School of Clinical Medicine, University of Cambridge, Cambridge, UK.
Royal Free Hospital, London, UK.
Eur Child Adolesc Psychiatry. 2022 May;31(5):729-736. doi: 10.1007/s00787-020-01704-3. Epub 2021 Jan 11.
Adults with major depressive disorder (MDD) with psychotic features (delusions and/or hallucinations) have more severe symptoms and a worse prognosis. Subclinical psychotic symptoms are more common in adolescents than adults. However, the effects of psychotic symptoms on outcome of depressive symptoms have not been well studied in adolescents. Depressed adolescents aged 11-17 with and without psychotic symptoms were compared on depression severity scores at baseline and at 28- or 42-week follow-up in two large UK cohorts. Psychotic symptoms were weakly associated with more severe depression at baseline in both cohorts. At follow-up, baseline psychotic symptoms were only associated with depressive symptoms in one sample; in the other, the effect size was close to zero. This supports the DSM5 system of psychotic symptoms being a separate code to severity rather than the ICD10 system which only allows the diagnosis of psychotic depression with severe depression. There was no clear support for psychotic symptoms being a baseline marker of treatment response.
患有伴有精神病特征（妄想和/或幻觉）的重性抑郁障碍（MDD）的成年人症状更严重，预后更差。亚临床精神病症状在青少年中比在成年人中更为常见。然而，精神病症状对青少年抑郁症状的预后影响尚未在青少年中得到很好的研究。在两个英国大型队列中，比较了伴有和不伴有精神病症状的 11-17 岁抑郁青少年在基线和 28 或 42 周随访时的抑郁严重程度评分。在两个队列中，基线时精神病症状与更严重的抑郁症状弱相关。在随访时，基线时的精神病症状仅与一个样本中的抑郁症状相关；在另一个样本中，效应大小接近零。这支持了 DSM5 系统，即将精神病症状作为严重程度的独立编码，而不是 ICD10 系统，后者仅允许严重抑郁时诊断为精神病性抑郁症。没有明确的证据表明精神病症状是治疗反应的基线标志物。
