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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

Christina M. Dording ,
David Mischoulon ,
Tracie M. Goodness ,
Lee Baer ,
Alisabet Clain ,
Jonathan W. Stewart ,
John D. Matthews ,
Patrick J. McGrath ,
Andrew A. Nierenberg  and
Maurizio Fava
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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
Information
CNS Spectrums , Volume 15 , Issue 8 , August 2010 , pp. 515 - 521
Copyright
Copyright © Cambridge University Press 2010

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