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Psychoticism and Paranoid Ideation in Patients With Nonpsychotic Major Depressive Disorder: Prevalence, Response to Treatment, and Impact on Short- and Long-Term Treatment Outcome

Published online by Cambridge University Press:  07 November 2014

Abstract

Objective/Introduction: We sought to characterize the impact of the 90-item Symptom Checklist (SCL-90) subscales for paranoid ideation (PI) and psychoticism (P) in patients with major depressive disorder (MDD), on acute anti-depressant response and on relapse prevention.

Methods: Subjects with Structured Clinical Interview for DSM Disorders-diagnosed non-psychotic MDD were recruited into a clinical trial of open-label fluoxetine 10–60 mg/day for 12 weeks, followed by double-blind randomization of responders (n=262) to fluoxetine continuation or placebo for 12 months. PI and P were assessed with the patient-rated SCL-90. The association of these symptoms with response to treatment was assessed by logistic regression.

Results: We found significant decreases in PI and P during acute treatment phase for fluoxetine responders and nonresponders, although only 10.3% and 7.5% of patients experienced a ≥50% reduction in PI and P scores, respectively. Neither PI nor P scores significantly predicted time to relapse. P scores predicted a lower response rate to treatment with fluoxetine.

Discussion: The results of the present study suggest that there is a significant relationship between the presence of psychoticism in patients with nonpsychotic MDD, and the likelihood of overall depressive symptom improvement following a trial of monotherapy with fluoxetine.

Conclusion: An increased burden of psychoticism in depressed subjects may confer poorer response to fluoxetine, but not increased risk of relapse among fluoxetine responders.

Type
Original Research
Copyright
Copyright © Cambridge University Press 2010

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References

REFERENCES

1.Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.Google Scholar
2.Schatzberg, AF and Rothschild, AJ. Psychotic (delusional) major depression: should it be included as a distinct syndrome in DSM-IV? Am J Psychiatry. 1992;149:733745.Google Scholar
3.Rothschild, AJ. Challenges in the treatment of depression with psychotic features. Biol Psychiatry. 2003;53(8):680–90.Google Scholar
4.Charney, DS, Nelson, J. Delusional and nondelusional unipolar depression: further evidence for distinct subtypes. Am J Psychiatry. 1981;138:328333.Google ScholarPubMed
5.Keller, J, Schatzberg, AF, Maj, M. Current issues in the classification of psychotic major depression. Schizophr Bull. 2007;33(4):877–85.CrossRefGoogle ScholarPubMed
6.Coryell, W. Psychotic depression. J Clin Psychiatry. 1996;57(suppl 3):27–3.Google Scholar
7.Wijkstra, J, Burger, H, van den Broek, WW, et al. Pharmacological Treament of Unipolar psychotic Depression. A randomized, double-blind study comparing imipramine, venlafaxine, and venlafaxine plus quetiapine. J Affect Disord. 2010;123(1–3):238242.CrossRefGoogle Scholar
8.Rothschild, AJ, Williamson, DJ, Tohen, MF, et al. A double-blind, randomized study of olanzapine and olanzapine/fluoxetine combination for major depression with psychotic features. J Clin Psychopharmacol. 2004;24(4):365373.Google Scholar
9.Spiker, DG, Weiss, JC, Dealy, RS, et al. The pharmacologic treatment of delusional depression. Am J Psychiatry. 1985;142(4):430436.Google ScholarPubMed
10.American Psychiatric Association: Practice guideline for the treatment of major depressive disorder (revision). Am J Psychiatry. 2000;157(suppl 4).Google Scholar
11.Simpson, GM, El Sheshai, A, Rady, A, Kingsbury, SJ, Fayek, M. Sertraline as monotherapy in the treatment of psychotic and nonpsychotic depression. J Clin Psychiatry. 2003;64(8):959965.Google Scholar
12.Meyers, BS, Flint, AJ, Rothschild, AJ, et al. A double-blind randomized controlled trial of olanzapine plus sertraline vs olanzapine plus placebo for psychotic depression: the study of pharmacotherapy of psychotic depression (STOP-PD). Arch Gen Psychiatry. 2009;66(8):838847.CrossRefGoogle Scholar
13.Zanardi, R, Franchini, L, Gasperini, M, Perez, J, Smeraldi, E. Double-blind controlled trial of sertraline versus paroxetine in the treatment of delusional depression. Am J Psychiatry. 1996;153(12):16311633.Google ScholarPubMed
14.Zanardi, R, Franchini, L, Serretti, A, Perez, J, Smeraldi, E. Venlafaxine versus fluvoxamine in the treatment of delusional depression: a pilot double-blind controlled study. J Clin Psychiatry. 2000;61(1):2629.Google Scholar
15.Englisch, S, Knopf, U, Scharnholz, B, Kuwilsky, A, Deuschle, M, Zink, M. Duloxetine for major depressive episodes in the course of psychotic disorders: an observational clinical trial. J Psychopharmacol. (In press).Google Scholar
16.Birkenhager, TK, van den Broek, WW, Mulder, PG, Moleman, P, Bruijn, JA. Efficacy of imipramine in psychotic versus nonpsychotic depression. J Clin Psychopharmacol. 2008;28(2):166170.CrossRefGoogle ScholarPubMed
17.van de Broek, WW, Birkenhäger, TK, Mulder, PG, Bruijn, JA, Moleman, P. A double-blind randomized study comparing imipramine with fluvoxamine in depressed inpatients. Psychopharmacology (Berl). 2004;175(4)481486.Google Scholar
18.Spiker, DG, Dealy, RS, Hanin, I, Weiss, JC, Kupfer, DJ. Treating delusional depressives with amitriptyline. J Clin Psychiatry. 1986;47(5):243246.Google ScholarPubMed
19.Spiker, DG, Kupfer, DJ. Placebo response rates in psychotic and nonpsychotic depression. J Affect Disord. 1988;14(1):2123.CrossRefGoogle ScholarPubMed
20.Bruijn, JA, Moleman, P, Mulder, PG, et al. A double-blind, fixed blood-level study comparing mirtazapine with imipramine in depressed in-patients. Psychopharmacology (Berl). 1996;127(3):231237.Google Scholar
21.Mulsant, BH, Sweet, RA, Rosen, J, et al. A double-blind randomized comparison of nortriptyline plus perphenazine versus nortriptyline plus placebo in the treatment of psychotic depression in late life. J Clin Psychiatry. 2001;62(8):597604.Google Scholar
22.Künzel, HE, Ackl, N, Hatzinger, M, et al. Outcome in delusional depression comparing trimipramine monotherapy with a combination of amitriptyline and haloperidol - A double-blind multicenter trial. J Psychiatr Res. (In press).Google Scholar
23.Janicak, PG, Pandey, GN, Davis, JM, Boshes, R, Bresnahan, D, Sharma, R. Response of psychotic and nonpsychotic depression to phenelzine. Am J Psychiatry. 1988;145(1):9395.Google Scholar
24.Nelson, JC, Mazure, CM, Jatlow, PI. Characteristics of desipramine-refractory depression. J Clin Psychiatry. 1994;55(1):1219.Google ScholarPubMed
25.Benazzi, F. Is there a continuity between bipolar and depressive disorders? Psychother Psychosom. 2007;76(2):7076.CrossRefGoogle Scholar
26.Dording, CM, Sinicropi-Yao, L, Papakostas, G, et al. The response of psychotic-like symptoms to fluoxetine in non-psychotic major depressive disorder. Nord J Psychiatry. 2009;11:16.Google Scholar
27.McGrath, P, Stewart, J, Quitkin, F, et al. Predictors of relapse in a prospective study of fluoxetine treatment of major depression. Am J Psychiatry. 2006;163:15421548.Google Scholar
28.Derogatis, L, Lipman, R, Rickels, K, et al. The Hopkins symptom checklist (HSCL): a self-report symptom inventory. J App Behav Sci. 1974;19:115.Google Scholar
29.First, M, Spitzer, R, Gibbon, M, et al. Structured Clinical Interview for DSM-IV Axis I Disorders–Patient Edition (SCID-I/P, Version 2.0). New York, NY: biometrics Research Department, New York State Psychiatric Institute; 1995.Google Scholar
30.Guy, W, ed. ECDEU Assessment Manual for Psychopharmacology. Rockville, MD: National Institute of Mental Health; revised. DHEW Pub. No. (ADM) 1976;76338.Google Scholar
31.Hamilton, M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23:5662.Google Scholar
32.Derogatis, LR. SCL-90: Administration, Scoring, and Procedures Manual. 3rd ed. Minneapolis, MN: National Computer Systems; 1994.Google Scholar
33.Overall, JE, Gorham, DR. The Brief Psychiatric Rating Scale. Psychological Reports. 1962;10;790812.CrossRefGoogle Scholar
34.Meyers, BS, English, J, Gabriele, M, et al. A delusion assessment scale for psychotic major depression: Reliability, validity, and utility. Biol Psychiatry. 2006;60(12):13361342.Google Scholar