Citation

Dold M, Bartova L, Kautzky A, Porcelli S, Montgomery S, Zohar J, Mendlewicz J, Souery D, Serretti A, Kasper S. J. Clin. Psychiatry 2019; 80(1): e12090.

Affiliation

Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria.

Copyright

(Copyright © 2019, Physicians Postgraduate Press)

DOI

10.4088/JCP.17m12090

PMID

30677267

Abstract

OBJECTIVE: To elucidate the impact of the presence of psychotic features in patients diagnosed with major depressive disorder (MDD) on sociodemographic, psychosocial, clinical, and response characteristics.

METHODS: A total of 1,410 DSM-IV-TR MDD patients were included in the present European multicenter study, which was conducted between 2011 and 2016. Analyses of covariance, χ² tests, and binary logistic regression analyses were performed to explore differences in sociodemographic and clinical variables between MDD patients with and without psychotic symptoms.

RESULTS: A prevalence rate of 10.92% for psychotic features was found in MDD. Compared to nonpsychotic MDD patients, those with psychotic features were characterized by a higher likelihood for melancholic characteristics (73.38% vs 59.16%, P =.0006), a higher rate of current suicide risk (60.39% vs 44.27%, P =.0002), greater likelihood of receiving inpatient treatment (55.84% vs 32.01%, P <.0001), greater depressive symptom severity (measured by various rating scales), and more often receiving augmentation/combination treatment strategies in general (81.17% vs 58.12%, P <.0001) and add-on therapy with antipsychotics (50.00% vs 22.69%, P <.0001) and benzodiazepines (47.40% vs 31.29%, P =.0001) in particular. Moreover, psychotic symptoms in MDD were highly predictive of treatment resistance, expressed by a more than 2.2-fold higher likelihood for resistance compared to nonpsychotic MDD patients (79.87% vs 35.75%, P <.0001). Only 3.25% of the patients with psychotic MDD achieved treatment response (vs 27.15% of those with nonpsychotic MDD, P <.0001).

CONCLUSIONS: These findings suggest that adequate diagnosis of psychotic features in MDD should be ensured in routine clinical care. As a combination of antipsychotics and antidepressants represents the first-line treatment option in psychotic MDD, the finding of a 2-fold higher prescription rate for antipsychotic drugs in psychotic versus nonpsychotic MDD patients reflects the current evidence.

© Copyright 2019 Physicians Postgraduate Press, Inc.

Language: en