Gaudiano Brandon A, Young Diane, Chelminski Iwona, Zimmerman Mark
Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI 02912, USA.
Compr Psychiatry. 2008 Sep-Oct;49(5):421-9. doi: 10.1016/j.comppsych.2008.02.007. Epub 2008 Mar 28.
Previous research suggests that patients with psychotic major depression (PMD) may differ from those with nonpsychotic major depression (NMD) not only in 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 vs NMD.
The sample consisted of 1112 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 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition and supplemented by severity items from the Schedule for Affective Disorders and Schizophrenia.
Patients with PMD were more likely to endorse the presence of weight loss, insomnia, psychomotor agitation, indecisiveness, and suicidality compared with NMD patients. Furthermore, PMD patients 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 was predictive of diagnostic status even after controlling for the effects of demographic characteristics and other symptoms.
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 vs 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.
先前的研究表明，伴有精神病性症状的重度抑郁症（PMD）患者与非精神病性重度抑郁症（NMD）患者不仅在精神病性特征方面存在差异，而且在抑郁症状表现上也有所不同。本研究对比了被诊断为PMD与NMD的门诊患者的抑郁症状发生率及严重程度。
样本包括1112名被诊断为重度抑郁症的患者，其中60名（5.3%）表现出精神病性特征。抑郁症状由经过培训的诊断人员在初诊时使用《精神障碍诊断与统计手册》第四版的结构化临床访谈进行评估，并辅以情感障碍与精神分裂症量表中的严重程度项目。
与NMD患者相比，PMD患者更有可能认可存在体重减轻、失眠、精神运动性激越、犹豫不决和自杀观念。此外，PMD患者在几种抑郁症状上表现出更高的严重程度，包括情绪低落、食欲减退、失眠、精神运动性障碍（激越和迟缓）、疲劳、无价值感、内疚、认知障碍（注意力不集中和犹豫不决）、绝望和自杀意念。即使在控制了人口统计学特征和其他症状的影响后，精神运动性障碍、失眠、犹豫不决和自杀意念的存在仍可预测诊断状态。
这些发现与过去的研究一致，表明PMD除了具有精神病性特征和更高的总体抑郁严重程度外，还具有独特的抑郁症状特征。除了妄想/幻觉之外，识别出能够区分PMD与NMD患者的特定抑郁症状，有助于该疾病的早期发现。这些研究还为这一高危人群的潜在治疗靶点提供了见解。
