Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aarhus University Hospital, Aalborg, Denmark.
J Affect Disord. 2013 May;147(1-3):232-40. doi: 10.1016/j.jad.2012.11.009. Epub 2012 Dec 7.
Severe unipolar depression can be classified as either psychotic depression (PD) or non-psychotic depression (non-PD). A number of biological and clinical differences have been detected between PD and non-PD, but it remains unknown whether risk factors for the two subtypes also differ. The aim of the present study was therefore to investigate whether a number of potential risk factors influenced the risk of developing PD and non-PD to different extents.
This is a register-based historical prospective cohort study following all 2.4 million individuals born in Denmark between 1955 and 1990. During follow-up 2183 and 9101 individuals were registered in the Danish Psychiatric Central Research Register with PD and non-PD respectively. The association between risk factors and the development of PD and non-PD was estimated by survival analysis (Poisson regression) and expressed as incidence rate ratios (IRR).
The most consistent finding of the study was that of a general overlap in familial and environmental risk factors for PD and non-PD. However, a parental history of bipolar disorder was a risk factor for PD (mother, IRR=1.66, p=0.003. Father, IRR=1.56, p=0.040) and not for non-PD (mother, IRR=0.92, p=0.430. Father, IRR=1.08, p=0.552). Conversely, a positive family history of schizophrenia was associated with neither PD nor non-PD LIMITATIONS: Diagnoses were assigned as part of routine clinical practice.
Our findings justify the distinction between PD and non-PD in the current diagnostic manuals. Furthermore, the fact that parental bipolar disorder and not schizophrenia was a risk factor for PD supports the Kraepelinian dichotomy.
重度单相抑郁可分为精神病性抑郁（PD）或非精神病性抑郁（non-PD）。PD 和 non-PD 之间已经检测到许多生物学和临床差异，但尚不清楚两种亚型的风险因素是否也不同。因此，本研究旨在调查一些潜在的风险因素是否在不同程度上影响 PD 和 non-PD 的发病风险。
这是一项基于登记的历史前瞻性队列研究，跟踪了 1955 年至 1990 年间出生在丹麦的 240 万人。在随访期间，分别有 2183 人和 9101 人在丹麦精神病中央研究登记处被登记为 PD 和 non-PD。通过生存分析（泊松回归）和表达为发病率比（IRR）来估计风险因素与 PD 和 non-PD 发展之间的关联。
该研究最一致的发现是 PD 和 non-PD 的家族和环境风险因素存在普遍重叠。然而，父母的双相障碍病史是 PD 的一个风险因素（母亲，IRR=1.66，p=0.003. 父亲，IRR=1.56，p=0.040），而不是 non-PD（母亲，IRR=0.92，p=0.430. 父亲，IRR=1.08，p=0.552）。相反，精神分裂症的阳性家族史与 PD 或 non-PD 均无关。
诊断是作为常规临床实践的一部分分配的。
我们的研究结果证明了当前诊断手册中 PD 和 non-PD 的区分是合理的。此外，父母的双相障碍而不是精神分裂症是 PD 的一个风险因素，这支持了克雷佩林的二分法。
