Delusional depression in elderly patients: Characteristics and relationship to age at onset

Abstract

SUMMARYIn a prospective study, 34 patients with delusional depression were compared with 100 non-psychotically depressed patients and a subgroup of 30 age-and sex-matched control patients. Depressed patients with delusions were more likely to be single, especially single men. The most common delusions were those of persecution and hypochondriasis. There were no striking differences in other depression symptoms and no evidence for the hypothesis that delusional depression is associated with a later age of depression onset. KEY womsdepression; delusions; psychotic; ageing; elderlyDelusional depression is a distinct subtype of major depression. In studies of mixed-aged or younger adults, compared with non-delusional depression there are differences in glucocorticoid and dopamine-P-hydroxylase activity, levels of dopamine and serotonin metabolites, sleep measures and ventricle-to-brain ratios (summarized by Schatzberg and Rothschild, 1992). Furthermore, the presence of delusions tends to run true through relapses of depression (Charney and Nelson, 1980).In an earlier study, I confirmed that a number of the above distinguishing features of delusional depression are valid for elderly patients (Baldwin, 1988). Nevertheless, delusional depression in older patients remains a relatively neglected area of research.There are clinical and theoretical reasons for studying delusional forms of depression as a separate entity. First, the treatment of the delusional variant of depressive illness differs from nondelusional depression (Baldwin, 1988). Second, Meyers and Greenberg (1986) found an increase in delusional forms of depression with increasing age at onset. In an elderly sample of 161 patients,

Psychotic (delusional) major depression in late life: a clinical study

“…Our ®ndings were in line with those of other geriatric studies (Baldwin, 1995;Kivela and Pahkala, 1989). George (1994) suggested that unmarried, divorced, separated, or widowed subjects in old age are at greater risk for developing depression.…”

“…In geriatric inpatient studies, Meyers and Greenberg (1986) presented results very similar to ours claiming that an age effect occurring only after the seventh decade of life could be washed out in studies using mixed-age samples with mean ages usually under 60 years. Nelson et al (1989), in a retrospective study, and Baldwin (1995) in a prospective study, also using geriatric samples, did not ®nd any differences as regards age at onset between PMD and NPMD patients. Elderly depressives may have a greater vulnerability in developing PMD, due to their abnormalities of cortisol (Alexopoulos et al, 1984;Davis et al, 1984;Stokes et al, 1984;Greden et al, 1986) and dopamine regulation (Schatzberg et al, 1984(Schatzberg et al, , 1995Meyers et al, 1999).…”

Clinical Features of Delusional Beliefs in Schizophrenic and Unipolar Mood Disorders: A Comparative Study

“…To this time, the investigation of delusions in depressive disorders focused, almost exclusively, on the types of their thematic content, neglecting thus other more formal features [10][11][12][13][14]. The present study aims at contributing to the solution of the aforementioned differential diagnostic problem by focusing on more formal features of delusional beliefs, as well as on broader dimensions thereof, obtained through the application of multivariate statistical techniques.…”

Dimensional approach to delusions in psychotic depression in the elderly: factor structure and clinical correlates

“…Thus far, the investigators of delusions of PMD in the elderly have mainly adopted a categorical approach to their study (Meyers and Greenberg, 1986;Baldwin, 1995;Gournellis et al, 2001). The only available dimensional study of PMD included patients of all ageranges (Meyers et al, 2006).…”