Title: Depressive symptom profiles and severity patterns in outpatients with psychotic vs nonpsychotic major depression
Abstract: Background-Previous research suggests that patients with psychotic major depression (PMD) may differ from those with nonpsychotic major depression (NMD) not only in terms psychotic features, but also in their depressive symptom presentation.The present study contrasted the rates and severity of depressive symptoms in outpatients diagnosed with PMD versus NMD.Method-The sample consisted of 1,112 patients diagnosed with major depression, of which 60 (5.3%) exhibited psychotic features.Depressive symptoms were assessed by trained diagnosticians at intake using the Structured Clinical Interview for DSM-IV and supplemented by severity items from the Schedule for Affective Disorders and Schizophrenia.Results-PMD patients were more likely to endorse the presence of weight loss, insomnia, psychomotor agitation, indecisiveness, and suicidality compared to NMD patients.Furthermore, PMD patient showed higher levels of severity on several depressive symptoms, including depressed mood, appetite loss, insomnia, psychomotor disturbances (agitation and retardation), fatigue, worthlessness, guilt, cognitive disturbances (concentration and indecisiveness), hopelessness, and suicidal ideation.The presence of psychomotor disturbance, insomnia, indecisiveness, and suicidal ideation were predictive of diagnostic status even after controlling for the effects of demographic characteristics and other symptoms.Conclusions-These findings are consistent with past research suggesting that PMD is characterized by a unique depressive symptom profile in addition to psychotic features and higher levels of overall depression severity.The identification of specific depressive symptoms in addition to delusions/hallucinations that can differentiate PMD versus NMD patients can aid in the early detection of the disorder.These investigations also provide insights into potential treatment targets for this high-risk population.In the current nomenclature of psychiatric diagnosis, psychotic major depression (PMD) is conceptualized as a severe subtype of unipolar depression that is defined by the presence of