Major Depressive Disorder With Psychosis-Like Symptoms Among Latinos

Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, Sixth Floor, Boston, MA 02114, USA.
Psychiatric services (Washington, D.C.) (Impact Factor: 2.41). 03/2012; 63(5):482-7. DOI: 10.1176/
Source: PubMed


The lifetime prevalence of psychosis-like symptoms among Latinos living in the United States is 9.5%, and up to 27% of Latinos with major depressive disorder also experience psychosis-like symptoms. Yet clinicians remain uncertain about the nature and clinical implications of these putative psychotic symptoms, and there is no consensus about treatment strategies. The authors conducted a review of the literature to examine the epidemiology, clinical features, and significance of psychosis-like symptoms among Latinos, particularly when such symptoms present with major depressive disorder, and the strategies to treat them.
A search of the National Library of Medicine was conducted for all articles published through February 2011 by using the keywords "Hispanic" and "Latino" with "depression and psychotic," with "idiom of distress," and with "psychotic."
A total of 37 articles were reviewed. In clinical settings, the prevalence of psychosis-like symptoms among cross-sections of Latino patients ranged from 22% to 46% and was even higher among Latino veterans. Psychosis-like symptoms were associated with higher medical and psychiatric comorbidity and greater suicidality, functional impairment, and utilization of services. The authors describe the types of psychosis-like symptoms experienced by Latinos and propose criteria for the differential diagnosis of such symptoms and typical psychotic features.
Clinicians treating depressed Latinos are often confronted with the clinical dilemma of whether to augment antidepressants with an antipsychotic. The authors argue that atypical psychotic symptoms experienced by Latinos with major depressive disorder are nonpsychotic manifestations and that antipsychotic medication should be delayed unless treatment of depression fails to address the psychosis-like symptoms.

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    • "In an affiliated community clinic, we conducted a chart review and selected subjects based on their ethnicity (self-identified as Latinos), clinical diagnosis (MDD diagnosis according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria), endorsement of psychosislike symptoms (criteria from Cassano et al., 2012) and use of self-assessments for depression at clinical visits (Nine-Item Patient Health Questionnaire [PHQ-9]). To be included in the analyses, subjects needed to have at least one recorded assessment after baseline. "
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    ABSTRACT: We compared treatment response (≥50 decrease in Nine-Item Patient Health Questionnaire total score) among 24 Latinos with major depressive disorder, presenting with and without specific psychosislike symptoms: A, hearing noises or house sounds, B, hearing voices calling one's name, C, seeing fleeting visions such as shadows, and D, symptoms more likely to be truly psychotic (e.g., poorly defined and short-lasting voices [other than B], fleeting paranoid ideation, or fleeting ideas of reference). 18 subjects (75%) endorsed symptoms of cluster A, 12 (50%) of cluster B, 10 (31%) of cluster C, and 12 (50%) of cluster D. Only subjects who reported symptoms from the D cluster exhibited significantly unfavorable depressive outcomes (compared to those with absence of D symptoms). The authors propose a phenomenological differentiation between benign psychosislike symptoms (clusters A-C) and the expression of the psychotic continuum (cluster D) in depressed Latinos.
    No preview · Article · Sep 2015 · The Journal of nervous and mental disease
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    • "Abnormal auditory and visual perceptions are often reported by Latinos with MDD as well as by Latinos with other mood and anxiety disorders (Posternak and Zimmerman, 2005; David et al., 1999; Mischoulon et al., 2005). In a separate paper, we attempted to systematically differentiate psychosis-like manifestations from genuine psychotic presentations in Latinos (Cassano et al., 2012). Unfortunately in the STAR*D cohort these differential features were not explored. "
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    ABSTRACT: OBJECTIVE: To determine whether isolated psychotic symptoms are more likely to be endorsed by depressed Latinos as opposed to other ethnic-racial groups; whether these symptoms affect Latinos similarly to other ethnic-racial groups in terms of treatment response; and whether they are more likely to be associated with anxiety disorders in depressed Latinos. METHODS: We analyzed data from STAR⁎D subjects who self identified as White, Black, or Latino. Rates of isolated psychotic symptoms were assessed by the self-rated Psychiatric Diagnostic Screening Questionnaire (PDSQ) and compared between ethnic-racial groups. Depressive remission outcomes were compared within each ethnic-racial group between subjects who endorsed psychotic symptoms versus no psychotic symptoms. Associations between isolated psychotic symptoms and anxiety disorders were also examined. RESULTS: Among 2597 eligible subjects with at least one post-baseline assessment and available PDSQ data excluding first-rank symptoms, the prevalence of auditory-visual hallucination was 2.5% in Whites (n=49/1928), 11.3% in Blacks (n=45/398) 6.3% in Latinos (n=17/270) (χ(2)=64.9; df=2; p<0.001). Prevalence of paranoid ideation was 15.5% in Whites (n=299/1927), 31.5% in Blacks (n=126/400), and 21.1% in Latinos (n=57/270) (χ(2)=57.3; df=2; p<0.001). Among Whites and Blacks but not Latinos, depressive remission rates were worse in subjects with auditory-visual hallucinations compared to those without them. Paranoid ideation had a significant negative impact on remission in Whites only. In all ethnic-racial groups, a significant association was found between auditory-visual hallucinations and PTSD and panic disorder. LIMITATIONS: The STAR*D study did not include any structured clinician-based assessment of psychotic symptoms. CONCLUSION: Latinos do not appear to have worse outcomes when treated for MDD with auditory-visual hallucinations, differently from Whites and Blacks.
    Full-text · Article · Mar 2013 · Journal of Affective Disorders

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