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Sub-typing depression, II. Clinical distinction of psychotic depression and non-psychotic melancholia

Published online by Cambridge University Press:  09 July 2009

G. Parker ,
D. Hadzi-Pavlovic ,
H. Brodaty ,
M.-P. Austin ,
P. Mitchell ,
K. Wilhelm  and
I. Hickie
G. Parker*
Affiliation:
Mood Disorders Unit, Prince Henry Hospital and the School of Psychiatry, University of New South Wales, NSW, Australia
D. Hadzi-Pavlovic
Affiliation:
Mood Disorders Unit, Prince Henry Hospital and the School of Psychiatry, University of New South Wales, NSW, Australia
H. Brodaty
Affiliation:
Mood Disorders Unit, Prince Henry Hospital and the School of Psychiatry, University of New South Wales, NSW, Australia
M.-P. Austin
Affiliation:
Mood Disorders Unit, Prince Henry Hospital and the School of Psychiatry, University of New South Wales, NSW, Australia
P. Mitchell
Affiliation:
Mood Disorders Unit, Prince Henry Hospital and the School of Psychiatry, University of New South Wales, NSW, Australia
K. Wilhelm
Affiliation:
Mood Disorders Unit, Prince Henry Hospital and the School of Psychiatry, University of New South Wales, NSW, Australia
I. Hickie
Affiliation:
Mood Disorders Unit, Prince Henry Hospital and the School of Psychiatry, University of New South Wales, NSW, Australia
*
1Address for Correspondence: Professor Gordon Parker, Psychiatry Unit, Prince of Wales Hospital, Randwick, NSW 2031, Australia.
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Synopsis

We have attempted to clarify clinical differentiating features of psychotic depression. Forty-six depressed subjects meeting DSM-III-R criteria for major depression with psychotic features were compared with (i) DSM-defined melancholic, (ii) Newcastle-defined endogenous, and (iii) a residual DSM-defined major depressive episode group. Additionally, a ‘bottom up’ latent class analysis (LCA) suggested a larger sample of 82 ‘psychotic depressive’ subjects, and multivariate analyses contrasted these subjects with both LCA-identified melancholic and all residual depressed subjects. Analyses suggested that, in addition to two features with absolute specificity (delusions and hallucinations), both the DSM-defined and LCA-defined ‘psychotic depressive’ subjects were significantly more likely to demonstrate marked psychomotor disturbance, to report two morbid cognitions (feeling sinful and guilty; feeling deserving of punishment), as well as be more likely to report constipation, terminal insomnia, appetite/weight loss and (variable across the defined ‘psychotic depressive’ groups) loss of interest and pleasure. The study identifies a wider set of potentially discriminating clinical variables than previous studies, as well as both indicating the existence and assisting identification of ‘true’ psychotic depression in the absence of formal psychotic features being acknowledged or elicited.

Type
Original Articles
Information
Psychological Medicine , Volume 25 , Issue 4 , July 1995 , pp. 825 - 832
Copyright
Copyright © Cambridge University Press 1995

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