Phenomenology of psychotic mood disorders: Lifetime and major depressive episode features

Laboratoire de Psychologie Medicale, Université Libre de Bruxelles and Psy Pluriel, Centre Européen de Psychologie Medicale, Brussels, Belgium.
Journal of Affective Disorders (Impact Factor: 3.38). 08/2011; 135(1-3):241-50. DOI: 10.1016/j.jad.2011.07.027
Source: PubMed


The nosological and clinical implications of psychotic features in the course of mood disorders have been widely debated. Currently, no specification exists for defining a subgroup of lifetime Psychotic Mood Disorder (PMD) patients.
A total of 2178 patients were examined, including subjects with Bipolar Disorder (BP) type I (n=519) and II (n=207) and Major Depressive Disorder (n=1452). Patients were divided between PMD (n=645) and non-psychotic Mood Disorders (MD) (n=1533) by the lifetime presence of at least one mood episode with psychotic features. Subjects having a depressive episode at the time of assessment were also examined: HAM-D and YMRS scores were compared between MD and PMD subjects, both with and without current psychotic features.
A diagnosis of BP-I, a higher familial load for BP, a higher number of mood episodes lifetime, and a higher prevalence of OCD and somatic comorbidities were all associated to PMD. A diagnosis of BP (OR=4.48) was the only significant predictor for psychosis. PMD with non-psychotic depression were apparently less severe than MD patients and had a lower rate of "non-responders" to AD treatment. Sub-threshold manic symptoms and suicidal risk were also more pronounced among PMD.
The lack of information about number and polarity of previous psychotic mood episodes may be the major limitations of our study.
BP diagnosis is the most significant predictor for psychosis in mood disorders. Non-psychotic mood episodes in PMD patients may be characterized by a distinctive symptom profile and, possibly, a different response to treatment.

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Available from: Raffaella Calati, Jul 29, 2014
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    • "Patients were recruited in the 'Psy Pluriel' center, Centre Européen de Psychologie Médicale and the Department of Psychiatry of Erasme Hospital in Brussels. A detailed description of the sample has been reported elsewhere (Souery et al. 2011, 2012). In brief, the COPE-BD (Clinical Outcome Measures for Bipolar Disorder) project enrolled patients that met DSM-IV criteria for a diagnosis of BD type I or II or major depressive disorder. "
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    • "However, in the study setting, many patients present late for treatment and the possibility of undisclosed self-medication or unlabelled prescribed medication from other sources cannot be totally ruled out. Though patients with comorbid psychiatric disorders were excluded, due to the cross-sectional nature of the study, it is not known if patients presenting with a depressive episode may eventually evolve to other mood disorder (e.g., bipolar disorder) if followed up longitudinally; this is important considering the evidence that the best predictor of psychosis in the course of mood disorder is bipolar disorder [33]. However, this study has a number of strengths; we provided data from a previously understudied ethnic and cultural setting therefore filling a gap in knowledge. "
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