Major Depressive Disorder (MDD) with psychotic features is common and it is associated with worse symptoms and outcomes. But should it represent a severe MDD or should it constitute a different syndrome? One of the answers to that question may live in a long term follow up of these patients.

To assess the diagnostic consistency of MDD with psychotic features over 5 years.

The sample included 47 income patients from the Departamento de Psiquiatria e Saúde Mental do Centro Hospitalar Barreiro-Montijo, hospitalized between 1998 and 2006, to whom was diagnosed MDD with psychotic symptoms. there clinical processes were consulted and those with at least 5 years of follow up were assessed and the most updated diagnosis was registered applying DSM-IV.

31 of 47 participants had a diagnosis of MDD with psychotic symptoms with five years of evolution. about 74% (23), had a Mood Disorder (Recurrent MDD; MDD - Single episode; Bipolar Disorder) comparing to 19% (6) with a Psychotic Disorder (Schizophrenia and Schizoafective Disorder). from those with a Mood Disorder, Recurrent Depressive Disorder was the most frequent, with 32% (10), but it was close to those who switched to a Bipolar Disorder, about 26% (8). Only 2 patients still had the same diagnosis of MDD with psychotic symptoms - Single Episode, the same as those with dementia.

The diagnosis of MDD with psychotic features among inpatients demonstrated poor long term consistency and when it is based on a single assessment should be provisional.