Gaudiano Brandon A, Dalrymple Kristy L, Zimmerman Mark
Department of Psychiatry & Human Behavior, Warren Alpert Medical School of Brown University, 345 Blackstone Boulevard,Providence, RI 02906, USA.
Depress Anxiety. 2009;26(1):54-64. doi: 10.1002/da.20470.
Psychotic major depression (PMD) is a severe mental disorder characterized by high levels of illness severity, chronicity, impairment, and treatment resistance. However, most past research on PMD has been conducted in inpatient hospital samples, and relatively little is known about PMD patients presenting for treatment in the community specifically.
In this study, we examined the prevalence and clinical characteristics of PMD in a large sample (n=2,500) of treatment-seeking outpatients who were administered structured clinical interviews by trained diagnosticians.
Of the patients diagnosed with major depression, 5.3% had psychotic features. PMD patients were more likely to be members of a racial/ethnic minority and to have lower educational attainment compared to those with nonpsychotic major depression. In addition, PMD patients were found to have greater current depression severity, suicidal ideation, and social and work impairment. These patients also were more likely to have histories of suicide attempts and psychiatric hospitalizations, to report an earlier age of illness onset, and to meet criteria for chronic depression. In terms of psychiatric comorbidity, PMD patients had higher rates of certain anxiety disorders as well as more somatoform and cluster A personality disorders.
Results indicated that PMD was present in a relatively small percentage of treatment-seeking outpatients but was associated with disproportionately high levels of severity and impairment. Similarities and differences between the current findings and those from past research are discussed, including clinical implications for the identification and treatment of PMD in routine practice settings.
伴有精神病性症状的重度抑郁症(PMD)是一种严重的精神障碍,其特点是疾病严重程度高、病程慢性化、功能受损且治疗抵抗性强。然而,过去大多数关于PMD的研究都是在住院患者样本中进行的,对于在社区寻求治疗的PMD患者的了解相对较少。
在本研究中,我们对一大样本(n = 2500)寻求治疗的门诊患者进行了研究,这些患者由经过培训的诊断医生进行结构化临床访谈,以检查PMD的患病率和临床特征。
在被诊断为重度抑郁症的患者中,5.3%有精神病性特征。与非精神病性重度抑郁症患者相比,PMD患者更有可能是少数种族/族裔成员,且教育程度较低。此外,发现PMD患者当前的抑郁严重程度更高、有自杀观念以及社会和工作功能受损更严重。这些患者也更有可能有自杀未遂和精神病住院史,报告发病年龄更早,且符合慢性抑郁症的标准。在精神共病方面,PMD患者某些焦虑症的发生率更高,以及更多的躯体形式障碍和A簇人格障碍。
结果表明,PMD在寻求治疗的门诊患者中所占比例相对较小,但与不成比例的高严重程度和功能受损相关。讨论了当前研究结果与过去研究结果之间的异同,包括在常规实践环境中对PMD进行识别和治疗的临床意义。