HAMD, HAMA and positive symptom subscale of PANSS in both PD and NPD groups. Two-way ANOVA showed that PD patients had significantly higher scores on the HAMD, HAMA and positive symptom subscale of PANSS than non-PD patients. However, there were no significant effects of sex and sex* subtypes. LimitationsThe main limitations are cross-sectional design and inability to control selection bias. ConclusionsOur findings show significant differences in clinical profiles between PD and NPD patients; however, no sex difference has been observed in the either PD or NPD patients.

Cost-effectiveness modeling of repetitive transcranial magnetic stimulation compared to electroconvulsive therapy for treatment-resistant depression in Singapore

Background Compared to electroconvulsive therapy (ECT), the cost-effectiveness of repetitive transcranial magnetic stimulation (rTMS) in the management of treatment-resistant depression (TRD) remains unclear. Objective/hypothesis This study evaluated the cost-effectiveness of rTMS vs. ECT for TRD from Singapore societal perspective. Methods We constructed a Markov model to project the cost and benefit of rTMS compared with ECT over one year in patients with TRD. The relative treatment effects between rTMS and ECT were obtained from meta-analyses of published trials. The effectiveness and quality of life data for patients using ECT, resource use for TRD and their associated costs were derived from the national tertiary mental institution in Singapore. Results At one year, rTMS was cost-effective relative to ECT. The incremental cost-effectiveness ratio (ICER) associated with ECT was Singapore dollars (SGD) 311,024 per quality-adjusted life-year (QALY) gained. This exceeded the willingness-to-pay threshold of SGD 70,000 per QALY gained. A similar trend was observed for ICER per remission achieved (i.e., SGD 143,811 per remission achieved with ECT). In the subgroup analysis, rTMS was found to be less costly and more effective than ECT in nonpsychotic depressive patients. In the scenario analysis, ECT employed as an ambulatory service yielded a much smaller ICER (i.e., SGD 78,819 per QALY gained) compared to the standard inpatient setting. Conclusions rTMS was a cost-effective treatment compared to ECT in TRD over one year. The cost-effectiveness of rTMS was attenuated when ECT was used in the outpatient setting.

Cost-Effectiveness Modeling of Repetitive Transcranial Magnetic Stimulation Compared to Electroconvulsive Therapy for Treatment-Resistant Depression in Singapore

Compared to electroconvulsive therapy (ECT), the cost-effectiveness of repetitive transcranial magnetic stimulation (rTMS) in the management of treatment-resistant depression (TRD) remains unclear. This study evaluated the cost-effectiveness of rTMS vs. ECT for TRD from Singapore societal perspective. We constructed a Markov model to project the cost and benefit of rTMS compared with ECT over one year in patients with TRD. The relative treatment effects between rTMS and ECT were obtained from meta-analyses of published trials. The effectiveness and quality of life data for patients using ECT, resource use for TRD and their associated costs were derived from the national tertiary mental institution in Singapore. At one year, rTMS was cost-effective relative to ECT. The incremental cost-effectiveness ratio (ICER) associated with ECT was Singapore dollars (SGD) 311,024 per quality-adjusted life-year (QALY) gained. This exceeded the willingness-to-pay threshold of SGD 70,000 per QALY gained. A similar trend was observed for ICER per remission achieved (i.e., SGD 143,811 per remission achieved with ECT). In the subgroup analysis, rTMS was found to be less costly and more effective than ECT in nonpsychotic depressive patients. In the scenario analysis, ECT employed as an ambulatory service yielded a much smaller ICER (i.e., SGD 78,819 per QALY gained) compared to the standard inpatient setting. rTMS was a cost-effective treatment compared to ECT in TRD over one year. The cost-effectiveness of rTMS was attenuated when ECT was used in the outpatient setting.

Executive Dysfunction in Non-Psychotic Unipolar Depressed Patients: Assessement by the Wisconsin (Berg) Card Sorting Test

&lt;p&gt;Introduction: Alterations in executive functioning are frequent in depressed subjects, being the Wisconsin Card Sorting Test (WCST) one of the most utilized instruments to assess it, even though, when individually compared, this test’s items did not show consistency.&lt;/p&gt;&lt;p&gt;Method: This study aimed to compare the performance of a group comprising 36 non-psychotic unipolar depressed patients (23 women and 13 men, with a mean age of 44.28 years old [&lt;em&gt;SD&lt;/em&gt; = 14.78]) with 36 healthy controls (22 women and 14 men, with a mean age of 42.22 years old [&lt;em&gt;SD&lt;/em&gt; = 15.19]) in a computerized version of WCST.&lt;/p&gt;&lt;p&gt;Results: We found significant differences between depressed patients and healthy controls regarding number of categories, perseverative responses, perseverative errors, non-perseverative errors, percentage of conceptual level responses and failure to maintain set, clearly influenced by the variable age, which showed a shared variance between 17% and 33% in depressive patients’ performance and between 16% and 26% in healthy controls’ performance.&lt;/p&gt;&lt;p&gt;Conclusions: Results allowed us to identify differences in performance between the two groups, therefore this version of the WCST revealed itself a reliable alternative to assess Executive Functions (EFs), accessible to all clinicians.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;

Planning Dysfunction in Non-Psychotic Unipolar Depressed Patients: Assessement by a Computerized Version of the Tower of London Task

&lt;p&gt;Introduction: Alterations in executive functioning are frequent in depressed patients, being common the appearance of planning difficulties.&lt;/p&gt;&lt;p&gt;Method: This study aimed to compare the performance of a sample of 40 non-psychotic unipolar depressed patients (26 women and 14 men, with a mean age of 44.15 years old [&lt;em&gt;SD&lt;/em&gt; = 13.82]) with 40 healthy controls (24 women and 16 men, with a mean age of 42.05 years old [&lt;em&gt;SD&lt;/em&gt; = 15.19]) using a computerized version of the Tower of London (TOL) task.&lt;/p&gt;&lt;p&gt;Results: Significant differences regarding extra moves and execution time between groups were found, with healthy controls outperforming depressed patients, who took significantly longer to complete the task. The variable age influenced clearly the results, showing a shared variance of 55% for both groups.&lt;/p&gt;&lt;p&gt;Conclusions: The results allowed us to identify differences in performance between both groups, therefore this version of the TOL revealed itself as a reliable alternative to assess planning, accessible to all clinicians.&lt;/p&gt;

Is major depressive disorder with psychotic features more likely in elderly than adulthood?

Objective: Although psychotic depression is very common among old depressed patients, studies have generally failed to find any socio-demographic differences between psychotic depressed patients and non-psychotic patients. Comparison of the age related factors in psychotic depression and non-psychotic depression patients could contribute to a better understanding of the clinical features of psychotic depression and its management. Method: The sample comprised of 50 inpatients; 25 of them major depressive disorder with psychotic features, and the other 25 major depressive disorder without psychotic features. The diagnosis made after consensus of two psychiatrists by Structured Clinical Interview for DSM-IV Axis I Disorder (SCID-IV). The severity of depression measured with the Hamilton Depression Rating Scale (HDRS), and concomitantly Hamilton Anxiety Rating Scale (HARS) were performed. Results: The average age of the patients with psychotic depression (46,6±15.4 years) was higher than that of non-psychotic depressed patients (35,1±15.2 years). Also, patients with psychotic depression had higher mean of total HDRS and HARS scores. There were no significant differences between the patient groups in number of episodes and duration of illness. Conclusion: These findings suggest that major depressive disorder with psychotic features is more likely in elderly than adulthood.

Is the Psychotic Depression Assessment Scale a useful diagnostic tool?: The CRESCEND study

BackgroundThe Psychotic Depression Assessment Scale (PDAS) has been validated as a method of assessing the severity and treatment outcomes of psychotic depression (PD). We aimed to compare the results of the PDAS in PD and non-psychotic depression (non-PD) patients and validate the PDAS as a diagnostic tool for PD. MethodsWe included 53 patients with PD and 441 with non-PD who participated in the Clinical Research Center for Depression study in South Korea. In addition to the PDAS, psychometric tools including the HAMD17, HAMA, BPRS, CGI-S, SOFAS, SSI-Beck, WHOQOL-BREF, AUDIT, and FTND were used to assess, respectively, depression, anxiety, overall symptoms, global severity, social functioning, suicidal ideation, quality of life, alcohol use, and nicotine use. ResultsAfter adjusting for age and total HAMD17 score, PD patients had higher scores for depressive mood, hallucinations, unusual thought content, suspiciousness, blunted affect, and emotional withdrawal on the PDAS and higher total scores on the SSI-Beck than non-PD patients. Binary logistic regression identified hallucinatory behavior and emotional withdrawal as predictors of PD. Receiver operating characteristic analysis showed that emotional withdrawal could be used to differentiate psychotic from non-psychotic depression. LimitationsThe inter-rater reliability for psychometric assessments was not evaluated. ConclusionsIn addition to assessing the severity and treatment outcomes of PD, PDAS can help in the diagnosis of PD.

Psychotic versus non-psychotic major depressive disorder: A comparative naturalistic study

ObjectivePsychotic depressed patients were found to have more severe cognitive deficits, poorer treatment response and higher suicidal risk respect to non-psychotic depressives. Aim of the present research was to compare clinical variables and outcome between psychotic and non-psychotic major depressive patients. MethodA sample of 36 major depressed patients was divided into two groups according to the presence of psychotic symptoms. Structured Clinical Interview for DSM (SCID-I) and Hamilton Depression Rating Scale (HAM-D) were administered to the patients at baseline by trained raters. One-way analysis of variance (ANOVAs) and chi-square tests were performed to compare the two groups. Binary logistic regression was performed to assess the risk of lack of response/remission in patients with psychotic symptoms and the risk of developing psychotic symptoms in major depressives with a family history of schizophrenia or bipolar disorder. ResultsPsychotic major depressives presented more severe illness as showed by HAM-D baseline scores (F=17.20, p<0.001), a longer duration of hospitalization (F=7.64, p=0.009) and they were more frequently treated with clomipramine (χ2=16.22, p=0.027). Psychotic symptoms were predictive of lack of remission (OR=4.09, p=0.05) and family history of schizophrenia/psychotic bipolar disorder was associated with psychotic major depression (OR=10.81, p=0.04). ConclusionsPatients with psychotic symptoms present a more severe course of illness as showed by long hospitalizations and lower rates of remission. Psychotic depressives show more frequently a family history of “major psychoses” suggesting a continuum in psychotic disorders and a genetic association of major psychotic depression with bipolar disorder and schizophrenia.

Are There Gender‐Specific Risk Factors for Suicidal Activity among Patients with Schizophrenia and Depression?

Are there gender-specific risk factors for suicidal activity among patients with schizophrenia and depression? A total of 74 schizophrenia patients (51 men, 23 women) and 77 unipolar nonpsychotic depressed patients (26 men, 51 women) from the Chicago Follow-up Study were studied prospectively at 2 years posthospitalization and again at 7.5 years. Poor early posthospital global functioning is significantly associated with later suicidal activity only for men in both our schizophrenia and depressive samples. Early display of psychotic symptoms is associated with later suicidal activity among male schizophrenia patients. Early cognitive impairment is not significantly associated with later suicidal activity for any of the four groups of patients. The study results must be seen as exploratory and will hopefully spur future research on this important topic.

Backward masking reveals different visual processing of schizophrenic and depressive patients

Visual backward masking is a very sensitive tool for studying early visual processing deficits and a reliable endophenotype of schizophrenia. Mental diseases strongly overlap in many aspects, for example, in psychopathology, cognition, and genetics. Here, we show that strong masking deficits are found in patients with functional psychoses but not in non-psychotic patients, namely, depressive patients and abstinent alcoholics. We tested 28 schizophrenic, 22 schizoaffective, 20 bipolar patients, 26 major depressive patients, 23 abstinent alcoholics, and 24 healthy control subjects with various variants of the shine-through masking paradigm. Patients with schizophrenia, schizoaffective disorder, and bipolar disorder, show strongly prolonged SOAs compared to controls. Patients with unipolar major depression and abstinent alcoholics, however, perform like healthy controls. We suggest that patients with functional psychoses suffer from similar visual dysfunctions whereas visual processing of depressive patients seems to differ. [The work was supported by the Volkswagen Foundation.]

A comparison of the Major Depression Inventory (MDI) and the Beck Depression Inventory (BDI) in severely depressed patients

Background. We set out to examine the psychometric properties of the MDI in comparison to the BDI in a mixed group of patients with primary depression. Methods. At the Department of Biological Psychiatry in Vienna currently depressed inpatients with either a depressive or a schizo-affective disorder filled out both MDI and BDI on day of admission and at a time-point two weeks later during their treatment. Furthermore the Hamilton Depression Scale (HAM-D) was administered by the treating clinician at both time-points. Results. In total, 51 patients were included in the study. The non-parametric item response analysis was preferred to the classical Cronbach coefficient α as the latter is influenced by the number of items in a questionnaire. MDI obtained a Mokken analysis coefficient above 0.40, indicating unidimensionality. To determine external validity severely depressed patients with psychotic symptoms (N = 10) were compared to the remaining non-psychotic depressed patients (N = 41). Although BDI and MDI showed a lower score for psychotic than for non-psychotic inpatients, the standard deviations for both were greater for psychotic inpatients. On the intercorrelations between the different scales, MDI showed for all coefficients values above 0.70. On the other hand BDI and MDI both showed the same degree of linear relationship as the usual versions of HAM-D. Conclusion. Our results demonstrate that the MDI had the highest coefficients values and was sufficient as a measure for depressive disorders in psychiatric patients.

Response suppression deficits in treatment-naïve first-episode patients with schizophrenia, psychotic bipolar disorder and psychotic major depression

Recent evidence indicates common genetic, neurobiological, and psychopharmacological aspects of schizophrenia and psychotic affective disorders. Some similarities in neurocognitive deficits associated with these disorders have also been reported. We investigated performance on antisaccade and visually-guided saccade tasks in treatment-naïve first-episode psychosis patients (schizophrenia n = 59, major depression n = 15, bipolar disorder n = 9), matched non-psychotic major depression patients ( n = 40), and matched healthy individuals ( n = 106). All psychosis groups displayed elevated antisaccade error rates relative to healthy individuals. Antisaccade latencies were elevated in schizophrenia, but no significant error rate or latency differences were observed among psychosis groups. For schizophrenia only, shorter visually guided saccade latencies were associated with higher antisaccade error rates. Schizophrenia was also the only group without a significant relationship between visually guided and antisaccade latencies. Reflexive saccades were unimpaired except in psychotic unipolar depression, where saccades were hypometric. As in schizophrenia, antisaccade abnormalities are present in affective psychoses, even early in the course of illness and prior to treatment. Disturbances in frontostriatal systems are believed to occur in both affective psychoses and schizophrenia, potentially causing some similar cognitive abnormalities across psychotic disorders. However, the distinct pattern of dysfunction in schizophrenia across oculomotor paradigms suggests possible unique causes of their observed oculomotor performance deficits.

Seizure (Ictal)—EEG Characteristics in Subgroups of Depressive Disorder in Patients Receiving Electroconvulsive Therapy (ECT)—A Preliminary Study and Multivariate Approach

Objectives. Examine frequency distributions of ictal EEG after ECT stimulation in diagnostic subgroups of depression. Methods. EEG registration was consecutively monitored in 33 patients after ECT stimulation. Patients were diagnosed according to DSM IV and subdivided into: (1) major depressive disorder with psychotic features (n = 7), (2) unipolar depression (n = 20), and (3) bipolar depression (n = 6). Results. Results indicate that the diagnostically subgroups differ in their ictal EEG frequency spectrumml: (1) psychotic depression has a high occurrence of delta and theta waves, (2) unipolar depression has high occurrence of delta, theta and gamma waves, and (3) bipolar depression has a high occurrence of gamma waves. A linear discriminant function separated the three clinical groups with an accuracy of 94%. Conclusion. Psychotic depressed patients differ from bipolar depression in their frequency based on probability distribution of ictal EEG. Psychotic depressed patients show more prominent slowing of EEG than nonpsychotic depressed patients. Thus the EEG results may be supportive in classifying subgroups of depression already at the start of the ECT treatment.

Periods of Recovery in Deficit Syndrome Schizophrenia: A 20-Year Multi-follow-up Longitudinal Study

Periods of recovery were examined in patients with and without deficit syndrome schizophrenia. Fifty-six patients with schizophrenia were studied, 39 of whom were divided into deficit and nondeficit syndrome schizophrenia subtypes using a proxy method. We also studied 39 nonpsychotic depressive comparison patients. Patients were evaluated as part of the Chicago Follow-up Study, which prospectively examined patients at regular intervals over a 20-year period. Using standardized instruments, patients were evaluated for the deficit syndrome, global recovery, rehospitalization, social dysfunction, occupational disability, and symptom presentation. Recovery was examined at 6 time points measured at 2-, 4.5-, 7.5-, 10-, 15-, and 20-year postindex hospitalization. Cumulatively, over the 20-year period, 13% of patients classified as meeting criteria for the deficit syndrome showed 1 or more 1-year periods of global recovery, in comparison to 63% of nondeficit schizophrenia patients and 77% of depressed patient controls. Results indicate that the deficit syndrome represents a persistently impaired subsample of schizophrenia patients, with continuous social, occupational, and symptom impairment. In contrast, nondeficit syndrome schizophrenia patients showed at least some periods of remission or recovery, with the likelihood of these periods increasing as they became older. Findings provide further support for the validity of the deficit syndrome concept and suggest that deficit status is characterized by a more persistently impaired course of illness and particularly poor long-term prognosis.

Theory of mind disability in major depression with or without psychotic symptoms: A componential view

Previous reports have conceptualized theory of mind (ToM) as comprising two components and questioned whether ToM deficits are associated with psychotic symptoms. We investigated 33 nonpsychotic depressed inpatients, 23 psychotic depressed inpatients, and 53 normal controls with the following measures: Eyes Task, Faux pas Task, Verbal Fluency Test (VFT), Digit Span Test (DST) and WAIS-IQ. The depressed patients were also evaluated with the Beck Depression Inventory-II (BDI-II) and the Brief Psychiatric Rating Scale (BPRS). The nonpsychotic depressed patients and the psychotic depressed individuals were significantly impaired on tasks involving ToM social-perceptual and social-cognitive components, as well as the VFT. The psychotic depressed patients performed significantly worse than nonpsychotic depressed patients on ToM tasks. An association was found between ToM performances and both BPRS total and hostile-suspiciousness scores in the depressed group. Both of the ToM components were impaired in depressed patients. Similar mechanisms and neurobiological substrate may contribute to schizophrenia and major depression.

Efficacy of Imipramine in Psychotic Versus Nonpsychotic Depression

The purpose of the present study is to compare the efficacy of imipramine in the treatment of psychotic versus nonpsychotic depression. Previous studies report varying results of monotherapy with antidepressants in psychotic depression. Because psychotic depression is seriously underinvestigated, performing a post hoc analysis of randomized clinical trials consisting of both psychotic and nonpsychotic depressed patients may contribute to the discussion on the optimal treatment of depressed patients with mood-congruent psychotic features. A total of 112 patients diagnosed with major depression (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) (40 with psychotic depression and 82 without psychotic features) received treatment with imipramine for 6 weeks after a washout period of 7 days. Imipramine doses were adjusted to attain a predefined fixed plasma level. Treatment response was assessed with the Hamilton Rating Scale for Depression (HAM-D). A logistic regression analysis showed a significantly larger reduction in HAM-D score in the sample with psychotic features compared with the nonpsychotic sample (regression coefficient, -3.47; SE, 1.7; P = 0.04). According to the primary outcome criterion, that is, the change in HAM-D score, imipramine was significantly more effective in the sample with psychotic depression compared with the nonpsychotic depressed patients. The contradiction between our results and those of several previous studies may be due to the fixed plasma level dosing of imipramine refraining from concurrent psychotropic medication or limiting our patient sample to patients with mood-congruent psychotic features.

Out-patient care to schizophrenic patients having antisocial records

Background: Depression occurring in schizophrenia is a common problem; however, investigators have typically not studied it with the paranoid/nonparanoid dichotomy in mind. This study examines the quality as well as the severity of depression in three psychiatric groups: paranoid schizophrenia patients, nonparanoid schizophrenia patients, and nonpsychotic major depression patients. Method: Clinical and sociodemographic data were collected on 27 paranoid and 27 nonparanoid schizophrenia patients during their postpsychotic phase while they were at least mildly depressed, and a comparison group of 27 nonpsychotic patients diagnosed with major depressive disorder. The three groups were then assessed on various psychometric scales for severity of depression, profile of symptoms, suicidal risk, and anhedonia. Results: The paranoid schizophrenia patients were more depressed and more at risk for suicide than the nonparanoid schizophrenia patients, yet their depressive profiles and levels of anhedonia were similar. Conclusions: Depressed mood and anhedonia constitute serious problems for schizophrenia patients, but particularly for paranoid schizophrenia patients during the postpsychotic phase of their illnesses. Clinical implications: Schizophrenia patients, especially those with the paranoid features, should be routinely evaluated and monitored for depression. Apart from treatment with drugs, cognitive therapy may be considered a viable option, particularly for paranoid schizophrenia patients. Limitations: Gender was not matched for the two schizophrenia groups and extrapyramidal side effects were not measured.