Considerations on the ICD-11 Classification of Psychotic Depression

Østergaard, Søren Dinesen; Rothschild, Anthony J.; Uggerby, Peter; Munk‐Jørgensen, Povl; Bech, Per; Mors, Ole

doi:10.1159/000334487

Cited by 37 publications

(39 citation statements)

References 192 publications

(112 reference statements)

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“…Excitement has been indicated as correlates of risk for mania or current manic features within clinical samples 48. Hence, this findings partly support the suggestion by Østergaard et al,7 that the concept of PMD can be modified as a "meta-syndrome" across unipolar and bipolar disorders. Somatic anxiety corresponding to tension has also been seen as a distinctive aspect of MDD symptomatology 49.…”

Section: Discussionsupporting

confidence: 86%

“…The "severity-psychosis" hypothesis stipulates that severe levels of depression result in psychotic symptoms, and this view is generally accepted in contemporary psychiatric nosology or taxonomy. In both ICD-10 and DSM-IV, PMD is currently classified as a subtype of severe depression, or a severe variant of depression 6,7,8. Thus, the presence of delusion or hallucination has been conceptualized as the hallmark of PMD distinguishing it from non-psychotic major depression (NPMD).…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore depressive symptoms,9,10 psychomotor disturbances9,11 and guilt9,12,13 have been suggested as accessory features separating PMD and NPMD. On the other hand, several psychiatrists have insisted that PMD is a clinical syndrome distinct from PMD, based on a large body of findings of clinical and translational studies 6,7. Thus, there has been a longstanding debate about whether PMD is merely a subtype of depression distinguished by its severity, or is a distinctive diagnostic entity.…”

Section: Introductionmentioning

confidence: 99%

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Distinctive Clinical Correlates of Psychotic Major Depression: The CRESCEND Study

Park

Lee

Sakong

et al. 2014

Psychiatry Investig

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ObjectiveThe purpose of this investigation was to identify distinctive clinical correlates of psychotic major depression (PMD) as compared with non-psychotic major depression (NPMD) in a large cohort of Korean patients with major depressive disorder (MDD).MethodsWe recruited 966 MDD patients of age over 18 years from the Clinical Research Center for Depression of South Korea (CRESCEND) study. Diagnoses of PMD (n=24) and NPMD (n=942) were made with the DSM-IV definitions and confirmed with SCID. Psychometric scales were used to assess overall psychiatric symptoms (BPRS), depression (HAMD), anxiety (HAMA), global severity (CGI-S), suicidal ideation (SSI-Beck), functioning (SOFAS), and quality of life (WHOQOL-BREF). Using independent t-tests and χ2 tests, we compared clinical characteristics of patients with PMD and NPMD. A binary logistic regression model was constructed to identify factors independently associated with increased likelihood of PMD.ResultsPMD subjects were characterized by a higher rate of inpatient enrollment, and higher scores on many items on BPRS (somatic concern, anxiety, emotional withdrawal, guilt feelings, tension, depression, suspiciousness, hallucination, motor retardation, blunted affect and excitement) global severity (CGI-s), and suicidal ideation (SSI-Beck). The explanatory factor model revealed that high levels of tension, excitement, and suicidal ideation were associated with increased likelihood of PMD.ConclusionOur findings partly support the view that PMD has its own distinctive clinical manifestation and course, and may be considered a diagnostic entity separate from NPMD.

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Distinctive Clinical Correlates of Psychotic Major Depression: The CRESCEND Study

Park

Lee

Sakong

et al. 2014

Psychiatry Investig

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“…In addition to antecedent characteristics and affective presentations as risk factors for suicidal behavior, suicidal psychotic subjects were most likely to meet diagnostic criteria for bipolar mixed-states or psychotic major depression (Table 3). These mood-states, though separated by current nosological conventions, may be closely related in that manic-depressive mixed-states appear to have more in common with psychotic major depression than with mania [18,35,36,37]. This study is limited in the numbers of subjects and of suicide attempts in some psychotic disorders.…”

Section: Discussionmentioning

confidence: 99%

Negative Affective Features in 516 Cases of First Psychotic Disorder Episodes: Relationship to Suicidal Risk

Salvatore¹

2013

J Depress Anxiety

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Objectives Plausible candidates of psychopathological phenomena that may associate with or anticipate suicidal risk, include negative affects, including admixtures of dysphoria, depression and anxiety described mainly in nonpsychotic disorders. We ascertained the distribution of such affective features in various first-episode psychotic disorders and correlated these and other clinical and antecedent features with intake suicidal status. Methods We evaluated 516 adult subjects in first-lifetime episodes of various DSM-IV-TR psychotic disorders. Blinded, protocol-guided, assessments of clinical features ascertained in SCID examinations, self- and family reports and clinical records supported analyses of associations of suicide attempts at first-psychotic episodes with antecedent and intake clinical characteristics, including negative affects and diagnoses, using standard bivariate and multivariate methods. Results Negative affective features in various combinations were prevalent (90%) and at >75% in both affective and nonaffective psychotic disorders; anxious depression was most common (22%). We identified antecedent and intake clinical factors preliminarily associated with suicide attempts. Factors remaining independently associated in multivariate logistic modelling (ranked by OR) were: (a) prior suicide attempt, (b) prior aggressive assault, (c) bipolar-mixed state or psychotic major depression diagnosis, (d) prior dysphoria, (e) intake dysphoric-anxiousdepression, (f) prior impulsivity, (g) previous affective instability, (h) previous nonpsychotic depression, (i) previous decline in vital drive, and (j) prior sleep disturbances. Conclusions Various types and combinations of negative affective features (especially anxious depression with and without dysphoria) were prevalent across nonaffective as well as affective first psychotic episodes and strongly associated with suicide attempts. These findings extend previous observations in nonpsychotic disorders.

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“…A recent editorial in Psychotherapy and Psychosomatics [1] discussed the boundaries between depression and psychosis. Indeed, the blurry boundaries that separate the classical Kraepelinian dichotomy of dementia praecox and manic-depressive illness were pointed out by the father of modern psychiatric nosology himself [2].…”

Section: Figmentioning

confidence: 99%

Is Schizoaffective Disorder Still a Neglected Condition in the Scientific Literature?

Murru¹,

Pacchiarotti²,

Nivoli³

et al. 2012

Psychother Psychosom

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Considerations on the ICD-11 Classification of Psychotic Depression

Cited by 37 publications

References 192 publications

Distinctive Clinical Correlates of Psychotic Major Depression: The CRESCEND Study

Distinctive Clinical Correlates of Psychotic Major Depression: The CRESCEND Study

Negative Affective Features in 516 Cases of First Psychotic Disorder Episodes: Relationship to Suicidal Risk

Is Schizoaffective Disorder Still a Neglected Condition in the Scientific Literature?

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