Insular cortex abnormalities in psychotic major depression: Relationship to gender and psychotic symptoms

The therapeutic strategies in managing patients with psychotic major depression (PMD) differ from those with non-psychotic major depression (NMD), because of differences in clinical profile and outcome. However, there is underrecognition of psychotic symptoms in depressed patients. Previous studies in Western population suggest that certain symptom patterns, apart from psychosis which may be concealed, can facilitate the discrimination of PMD from NMD. These studies may have limited applicability to sub-Saharan Africa due to cross-cultural differences in the phenomenology of depression. This study compared the rates and severity of depressive symptoms in outpatients with PMD (n=129) and NMD (n=117) using the Structured Clinical Interview for Depression (SCID) and Hamilton Depression Rating Scale (HAM-D). Patients with PMD had statistically significantly higher rates of suicidal ideation, suicidal attempt, psychomotor agitation, insomnia, and reduced appetite. Patients with NMD were more likely to manifest psychomotor retardation and somatic symptoms. PMD was associated with greater symptom severity. On logistic regression analysis, suicidal ideation, psychomotor disturbances, insomnia, and somatic symptoms were predictive of diagnostic status. The presence of these symptoms clusters may increase the suspicion of occult psychosis in patients with depression, thereby informing appropriate intervention strategies.

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C-20 * Examining the Effects of Negative Psychotic Symptoms and Cortisol Levels on Verbal Memory in Psychotic Major Depression

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acu038.201 ◽

2014 ◽

Vol 29 (6) ◽

pp. 579-580

Author(s):

A. Harley ◽

S. Gill ◽

L. Posecion ◽

R. Gomez

Keyword(s):

Major Depression ◽

Verbal Memory ◽

Psychotic Symptoms ◽

Psychotic Major Depression ◽

Cortisol Levels

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Clinical characteristics and socio-demographic features of psychotic major depression

10.21203/rs.3.rs-32003/v1 ◽

2020 ◽

Author(s):

Mengqi Wang ◽

Ranran Wang ◽

Yu Hao ◽

Weifeng Xiong ◽

Dongdong Qiao ◽

...

Keyword(s):

Family History ◽

Major Depression ◽

Primary School ◽

Clinical Characteristics ◽

Mental Health Center ◽

Psychotic Symptoms ◽

Birth Date ◽

First Onset ◽

Psychotic Major Depression ◽

Trigger Events

Abstract Background Psychotic major depression (PMD) is a special subtype of depression with a worse prognosis. Previous studies failed to find many differences among patients with PMD versus those with non-psychotic major depression (NMD) or schizophrenia(SZ). This study compared psychotic major depression with non-psychotic major depression and schizophrenia based on sociodemographic factors (including season of conception) and clinical characteristics. We aimed to provide data to inform clinical diagnoses and etiology research. Methods This case–control study used data for patients admitted to Shandong Mental Health Center from June 1, 2016 to December 31, 2017. We analyzed cases that had experienced a PMD episode (International Classification of Diseases, Tenth Revision codes F32.3, F33.3), NMD (F32.0–2/9, F33.0–2/9), and SZ (F20–20.9). Data were collected on sex, main discharge diagnosis, birth date, ethnicity, family history of psychiatric diagnoses, marital status, age at first onset, educational attainment, allergy history, and existence of trigger events. Results Patients with depression with a primary school/below education (odds ratio [OR] 0.397, CI: 0.18–0.874) and without a family history (OR 0.557, CI: 0.332–0.937) were less likely to have psychotic symptoms than other patients. Compared with patients with PMD, a primary school/below education (OR 3.646, CI: 1.65–8.053), no allergy history (OR 2.2, CI: 1.152–4.2), trigger events experienced before first onset (OR 2.428, CI: 1.528–3.859), being unmarried (OR 0.3, CI: 0.104–0.871), and an earlier age at first onset (OR 0.931, CI: 0.911–0.952) were features of SZ. Conclusion PMD and NMD are similar in terms of patients’ demographic variables and clinical characteristics, whereas there are differences between PMD and SZ. The significant factors we identified may point to underlying heterogeneity of these diseases.

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Clinical characteristics and sociodemographic features of psychotic major depression

Annals of General Psychiatry ◽

10.1186/s12991-021-00341-7 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Meng-qi Wang ◽

Ran-ran Wang ◽

Yu Hao ◽

Wei-feng Xiong ◽

Ling Han ◽

...

Keyword(s):

Family History ◽

Major Depression ◽

Clinical Characteristics ◽

Missing Values ◽

Psychotic Disorders ◽

Mental Health Center ◽

Psychiatric Diseases ◽

First Onset ◽

History Of ◽

Psychotic Major Depression

Abstract Background Psychotic major depression (PMD) is a subtype of depression with a poor prognosis. Previous studies have failed to find many differences between patients with PMD and those with non-psychotic major depression (NMD) or schizophrenia (SZ). We compared sociodemographic factors (including season of conception) and clinical characteristics between patients with PMD, NMD, and schizophrenia. Our aim was to provide data to help inform clinical diagnoses and future etiology research. Methods This study used data of all patients admitted to Shandong Mental Health Center from June 1, 2016 to December 31, 2017. We analyzed cases who had experienced an episode of PMD (International Classification of Diseases, Tenth Revision codes F32.3, F33.3), NMD (F32.0–2/9, F33.0–2/9), and SZ (F20–20.9). Data on sex, main discharge diagnosis, date of birth, ethnicity, family history of psychiatric diseases, marital status, age at first onset, education, allergy history, and presence of trigger events were collected. Odds ratios (OR) were calculated using logistic regression analyses. Missing values were filled using the k-nearest neighbor method. Results PMD patients were more likely to have a family history of psychiatric diseases in their first-, second-, and third-degree relatives ([OR] 1.701, 95% confidence interval [CI] 1.019–2.804) and to have obtained a higher level of education (OR 1.451, 95% CI 1.168–1.808) compared with depression patients without psychotic features. Compared to PMD patients, schizophrenia patients had lower education (OR 0.604, 95% CI 0.492–0.741), were more often divorced (OR 3.087, 95% CI 1.168–10.096), had a younger age of onset (OR 0.934, 95% CI 0.914–0.954), less likely to have a history of allergies (OR 0.604, 95% CI 0.492–0.741), and less likely to have experienced a trigger event 1 year before first onset (OR 0.420, 95% CI 0.267–0.661). Season of conception, ethnicity, and sex did not differ significantly between PMD and NMD or schizophrenia and PMD. Conclusions PMD patients have more similarities with NMD patients than SZ patients in terms of demographic and clinical characteristics. The differences found between PMD and SZ, and PMD and NMD correlated with specificity of the diseases. Furthermore, allergy history should be considered in future epidemiological studies of psychotic disorders.

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Antidepressant and antipsychotic treatment of Psychotic Major Depression in a British mental healthcare setting

Journal of Mental Health ◽

10.1080/09638237.2021.1922632 ◽

2021 ◽

pp. 1-7

Author(s):

Eshim S. Jami ◽

Megan Pritchard ◽

Hitesh Shetty ◽

Robert Stewart ◽

Allan H. Young ◽

...

Keyword(s):

Major Depression ◽

Mental Healthcare ◽

Healthcare Setting ◽

Antipsychotic Treatment ◽

Psychotic Major Depression

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Novel Strategies in the Treatment of Psychotic Major Depression

Psychiatric Annals ◽

10.3928/0048-5713-20021101-08 ◽

2002 ◽

Vol 32 (11) ◽

pp. 695-698

Author(s):

Charles DeBattista ◽

Joseph Belanoff

Keyword(s):

Major Depression ◽

Psychotic Major Depression

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CRH-R1 allelic variation and depressive and psychotic symptoms in major depression

Psychoneuroendocrinology ◽

10.1016/j.psyneuen.2016.07.031 ◽

2016 ◽

Vol 71 ◽

pp. 8-9

Author(s):

Alan Schatzberg

Keyword(s):

Major Depression ◽

Allelic Variation ◽

Psychotic Symptoms

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Les manifestations psychiatriques dans la démence: perspective phénoménologique

The Canadian Journal of Psychiatry ◽

10.1177/070674379303801009 ◽

1993 ◽

Vol 38 (10) ◽

pp. 671-677 ◽

Cited By ~ 1

Author(s):

Isabelle Paquette

Keyword(s):

Major Depression ◽

Cognitive Deficits ◽

Clinical Characteristics ◽

Depressive Symptomatology ◽

Psychiatric Symptoms ◽

Memory Loss ◽

Psychotic Symptoms ◽

Neuropsychological Evaluations ◽

Operational Criteria ◽

Psychiatric Manifestations

The study of psychiatric manifestations in dementia has long been overshadowed by the more classical manifestations of the disease, such as memory loss and other cognitive deficits. In recent years, however, psychiatric symptoms as part of the demential process have attracted interest and research has become more specific. Clinicians are faced with diagnostic, treatment and management difficulties related to affective or psychotic symptoms, which account for much distress and morbidity. Several studies indicate that the prevalence of psychiatric manifestations in clinical populations of patients suffering from dementia is high: 15% to 30% for hallucinations, 15% to 30% for delusions, ten percent to 20% for major depression and 40% to 50% for depressed mood. These figures tend to confirm the hypothesis that psychiatric features in dementia are neither infrequent nor atypical. Thus, researchers have sought to link psychotic or depressive symptomatology with several clinical characteristics of dementia, namely stage, severity, prognosis or cognitive dysfunction. Some recent studies involving extensive neuropsychological evaluations indicate that subgroups of patients can be defined according to psychiatric criteria, as well as cognitive or neurological criteria. Unfortunately, results are inconsistent. Some of the contradictions in the literature are related to poorly defined terms and symptoms, a lack of reliable operational criteria, absence of validation of instruments and scales and heterogeneity of the populations studied. Ambiguous syndromes, such as pseudodementia, while illustrative of certain clinical situations, have not been helpful in categorizing demented patients. The author suggests that research focused on specific and clearly defined psychiatric symptoms in dementia will better serve our comprehension of mixed syndromes.

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Combined Parietal-Insular-Striatal Cortex Stroke with New-Onset Hallucinations: Supporting the Salience Network Model of Schizophrenia

Psychiatry Journal ◽

10.1155/2020/4262050 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Saheba Nanda ◽

Krishna Priya ◽

Tasmia Khan ◽

Puja Patel ◽

Heela Azizi ◽

...

Keyword(s):

Functional Integration ◽

Insular Cortex ◽

Brain Regions ◽

Anterior Cingulate ◽

Psychotic Symptoms ◽

Salience Network ◽

Schizophrenic Patients ◽

Cortical Circuit ◽

The Brain ◽

New Onset

Brain imaging studies have identified multiple neuronal networks and circuits in the brain with altered functioning in patients with schizophrenia. These include the hippocampo-cerebello-cortical circuit, the prefrontal-thalamic-cerebellar circuit, functional integration in the bilateral caudate nucleus, and the salience network consisting of the insular cortex, parietal anterior cingulate cortex, and striatum, as well as limbic structures. Attributing psychotic symptoms to any of these networks in schizophrenia is confounded by the disruption of these networks in schizophrenic patients. Such attribution can be done with isolated dysfunction in any of these networks with concurrent psychotic symptoms. We present the case of a patient who presents with new-onset hallucinations and a stroke in brain regions similar to the salience network (insular cortex, parietal cortex, and striatum). The implication of these findings in isolating psychotic symptoms of the salience network is discussed.

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