Prevalence of Psychotic Symptoms in Those With Melancholic and Nonmelancholic Depression

Abstract

The best classification of depressive disorders is still to be established. A melancholic subtype has a lengthy history, and recent research demonstrates its relevance. This study compares the prevalence of psychotic symptoms in nonmelancholic and melancholic depression and assesses whether there is a dimensional pattern in the severity of symptoms among the subtypes. Patients with unipolar depression were assessed for melancholic status, psychotic symptoms, and severity of depression. The diagnosis of melancholia was made by both Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), criteria and CORE measure. The DSM criteria assigned a much higher percentage of patients as melancholics (67.4%) than did the CORE (24.9%). Prevalence of psychosis was distinctly higher in the melancholics. Symptoms severity was higher among the melancholics when compared with the nonmelancholics. The presence of psychotic symptoms was not associated with an increase in the intensity of depressive symptoms. Psychotic symptoms are more frequently associated with the melancholic subtype of depression. This suggests clinical contiguity between the melancholic and psychotic subtypes and the clinical relevance of identifying melancholia.

Melancholic-Like Behaviors and Circadian Neurobiological Abnormalities in Melatonin MT1 Receptor Knockout Mice

“…In keeping with the anxiogenic behavior in MT 1 -/- mice, melancholic patients usually display increased levels of anxiety ( Day and Williams, 2012 ). However, Parker et al (2013) found a lower prevalence of anxiety disorders in melancholic than in non-melancholic patients, and therefore, the issue of anxiety in melancholic depression is complex.…”

“…Finally, even if the interpretation of the results obtained in the tests of anxiety may be arguable, the complex phenotype emerging from the EPMT, OFT, and NSFT perfectly reflect the multifaceted manifestations of anxiety observed in melancholic patients ( Day and Williams, 2012 ; Parker et al, 2013 ). MLT, through MT 1 and MT 2 receptors, controls the activity of the SCN; in particular, MT 1 receptors are involved in the acute inhibitory effect of MLT on the SCN firing rate ( Liu et al, 1997 ), contributing to the control of circadian rhythms.…”

“… Weil et al (2006) confirmed that MT 1 -/- mice had increased immobility in the FST and an impaired prepulse inhibition response, a neurobiological sign often correlated to psychotic-like symptoms. Notably, melancholic depression can also include psychotic symptoms ( Caldieraro et al, 2013 ).…”

Distinguishing Subgroups Based on Psychomotor Functioning among Patients with Major Depressive Disorder

“…Several other studies have compared nonmelancholic with melancholic patients based on this cutoff [4, 9, 43, 44]. Patients who scored < 8 points formed the NMD group, while those who scored ≥8 were classified as MD patients.…”

“…Although most of the depressed patients with psychotic features indeed belong to the melancholic subtype, a small group of depressed patients with psychotic symptoms does not pre­sent with melancholic features. Although the prevalence of psychosis is higher among melancholic patients (51.1%) than among nonmelancholic patients (17.7%), psychotic nonmelancholics definitely exist [9]. …”