Mauricio Tohen1, Hari-Mandir K Khalsa2, Paola Salvatore3, Eduard Vieta4, Caitlin Ravichandran5, Ross J Baldessarini2. 1. University of Texas Health Science Center at San Antonio, United States; Department of Psychiatry, Harvard Medical School & McLean Hospital, Belmont, MA, United States. Electronic address: tohen@uthscsa.edu. 2. Department of Psychiatry, Harvard Medical School & McLean Hospital, Belmont, MA, United States. 3. Department of Psychiatry, Harvard Medical School & McLean Hospital, Belmont, MA, United States; Section of Psychiatry, Department of Neuroscience, University of Parma, Italy. 4. Department of Psychiatry, Harvard Medical School & McLean Hospital, Belmont, MA, United States; Department of Psychiatry, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Spain. 5. Laboratory for Psychiatric Biostatistics, McLean Hospital, Belmont, MA, United States.
Abstract
OBJECTIVE: Early assessment can guide accurate diagnosis, prognosis, and treatment-planning for patients with major mental illnesses. Longitudinal studies in psychotic depression from onset are rare, encouraging the present study. METHOD: We followed 56 DSM-IV MDD patients with psychotic features prospectively and systematically to assess course and predictors of operationally-defined syndromal remission, syndromal recovery, symptomatic remission, functional recovery, and new episodes, and to evaluate diagnostic stability. RESULTS: Among 49/56 cases followed for ≥2 years, 59% retained the initial diagnosis and most achieved syndromal remission (86%) and recovery (84%); 58% remitted symptomatically, and only 35% (17/49) recovered functionally. Syndromal recovery was earlier following subacute onset, lower initial depression scores, and lack of moodincongruent psychotic features. Within 2 years, 45% (22/49) experienced new episodes - earlier with younger onset and higher CGI scores. DSM diagnosis changed in 41%, to bipolar (33%), or schizoaffective disorders (12%), which followed early mania-like or schizophrenia-like features, respectively. CONCLUSIONS: Within 2 years of first-hospitalizations, 41% of patients initially diagnosed with psychotic-depression met criteria for DSM-IV bipolar or schizoaffective disorders. Of the 59% retaining the initial diagnosis for 2 years, nearly half experienced new episodes, 42% remained symptomatic, and two-thirds failed to regain their own prior functional status.
OBJECTIVE: Early assessment can guide accurate diagnosis, prognosis, and treatment-planning for patients with major mental illnesses. Longitudinal studies in psychotic depression from onset are rare, encouraging the present study. METHOD: We followed 56 DSM-IV MDDpatients with psychotic features prospectively and systematically to assess course and predictors of operationally-defined syndromal remission, syndromal recovery, symptomatic remission, functional recovery, and new episodes, and to evaluate diagnostic stability. RESULTS: Among 49/56 cases followed for ≥2 years, 59% retained the initial diagnosis and most achieved syndromal remission (86%) and recovery (84%); 58% remitted symptomatically, and only 35% (17/49) recovered functionally. Syndromal recovery was earlier following subacute onset, lower initial depression scores, and lack of moodincongruent psychotic features. Within 2 years, 45% (22/49) experienced new episodes - earlier with younger onset and higher CGI scores. DSM diagnosis changed in 41%, to bipolar (33%), or schizoaffective disorders (12%), which followed early mania-like or schizophrenia-like features, respectively. CONCLUSIONS: Within 2 years of first-hospitalizations, 41% of patients initially diagnosed with psychotic-depression met criteria for DSM-IV bipolar or schizoaffective disorders. Of the 59% retaining the initial diagnosis for 2 years, nearly half experienced new episodes, 42% remained symptomatic, and two-thirds failed to regain their own prior functional status.
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Authors: Juan L Molina; María Calvó; Eduardo Padilla; Mara Balda; Gabriela González Alemán; Néstor V Florenzano; Gonzalo Guerrero; Danielle Kamis; Beatriz Molina Rangeon; Mercedes Bourdieu; Sergio A Strejilevich; Horacio A Conesa; Javier I Escobar; Igor Zwir; C Robert Cloninger; Gabriel A de Erausquin Journal: NPJ Schizophr Date: 2017-01-11
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Authors: G M Goodwin; P M Haddad; I N Ferrier; J K Aronson; Trh Barnes; A Cipriani; D R Coghill; S Fazel; J R Geddes; H Grunze; E A Holmes; O Howes; S Hudson; N Hunt; I Jones; I C Macmillan; H McAllister-Williams; D R Miklowitz; R Morriss; M Munafò; C Paton; B J Saharkian; Kea Saunders; Jma Sinclair; D Taylor; E Vieta; A H Young Journal: J Psychopharmacol Date: 2016-03-15 Impact factor: 4.153