Distinctive Clinical Correlates of Psychotic Major Depression: The CRESCEND Study

Abstract

ObjectiveThe purpose of this investigation was to identify distinctive clinical correlates of psychotic major depression (PMD) as compared with non-psychotic major depression (NPMD) in a large cohort of Korean patients with major depressive disorder (MDD).MethodsWe recruited 966 MDD patients of age over 18 years from the Clinical Research Center for Depression of South Korea (CRESCEND) study. Diagnoses of PMD (n=24) and NPMD (n=942) were made with the DSM-IV definitions and confirmed with SCID. Psychometric scales were used to assess overall psychiatric symptoms (BPRS), depression (HAMD), anxiety (HAMA), global severity (CGI-S), suicidal ideation (SSI-Beck), functioning (SOFAS), and quality of life (WHOQOL-BREF). Using independent t-tests and χ2 tests, we compared clinical characteristics of patients with PMD and NPMD. A binary logistic regression model was constructed to identify factors independently associated with increased likelihood of PMD.ResultsPMD subjects were characterized by a higher rate of inpatient enrollment, and higher scores on many items on BPRS (somatic concern, anxiety, emotional withdrawal, guilt feelings, tension, depression, suspiciousness, hallucination, motor retardation, blunted affect and excitement) global severity (CGI-s), and suicidal ideation (SSI-Beck). The explanatory factor model revealed that high levels of tension, excitement, and suicidal ideation were associated with increased likelihood of PMD.ConclusionOur findings partly support the view that PMD has its own distinctive clinical manifestation and course, and may be considered a diagnostic entity separate from NPMD.

Psychotic (delusional) depression and suicidal attempts: a systematic review and meta‐analysis

“…Twelve studies met our high quality criteria , whereas eight studies were rated as of low quality . The fixed‐effects pooled OR in the former studies was 2.26 (95% CI: 1.84–2.77), whereas their random effect pooled OR was 2.23 (95% CI: 1.63–3.04), with I 2 statistic being 42.4%.…”

“…As regards the differences in suicidal attempts with respect to age, the fixed‐effects pooled OR of the three studies with only elderly patients was 2.11 (95% CI: 1.23–3.63) and the random‐effects pooled OR 2.12 (95% CI: 1.06–4.27), with the I 2 statistic being 54.6%. The corresponding fixed‐effects pooled OR of the remaining 17 studies which included younger adults was 2.11 (95% CI: 1.80–2.48), and the random‐effects pooled OR was 2.01 (95% CI: 1.54–2.63) with the I 2 statistic being 54.6%. The difference was not statistically significant (meta‐regression P = 0.888); thus, age of patients does not seem to act as an effect modifier (Table ).…”

“…Fifty studies were left for further investigation after exclusion of duplicates and irrelevant to the research question references. Eight studies reported data on completed suicides , nine included bipolar patients , five had no comparison group , five assessed suicidality by means of psychometric scales with no categorical data , two consisted of the same sample with the included studies , and two were excluded because their sample exclusively comprised patients with history of suicidal attempt or adolescent ones with psychotic experiences without fulfilling PMD criteria though .…”

“…Studies comparing suicidal attempts between PMD and non‐PMD patients have reported conflicting results: Some have shown that psychosis increases the risk of suicidal attempt , whereas other studies failed to show such an effect . A history of suicidal attempt increases the risk of a future completed suicide at 30–40 times compared with the risk in general population .…”

Association Between Suicidal Ideation and Exposure to Suicide in Social Relationships Among Family, Friend, and Acquaintance Survivors in South Korea

“…In recent Korean population‐based studies, high levels of suicidal ideation were associated with increased likelihood of metabolic syndrome in adults (Kim et al., ), psychotic major depression as compared with nonpsychotic major depression inpatients with major depressive disorder (Park et al., ), and type‐D personality inpatients with major depressive disorder (Park, Ko, Lee, Lee, & Kim, ).…”