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Persistent delusional theme over 13 episodes of psychotic depression

Published online by Cambridge University Press:  07 August 2013

Søren Dinesen Østergaard ,
Anne Katrine K. Leadholm  and
Anthony J. Rothschild
Søren Dinesen Østergaard*
Affiliation:
Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aalborg University hospital, Aalborg, Denmark Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
Anne Katrine K. Leadholm
Affiliation:
Copenhagen University Medical School, Copenhagen, Denmark
Anthony J. Rothschild
Affiliation:
University of Massachusetts Medical School and UMass Memorial Health Care, Worcester, MA, USA
*
Søren Dinesen Østergaard, Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aalborg University Hospital, Mølleparkvej 10, DK-9000 Aalborg, Denmark. Tel: +45 61282753; Fax: +45 97643754; E-mail: [email protected]
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Abstract

Objective

Unipolar psychotic depression (PD) is a highly debilitating condition, which needs intense monitoring and treatment. Among patients with recurrent PD, delusions tend to be very similar or identical over several separate episodes during the course of illness, but case reports illustrating this clinical phenomenon in detail are lacking from the literature.

Methods

Case report describing the 45-year-old Ms. J, who has experienced multiple episodes of PD. The report is based on a review of her medical file.

Results

The delusional theme of Ms. J's initial episode of PD reappeared at several subsequent episodes. During the majority of admissions, Ms. J was treated with electroconvulsive therapy, which resulted in significant improvement in the depressive, psychotic and catatonic features.

Conclusion

Ms. J's case illustrates that PD can be a stable phenotype over many episodes and that it is important to recognise psychotic symptoms in order to prescribe the best possible treatment.

Keywords

affective disorderdelusionsdepressionpsychosis
Type
Case Report
Information
Acta Neuropsychiatrica , Volume 25 , Issue 6 , December 2013 , pp. 370 - 373
Copyright
Copyright © Scandinavian College of Neuropsychopharmacology 2013 

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References

1.Rothschild, AJ. Clinical Manual for Diagnosis and Treatment of Psychotic Depression. Washington, DC, USA: American Psychiatric Publishing Inc., 2009.Google Scholar
2.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th edition. Washington, DC: Text Revision, 2000.Google Scholar
3.World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders. Diagnostic Criteria for Research. WHO: Geneva, 1993.Google Scholar
4.Ostergaard, SD, Petrides, G, Dinesen, PTet al. The association between physical morbidity and subtypes of severe depression. Psychother Psychosom 2013;82:45–52.CrossRefGoogle ScholarPubMed
5.Ostergaard, SD, Bille, J, Soltoft-Jensen, H, Lauge, N, Bech, P. The validity of the severity-psychosis hypothesis in depression. J Affect Disord 2012;140:48–56.CrossRefGoogle ScholarPubMed
6.Ostergaard, SD, Bertelsen, A, Nielsen, J, Mors, O, Petrides, G. The association between psychotic mania, psychotic depression and mixed affective episodes among 14,529 patients with bipolar disorder. J Affect Disord 2013;147:44–50.CrossRefGoogle Scholar
7.Maj, M, Pirozzi, R, Magliano, L, Fiorillo, A, Bartoli, L. Phenomenology and prognostic significance of delusions in major depressive disorder: a 10-year prospective follow-up study. J Clin Psychiatry 2007;68:1411–1417.CrossRefGoogle ScholarPubMed
8.Ostergaard, SD, Waltoft, BL, Mortensen, PB, Mors, O. Environmental and familial risk factors for psychotic and non-psychotic severe depression. J Affect Disord 2013;147:232–240.CrossRefGoogle ScholarPubMed
9.Petrides, G, Fink, M, Husain, MMet al. ECT remission rates in psychotic versus nonpsychotic depressed patients: a report from CORE. J ECT 2001;17:244–253.CrossRefGoogle Scholar
10.Birkenhager, TK, Pluijms, EM, Lucius, SA. ECT response in delusional versus non-delusional depressed inpatients. J Affect Disord 2003;74:191–195.CrossRefGoogle ScholarPubMed
11.Von Werne Baes, C, De Carvalho Tofoli, SM, Martins, CMS, Juruena, MF. Assessment of the hypothalamic–pituitary–adrenal axis activity: glucocorticoid receptor and mineralocorticoid receptor function in depression with early life stress – a systematic review. Acta Neuropsychiatrica 2012;24:4–15.CrossRefGoogle ScholarPubMed
12.Andreatini, A. Depression and the hypothalamic–pituitary–adrenal axis: increasing the scope. Acta Neuropsychiatrica 2012;24:1–3.CrossRefGoogle ScholarPubMed
13.Loo, CK, Mahon, M, Katalinic, N, Lyndon, B, Hadzi-Pavlovic, D. Predictors of response to ultrabrief right unilateral electroconvulsive therapy. J Affect Disord 2011;130:192–197.CrossRefGoogle ScholarPubMed
14.Charney, DS, Nelson, JC. Delusional and nondelusional unipolar depression: further evidence for distinct subtypes. Am J Psychiatry 1981;138:328–333.Google ScholarPubMed
15.Lykouras, E, Christodoulou, GN, Malliaras, D. Type and content of delusions in unipolar psychotic depression. J Affect Disord 1985;9:249–252.CrossRefGoogle ScholarPubMed
16.Angst, J, Adolfsson, R, Benazzi, Fet al. The HCL-32: towards a self-assessment tool for hypomanic symptoms in outpatients. J Affect Disord 2005;88:217–233.CrossRefGoogle ScholarPubMed
17.Ostergaard, SD, Rothschild, AJ, Uggerby, P, Munk-Jorgensen, P, Bech, P, Mors, O. Considerations on the ICD-11 classification of psychotic depression. Psychother Psychosom 2012;81:135–144.CrossRefGoogle ScholarPubMed
18.Rothschild, AJ. Challenges in the treatment of major depressive disorder with psychotic features. Schizophr Bull 2013. [Epub ahead of print].CrossRefGoogle ScholarPubMed
19.Leadholm, AK, Rothschild, AJ, Nolen, WA, Bech, P, Munk-Jorgensen, P, Ostergaard, SD. The treatment of psychotic depression: is there consensus among guidelines and psychiatrists? J Affect Disord 2013;145:214–220.CrossRefGoogle ScholarPubMed
20.Farahani, A, Correll, CU. Are antipsychotics or antidepressants needed for psychotic depression? A systematic review and meta-analysis of trials comparing antidepressant or antipsychotic monotherapy with combination treatment. J Clin Psychiatry 2012;73:486–496.CrossRefGoogle ScholarPubMed
21.Sackeim, HA, Haskett, RF, Mulsant, BHet al. Continuation pharmacotherapy in the prevention of relapse following electroconvulsive therapy: a randomized controlled trial. JAMA 2001;285:1299–1307.CrossRefGoogle ScholarPubMed
22.Sackeim, HA, Prudic, J, Devanand, DP, Decina, P, Kerr, B, Malitz, S. The impact of medication resistance and continuation pharmacotherapy on relapse following response to electroconvulsive therapy in major depression. J Clin Psychopharmacol 1990;10:96–104.CrossRefGoogle ScholarPubMed
23.Aronson, TA, Shukla, S, Hoff, A. Continuation therapy after ECT for delusional depression: a naturalistic study of prophylactic treatments and relapse. Convuls Ther 1987;3:251–259.Google ScholarPubMed
24.Flint, AJ, Meyers, BS, Rothschild, AJet al. Sustaining remission of psychotic depression: rationale, design and methodology of STOP-PD II. BMC Psychiatry 2013;13:38.CrossRefGoogle ScholarPubMed
25.Fink, M. Separating psychotic depression from nonpsychotic depression is essential to effective treatment. J Affect Disord 2003;76:1–3.CrossRefGoogle ScholarPubMed
26.Fink, M. Rediscovering catatonia: the biography of a treatable syndrome. Acta Psychiatr Scand Suppl 2013:1–47.CrossRefGoogle ScholarPubMed
27.Rothschild, AJ, Winer, J, Flint, AJet al. Missed diagnosis of psychotic depression at 4 academic medical centers. J Clin Psychiatry 2008;69:1293–1296.CrossRefGoogle ScholarPubMed