Materiały źródłowe

• #1 Epidemiology of psychotic depression – systematic review and meta-analysis – PubMed

  https://pubmed.ncbi.nlm.nih.gov/28893329/

  Large amount of data have been published on non-psychotic depression (NPD), schizophrenia (SZ), and bipolar disorder, while psychotic depression (PD) as an own entity has received much smaller attention. […] We found that the lifetime prevalence of PD varies between 0.35% and 1%, with higher rates in older age. Onset age of PD was earlier than that of NPD in younger samples, but later in older samples. […] Risk factors have rarely been studied, the main finding being that family history of psychosis and bipolar disorder increases the risk of PD. Outcomes of PD were mostly worse when compared with NPD, but better compared with SZ and schizoaffective disorder. […] Based on this review, the amount of research on PD is far from that of NPD, SZ, and bipolar disorder. Based on our findings, PD seems distinguishable from related disorders and needs more scientific attention.

• #2 Epidemiology of psychotic depression – systematic review and meta-analysis – UTU Research Portal – UTU Research Portal

  https://research.utu.fi/converis/portal/detail/Publication/32049634;jsessionid=poBhRx5t1ggIT04Pr7129nyU70zHuV-2ln2rtOd6.cris-02?lang=en_GB

  Epidemiology of psychotic depression – systematic review and meta-analysis […] We performed a systematic review and meta-analyses on epidemiology, especially incidence and prevalence, risk factors, and outcomes of PD. […] We found that the lifetime prevalence of PD varies between 0.35% and 1%, with higher rates in older age. […] Risk factors have rarely been studied, the main finding being that family history of psychosis and bipolar disorder increases the risk of PD. […] Based on this review, the amount of research on PD is far from that of NPD, SZ, and bipolar disorder. […] Based on our findings, PD seems distinguishable from related disorders and needs more scientific attention.

• #2 Unipolar major depression with psychotic features: Epidemiology, clinical features, assessment, and diagnosis – UpToDate

  https://www.uptodate.com/contents/unipolar-major-depression-with-psychotic-features-epidemiology-clinical-features-assessment-and-diagnosis

  Unipolar major depression with psychotic features is a severe subtype of unipolar major depression (major depressive disorder). The psychotic symptoms are delusions and/or hallucinations that are frequently consistent with depressive themes of guilt and worthlessness. Psychotic depression and nonpsychotic depression differ in their diagnosis, treatment, and prognosis. […] This topic reviews the epidemiology, pathogenesis, clinical features, assessment, and diagnosis of unipolar major depression with psychotic features. Treatment and prognosis are discussed separately. […] The lifetime prevalence rate of unipolar major depression with psychotic features varies depending upon the setting. […] Large, nationally representative surveys of the general adult population in European countries estimate that both the point and lifetime prevalence of unipolar major depression with psychotic features is 0.4 to 0.5 percent. The mean age of onset of unipolar major depression among individuals with psychotic depression is 29 years. […] Studies of risk factors have found that unipolar psychotic depression is.

• #3 Epidemiology of psychotic depression – systematic review and meta-analysis | Psychological Medicine | Cambridge Core

  https://www.cambridge.org/core/journals/psychological-medicine/article/epidemiology-of-psychotic-depression-systematic-review-and-metaanalysis/57F7BD26F05E0A4B78A3337C73536813

  Large amount of data have been published on non-psychotic depression (NPD), schizophrenia (SZ), and bipolar disorder, while psychotic depression (PD) as an own entity has received much smaller attention. […] We found that the lifetime prevalence of PD varies between 0.35% and 1%, with higher rates in older age. […] Risk factors have rarely been studied, the main finding being that family history of psychosis and bipolar disorder increases the risk of PD. […] Based on this review, the amount of research on PD is far from that of NPD, SZ, and bipolar disorder. Based on our findings, PD seems distinguishable from related disorders and needs more scientific attention.

• #4 Unipolar major depression with psychotic features: Epidemiology, clinical features, assessment, and diagnosis – UpToDate

  https://www.uptodate.com/contents/unipolar-major-depression-with-psychotic-features-epidemiology-clinical-features-assessment-and-diagnosis/print

  Unipolar major depression with psychotic features is a severe subtype of unipolar major depression (major depressive disorder). The psychotic symptoms are delusions and/or hallucinations that are frequently consistent with depressive themes of guilt and worthlessness. Psychotic depression and nonpsychotic depression differ in their diagnosis, treatment, and prognosis. […] This topic reviews the epidemiology, pathogenesis, clinical features, assessment, and diagnosis of unipolar major depression with psychotic features. […] The lifetime prevalence rate of unipolar major depression with psychotic features varies depending upon the setting. […] Large, nationally representative surveys of the general adult population in European countries estimate that both the point and lifetime prevalence of unipolar major depression with psychotic features is 0.4 to 0.5 percent. The mean age of onset of unipolar major depression among individuals with psychotic depression is 29 years. […] Studies of risk factors have found that unipolar psychotic depression is.

• #5 Depression Statistics: Types, Symptoms, Treatments, More

  https://www.healthline.com/health/depression/facts-statistics-infographic

  Major depressive disorder with psychotic features (aka psychotic depression) describes depression that involves psychosis, hallucinations, delusions, or paranoia. […] Research on depression with psychotic features remains fairly limited in comparison to research on other types of depression. However, some experts believe this subtype is more common than previously believed. […] According to a 2021 research review, depression with psychotic features affects: about 4 in every 1,000 adults; between 14 and 30 adults in every 1,000 people over age 60. […] The same researchers note that symptoms of psychosis develop during an episode of depression for: 10-19% of adults in community samples; 25-45% of adults receiving inpatient care; 24-53% of older adults receiving inpatient care.

• #6 Psychotic Depression: Underrecognized, Undertreated-and Dangerous

  https://www.psychiatrictimes.com/view/psychotic-depression-underrecognized-undertreatedand-dangerous

  Here: the history of psychotic depression for the Study of the Pharmacotherapy of Psychotic Depression (STOP-PD), a summary its epidemiology, significance, diagnostic complexity, and treatment, as well as case vignettes. […] This article describes the history of this diagnostic construct for the Study of the Pharmacotherapy of Psychotic Depression (STOP-PD) and summarizes research on the epidemiology, significance, diagnostic complexity, and treatment of psychotic depression. […] The overall community prevalence of PMD is 0.4%; it occurs in 14% to 20% of individuals with MDD. […] The prevalence of PMD is markedly higher among hospitalized patients; it exceeds 25% in mixed-age adults and occurs in up to 45% of depressed geriatric inpatients. […] PMD is associated with severe health consequences. Relapse and recurrence rates approximating 50% have been reported.

• #7 Depression with Psychotic Features

  https://www.sleepeval.com/correlates/depressivePsychotic.html

  There is little data regarding the prevalence of associated psychotic features in subjects with major depressive disorders in the general population. […] One study found that the lifetime prevalence of psychotic symptoms in subjects who at one time had met criteria for major depression was 14% (lifetime prevalence of major depressive episode with psychotic features at 0.6%). […] Our study reports on the prevalence of DSM-IV major depressive episodes with and without psychotic features in the general population of five major western European countries. […] The current prevalence of DSM-IV major depressive episode was set at 2.4% in this sample. About 19% of these subjects with a major depressive episode had psychotic features yielding a prevalence of major depressive episodes with psychotic features of 0.4% in this sample. Thus, psychotic major depression is a relatively common disorder affecting four out of 1000 individuals. […] This study underlines the extent of depression with psychotic features. This has a double impact, namely, on patients diagnosis identification and on treatment. Contrary to a common belief, depression with psychotic features is not associated with severity.

• #8 Prevalence and risk factors for psychotic symptoms in young, first-episode and drug-naïve patients with major depressive disorder | BMC Psychiatry | Full Text

  https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-024-05517-5

  Major depressive disorder (MDD) is a common psychiatric disorder worldwide. Psychotic depression has been reported to be frequently under-diagnosed due to poor recognition of psychotic features. Therefore, the purpose of this study was to reveal the rate and risk factors of psychotic symptoms in young, drug-naïve patients with major depressive disorder at the time of their first episode. […] The rate of psychotic symptoms among young adult MDD patients was 9.1%. […] Our findings suggest that psychotic symptoms are common in young MDD patients. Several clinical variables and biochemical indicators are associated with the occurrence of psychotic symptoms in young MDD patients. […] The prevalence of psychotic symptoms among young MDD patients was 9.1%. […] Our study showed that among young adult patients, the psychotic subgroup was more likely to have suicide attempts than the non-psychotic subgroup.

• #9 Psychotic Depression | Behavioral and Mental Health | Mercy Health

  https://www.mercy.com/health-care-services/behavioral-mental-health/conditions/psychotic-depression

  One out of every four people who goes to the hospital with depression has a form of psychotic depression. […] It can be very difficult to diagnose someone with psychotic depression. This condition isn’t well-studied. […] Early diagnosis is important for successful treatment of psychotic depression.

• #10 Epidemiology of depression with psychotic experiences and its association with chronic physical conditions in 47 low- and middle-income countries | Psychological Medicine | Cambridge Core

  https://www.cambridge.org/core/journals/psychological-medicine/article/epidemiology-of-depression-with-psychotic-experiences-and-its-association-with-chronic-physical-conditions-in-47-low-and-middleincome-countries/447B12B6BD246AA3B57C97687F77A527

  The co-existence of depression and psychotic experiences (PEs) is associated with more pronounced adverse health outcomes compared to depression alone. […] The crude overall prevalence of co-morbid depression/PEs was 2.5% [95% confidence interval (CI) 2.32.7%], with the age- and sex-adjusted prevalence ranging from 0.1% (Sri Lanka, Vietnam) to 9.03% (Brazil). […] Co-occurring depression/PEs was associated with significantly higher odds for arthritis, angina, and diabetes beyond that of depression alone after adjusting for sociodemographics, anxiety, and country, with odds ratios (depression/PEs v. depression only) being: arthritis 1.30 (95% CI 1.071.59, p = 0.0086); angina 1.40 (95% CI 1.181.67, p = 0.0002); diabetes 1.65 (95% CI 1.212.26, p = 0.0017). […] The prevalence of co-existing depression/PEs was non-negligible in most countries. Our study suggests that when depression/PE or a chronic condition (e.g. arthritis, angina, diabetes) is detected, screening for the other may be important to improve clinical outcomes.

• #11 Epidemiology of psychotic depression : systematic review and meta-analysis – OuluREPO

  https://oulurepo.oulu.fi/handle/10024/23874

  Large amount of data have been published on non-psychotic depression (NPD), schizophrenia (SZ), and bipolar disorder, while psychotic depression (PD) as an own entity has received much smaller attention. […] We performed a systematic review and meta-analyses on epidemiology, especially incidence and prevalence, risk factors, and outcomes of PD. […] We found that the lifetime prevalence of PD varies between 0.35% and 1%, with higher rates in older age. […] Onset age of PD was earlier than that of NPD in younger samples, but later in older samples. […] There were no differences in gender distribution in PD v. NPD, but higher proportion of females was found in PD than in SZ or in psychotic bipolar disorder (PBD). […] Risk factors have rarely been studied, the main finding being that family history of psychosis and bipolar disorder increases the risk of PD.

• #12 (PDF) Biological and psychosocial risk factors for psychotic major depression

  https://www.academia.edu/92702643/Biological_and_psychosocial_risk_factors_for_psychotic_major_depression

  Aims Few studies have investigated risk factors for psychotic major depression (PMD). […] Risk factors associated with PMD appear to overlap with those for schizophrenia, but less so for bipolar disorder. […] PMD patients were more likely to be members of a racial/ethnic minority and to have lower educational attainment compared to those with nonpsychotic major depression. […] Results indicated that PMD was present in a relatively small percentage of treatment-seeking outpatients but was associated with disproportionately high levels of severity and impairment.

• #13

  https://link.springer.com/article/10.1007/s00127-020-01835-7

  In the group of severe mental disorders, psychotic depression (PD) is essentially under-researched. Knowledge about the risk factors is scarce and this applies especially to early risk factors. Our aim was to study early childhood and adolescent risk factors of PD in a representative birth cohort sample with a follow-up of up to 50 years. […] The main finding was that parents psychiatric illness [HR 3.59 (1.847.04)] was a risk factor and a high sports grade in school was a protective factor [HR 0.29 (0.110.73)] for PD also after adjusting for covariates in the multivariate Cox regression model. Parental psychotic illness was an especially strong risk factor for PD. The PD subjects had a parent with psychiatric illness significantly more often (p0.05) than NPD subjects. […] A low sports grade in school may be a risk factor for PD. Psychiatric illnesses, especially psychoses, are common in the parents of PD subjects. A surprisingly low number of statistically significant risk factors may have resulted from the size of the PD sample and the underlying heterogeneity of the etiology of PD.

• #14

  https://link.springer.com/article/10.1007/s00127-020-01835-7

  The 0.5% prevalence rate of PD in the sample was in line with previous findings. A significant finding in this study was a high prevalence of mental illness in the families of PD subjects, and higher than that of those with NPD. […] The proportion of psychosis and schizophrenia, but not depression or bipolar disorder, was found to be significantly more common among parents in PD compared to the HC group. Findings concerning parental mental illness in general and psychosis are in line with previous population-representative research, but our finding of no bipolar disorder among parents of the study subjects was surprising and conflicting. […] Both lower school sports grades and reported frequency of sport hobbies may reflect low physical activity. After adjusting for covariates in the multivariate cox regression model, a higher sports grade remained a significant protective factor for PD compared to HC.

• #15 Biological and psychosocial risk factors for psychotic major depression

  https://lirias.kuleuven.be/662181

  AIMS: Few studies have investigated risk factors for psychotic major depression (PMD). We aimed to investigate the biological and psychosocial risk factors associated with PMD compared with other psychotic disorders. […] Living alone (aOR=2.26, CI=1.21-4.23), basic level qualification (aOR=2.89, CI=1.08-7.74), being unemployed (aOR=2.12, CI=1.13-3.96), having contact with friends less than monthly (aOR=4.24, CI=1.62-11.14), having no close confidants (aOR=4.71, CI=2.08-10.68), having experienced childhood adversity (aOR=2.57, CI=1.02-6.44), family history of mental illness (aOR=10.68, CI=5.06-22.52), family history of psychosis (aOR=12.85, CI=5.24-31.51), and having more neurological soft signs (aOR=1.15, CI=1.07-1.24) were all associated with a follow-up diagnosis of PMD and schizophrenia.

• #16 Prevalence and risk factors for psychotic symptoms in young, first-episode and drug-naïve patients with major depressive disorder | BMC Psychiatry | Full Text

  https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-024-05517-5

  We found that severe anxiety was independently associated with psychotic symptoms and was a significant protective factor for psychotic symptoms. Furthermore, among young depression adults, the psychotic subgroup was more likely to suffer from severe anxiety than the non-psychotic subgroup. […] We found that higher TSH levels were independently associated with psychotic symptoms. […] In conclusion, this study showed a prevalence of 9.1% of psychotic symptoms in young MDD patients. Furthermore, among young MDD patients, the rate of suicide attempts was higher in the psychotic depression patients than in the non-psychotic depression patients.

• #17 Epidemiology of psychotic depression : systematic review and meta-analysis – OuluREPO

  https://oulurepo.oulu.fi/handle/10024/23874

  Outcomes of PD were mostly worse when compared with NPD, but better compared with SZ and schizoaffective disorder. […] Based on this review, the amount of research on PD is far from that of NPD, SZ, and bipolar disorder. […] Based on our findings, PD seems distinguishable from related disorders and needs more scientific attention.

• #18 Psychotic Depression: Underrecognized, Undertreated-and Dangerous

  https://www.psychiatrictimes.com/view/psychotic-depression-underrecognized-undertreatedand-dangerous

  An index episode of PMD predicts a greater than 2-fold higher 15-year mortality rate and 3-fold greater risk of suicide after an initial suicide attempt. […] The longitudinal risk for suicide is substantial because approximately 20% of patients with PMD make a suicide attempt during an episode. […] In STOP-PD, 27% of patients who had delusions did not receive a diagnosis of PMD. […] Because depressive ruminations that focus on themes of somatic, financial, and guilty concerns are expected concomitants of MDD, clinicians may ignore the question of whether these concerns are held fixedly and are influencing the patient’s behavior. […] A recent population registry-based study demonstrated that earlier age of onset and recurrent depressive episodes of unipolar PMD significantly increased the likelihood of conversion to a bipolar diagnosis.

• #19 Mortality in psychotic depression: 18-year follow-up study. — Department of Psychiatry

  https://www.psych.ox.ac.uk/publications/1301770

  BACKGROUND: Evidence on the role of co-occurring psychiatric disorders in mortality associated with psychotic depression is limited. […] AIMS: To estimate the risk of cause-specific mortality in psychotic depression compared with severe non-psychotic depression while controlling for comorbid psychiatric disorders. […] RESULTS: We included 19 064 individuals with incident psychotic depression and 90 877 individuals with incident non-psychotic depression. Half (1199/2188) of the deaths in those with psychotic depression occurred within 5 years from the index diagnosis and the highest relative risk was during the first year after the diagnosis. Compared with individuals with non-psychotic depression, those with psychotic depression had a higher risk of all-cause mortality (adjusted hazard ratio, aHR = 1.59, 95% CI 1.48-1.70), suicides (aHR = 2.36, 95% CI 2.11-2.64) and fatal accidents (aHR 1.63, 95% CI 1.26-2.10) during the subsequent 5-year period after the index diagnosis.

• #20 Depression with psychosis: Symptoms, treatment, and recoveryMedical News Today

  https://www.medicalnewstoday.com/articles/323193

  Major depression with psychotic features is also sometimes referred to as psychotic depression. It is a grave illness characterized by a combination of unipolar major depressive symptoms and psychosis. […] Some estimates suggest that 14.7 to 18.5 percent of people with major depression may experience psychotic features and that the prevalence rates may rise with age. […] This form of depression is an underdiagnosed and undertreated condition. […] Most diagnostic guides categorize psychotic depression as a subset of major depressive disorder. […] The International Classification of Diseases (ICD), 11th Edition, considers psychotic depression to be the most severe subtype of major depressive disorder. […] A misdiagnosis is often due to a lack of recognition of the psychotic features of major depression.

• #21 Psychotic Depression: Underrecognized, Undertreated-and Dangerous

  https://www.psychiatrictimes.com/view/psychotic-depression-underrecognized-undertreatedand-dangerous

  Consensus guidelines consider 2 treatments as effective for PMD: ECT and pharmacotherapy that combines an antidepressant with an antipsychotic. […] Results from a STOP-PD randomized controlled trial (RCT) demonstrated the efficacy of combined olanzapine (average dosage, 14.7 mg/d) and sertraline (average dosage, 170 mg/d) compared with olanzapine plus placebo. […] The STOP-PD results underscore the importance of deciding on postremission treatment: STOP-PD participants experienced significant weight gain and increases in their plasma lipid levels during the trial. […] Knowledge about the diagnosis and treatment of PMD has increased markedly over the past 35 years.

• #22 Depression with psychosis: Symptoms, treatment, and recoveryMedical News Today

  https://www.medicalnewstoday.com/articles/323193

  Depression with psychosis is a very serious medical condition that requires immediate medical attention. […] As a result of psychosis, the risk of suicide is significantly higher in people with psychotic depression as compared to people with nonpsychotic depression. […] There is some debate around the best treatment process for psychotic depression, particularly regarding first- and second-line treatments. […] Electroconvulsive therapy is a safe and effective treatment for people with psychotic depression. […] If people follow a treatment program, the long-term outlook for depression with psychosis is good.

• #23 Early Sleep Improvement and Response to Pharmacotherapy in Psychotic Depression

  https://www.psychiatrictimes.com/view/early-sleep-improvement-and-response-to-pharmacotherapy-in-psychotic-depression

  Insomnia is a common symptom and part of the diagnostic criteria for MDD. A systematic review found that treatment of insomnia improves mood symptoms in MDD.1 There is some evidence that early insomnia improvement (EII) within the initial weeks of treatment predicts response to antidepressants.2-4 […] However, the clinical utility of EII as a predictor of outcomes of antidepressant treatment remains unclear. There is evidence that psychotic depression (ie, MDD with psychotic features) has a higher severity of insomnia and depressive symptoms and a lower response to antidepressants than nonpsychotic MDD.5 […] The authors performed the first study of EII as a predictor of treatment outcome in psychotic depression. They found evidence that EII was associated with depression response and remission and remission of psychosis. Insomnia symptoms improved within the first weeks of pharmacotherapy, whereas depressive symptoms improved more gradually. […] Early improvement in insomnia was associated with a higher response to depressive and psychotic symptoms in psychotic depression. Further studies are needed to investigate the generalizability of EII as a predictor of treatment response in depression.

• #24 A genetic risk score to predict treatment nonresponse in psychotic depression | Translational Psychiatry

  https://www.nature.com/articles/s41398-024-02842-x

  Psychotic depression is a severe and difficult-to-treat subtype of major depressive disorder for which higher rates of treatment-resistant depression were found. […] A 2.2-fold higher risk of treatment-resistant depression (79.9% and 35.8% respectively, based on the number of antidepressant trials) has been observed in patients suffering from psychotic depression compared to patients with non-psychotic depression. […] Despite several studies on treatment-resistant depression predictors, stratification tools and staging models, the risk of treatment-resistant depression or treatment nonresponse is not commonly assessed in clinical practice. […] Identification of which psychotic depression patients are at risk for treatment nonresponse is important, as such information could be included in clinical decision-making.

• #25 A genetic risk score to predict treatment nonresponse in psychotic depression | Translational Psychiatry

  https://www.nature.com/articles/s41398-024-02842-x

  Our results suggest that a treatment-resistant depression GRS is predictive of treatment nonresponse and nonremission in psychotic depression. […] We show that the risk of nonresponse and nonremission is the highest (PPV=100%) in patients within the top 10% of the treatment-resistant depression GRS and that patients with a GRS in the top 40% are more likely to show nonresponse and nonremission compared to patients with lower GRSs. […] We studied the clinical validity (i.e. the ability of the test to detect or predict the clinical disorder or phenotype associated with the genotype). […] The number of adequate antidepressant trials in our study did not show an association with the treatment-resistant depression GRS. […] In conclusion, our study suggests that the treatment-resistant depression GRS might be valuable in predicting treatment nonresponse and nonremission in psychotic depression.

• #26

  https://link.springer.com/article/10.1007/s00127-015-1131-1

  Few studies have investigated risk factors for psychotic major depression (PMD). We aimed to investigate the biological and psychosocial risk factors associated with PMD compared with other psychotic disorders. […] Risk factors associated with PMD appear to overlap with those for schizophrenia, but less so for bipolar disorder. Future work on the differential aetiology of PMD, from other psychoses is needed to find the specifier between PMD and other psychoses. Future research on aetiology in PMD, and perhaps other psychoses, should account for diagnostic change. […] PMD is a largely under-researched disorder and is commonly excluded from risk studies; the majority of studies of risk factors in psychosis focus on schizophrenia and bipolar disorder. […] The finding that the psychosocial risk factors investigated were not unique to PMD has several plausible interpretations. These are: (1) these psychosocial factors have been measured with insufficient precision to find the specifying factors; (2) the psychosocial factors investigated pose a risk generic for all psychoses, and it is other psychosocial factors that are the specifying factors; (3) the psychosocial factors investigated are generic in the risk for psychosis and it is some other factor, e.g. genetic factors, that are the specifying factors; (4) the diagnostic classification system used does not sufficiently distinguish between different disorders which confuse the aetiological picture. Based on data presented here, it is not possible to determine which interpretation is correct.

• #27

  https://link.springer.com/article/10.1007/s00127-020-01835-7

  Single parenthood has been associated with multiple negative mental health outcomes, but many factors associated with single parenthood contribute significantly to this effect. In line with these findings, in our sample, single parenthood or living without parents was a significant risk factor for PD compared to HC in the univariate analysis, but not after adjusting for covariates in the multivariate model. […] Our results, with a majority of nonsignificant findings, are also worth considering more closely. It is possible that internal heterogeneity of the diagnostic category of PD partly causes the lack of findings. […] Low school sports grade in adolescence and familial mental illness were common factors in PD in our study. The PD risk factor profile was similar to that of other mental illness in most variables. A small number of significant risk factors may point to underlying heterogeneity. Research on the risk factors of PD should also be carried out in other samples to reduce the gap in knowledge.

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