Coryell W
Department of Psychiatry, University of Iowa Hospitals and Clinics, College of Medicine, Iowa City 52242, USA.
J Clin Psychiatry. 1996;57 Suppl 3:27-31; discussion 49.
The presence of delusions or hallucinations in major depressive disorder indicates a severe form of that disorder. Compared with patients with nonpsychotic depression, those with psychotic depression have depressive symptoms that are individually more severe. They also are more likely to have hypothalamic-pituitary-adrenal axis hyperactivity and increased ventricular-to-brain ratios. The short- and long-term outcomes for such patients are poor. Findings that this prognostic disadvantage may be permanent and that psychotic features recur at high rates in subsequent episodes indicate that these symptoms in major depressive disorder have a lifelong significance. Although monotherapy with antidepressants may be effective, recovery is more rapid when antidepressants are combined with antipsychotics. Electroconvulsive therapy is particularly effective for psychotic depression. The importance of combination therapy for prophylaxis is unknown.
重度抑郁症中存在妄想或幻觉表明该疾病的一种严重形式。与非精神病性抑郁症患者相比，精神病性抑郁症患者的抑郁症状个体上更为严重。他们也更有可能出现下丘脑 - 垂体 - 肾上腺轴功能亢进以及脑室与脑比率增加。这类患者的短期和长期预后较差。有研究发现这种预后劣势可能是永久性的，且精神病性特征在后续发作中复发率很高，这表明重度抑郁症中的这些症状具有终身意义。虽然抗抑郁药单药治疗可能有效，但抗抑郁药与抗精神病药联合使用时恢复更快。电休克治疗对精神病性抑郁症特别有效。联合治疗用于预防的重要性尚不清楚。
