Materiały źródłowe

• #1 Clinical characteristics and sociodemographic features of psychotic major depression | Annals of General Psychiatry | Full Text

  https://annals-general-psychiatry.biomedcentral.com/articles/10.1186/s12991-021-00341-7

  PMD is a serious mental disorder, where patients suffer from a combination of low mood and psychosis. PMD is a subtype of major depressive disorder according to the classification systems of psychiatric diseases, the DSM-V and ICD-10, and accounts for about 14.7%–18.5% of patients with major depression. However, compared with major depression without psychotic features, PMD is associated with longer duration, greater morbidity and mortality, lower response to antidepressants and psychotherapy, higher rate of suicide risk, higher comorbidity of anxiety disorders, cognitive dysfunction, somatic disorders, and personality disorders. […] A longitudinal study of patients with PMD admitted to hospital for the first time showed that 41% of patients who were initially diagnosed with PMD met DSM-IV criteria for bipolar disorder or schizoaffective disorder within 2 years.

• #2 What Causes Psychotic Depression, and How Is It Treated? – BrightQuest Treatment Centers

  https://www.brightquest.com/blog/what-causes-psychotic-depression-and-how-is-it-treated/

  We can explore the causes and risk factors for psychotic depression and then turn our attention to the solutions. The treatment options for major depressive disorder with psychotic features are comprehensive and successful, especially when established in a long-term in-patient treatment setting. […] Researchers are still working to better understand mood disorders such as depression and their causes—as well as psychotic symptoms and their causes. But mood disorders can be linked directly to chemical imbalances in the brain and, generally, to biological, genetic, psychological, and environmental factors. […] While there isn’t a medication that is indicated for psychotic depression specifically, a combination of antidepressants and antipsychotics has shown to be effective with clients. But medication management must be handled very carefully to find the precise prescriptions and dosage balance for the individual. Medication is a primary approach to psychotic depression care, but for treatment-resistant clients, electroconvulsive therapy (ECT) may be a secondary treatment option.

• #3 Psychotic depression – NHS

  https://www.nhs.uk/mental-health/conditions/psychotic-depression/

  Some people who have severe depression may also experience hallucinations and delusional thinking, the symptoms of psychosis. […] Depression with psychosis is known as psychotic depression. […] The cause of psychotic depression is not fully understood. It’s known that there’s no single cause of depression and it has many different triggers. […] It’s not known why some people with severe depression also develop psychosis.

• #4 Clinical and Molecular Genetics of Psychotic Depression – PMC Lock

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3686457/

  This review provides a comprehensive overview of clinical and molecular genetic as well as pharmacogenetic studies regarding the clinical phenotype of “psychotic depression.” Results are discussed with regard to the long-standing debate on categorical vs dimensional disease models of affective and psychotic disorders on a continuum from unipolar depression over bipolar disorder and schizoaffective disorder to schizophrenia. Clinical genetic studies suggest a familial aggregation and a considerable heritability (39%) of psychotic depression partly shared with schizoaffective disorder, schizophrenia, and affective disorders. […] Molecular genetic studies point to potential risk loci of psychotic depression shared with schizoaffective disorder (1q42, 22q11, 19p13), depression, bipolar disorder, and schizophrenia (6p, 8p22, 10p13-12, 10p14, 13q13-14, 13q32, 18p, 22q11-13) and several vulnerability genes possibly contributing to an increased risk of psychotic symptoms in depression (eg, BDNF, DBH, DTNBP1, DRD2, DRD4, GSK-3beta, MAO-A).

• #5 Clinical and Molecular Genetics of Psychotic Depression – PMC Lock

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3686457/

  This review provides a comprehensive overview of clinical and molecular genetic as well as pharmacogenetic studies regarding the clinical phenotype of “psychotic depression.” Results are discussed with regard to the long-standing debate on categorical vs dimensional disease models of affective and psychotic disorders on a continuum from unipolar depression over bipolar disorder and schizoaffective disorder to schizophrenia. Clinical genetic studies suggest a familial aggregation and a considerable heritability (39%) of psychotic depression partly shared with schizoaffective disorder, schizophrenia, and affective disorders. […] Molecular genetic studies point to potential risk loci of psychotic depression shared with schizoaffective disorder (1q42, 22q11, 19p13), depression, bipolar disorder, and schizophrenia (6p, 8p22, 10p13-12, 10p14, 13q13-14, 13q32, 18p, 22q11-13) and several vulnerability genes possibly contributing to an increased risk of psychotic symptoms in depression (eg, BDNF, DBH, DTNBP1, DRD2, DRD4, GSK-3beta, MAO-A).

• #6 Clinical and Molecular Genetics of Psychotic Depression – PMC Lock

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3686457/

  This review provides a comprehensive overview of clinical and molecular genetic as well as pharmacogenetic studies regarding the clinical phenotype of “psychotic depression.” Results are discussed with regard to the long-standing debate on categorical vs dimensional disease models of affective and psychotic disorders on a continuum from unipolar depression over bipolar disorder and schizoaffective disorder to schizophrenia. Clinical genetic studies suggest a familial aggregation and a considerable heritability (39%) of psychotic depression partly shared with schizoaffective disorder, schizophrenia, and affective disorders. […] Molecular genetic studies point to potential risk loci of psychotic depression shared with schizoaffective disorder (1q42, 22q11, 19p13), depression, bipolar disorder, and schizophrenia (6p, 8p22, 10p13-12, 10p14, 13q13-14, 13q32, 18p, 22q11-13) and several vulnerability genes possibly contributing to an increased risk of psychotic symptoms in depression (eg, BDNF, DBH, DTNBP1, DRD2, DRD4, GSK-3beta, MAO-A).

• #7 Dysbindin (DTNBP1) – A role in psychotic depression? | QUT ePrints

  https://eprints.qut.edu.au/40596/

  Previous studies yielded evidence for dysbindin (DTNBP1) to impact the pathogenesis of schizophrenia on the one hand and affective disorders such as bipolar or major depressive disorder (MDD) on the other. […] In summary, the present results provide preliminary support for dysbindin (DTNBP1) gene variation, particularly SNPs rs1997679 and rs9370822, to be associated with the clinical phenotype of psychotic depression suggesting a possible neurobiological mechanism for an intermediate trait on the continuum between affective disorders and schizophrenia.

• #8 Psychotic depression – Wikipedia

  https://en.wikipedia.org/wiki/Psychotic_depression

  Psychotic depression, also known as depressive psychosis, is a major depressive episode that is accompanied by psychotic symptoms. […] Psychotic symptoms tend to develop after an individual has already had several episodes of depression without psychosis. […] The prognosis for psychotic depression is not considered to be as poor as for schizoaffective disorders or primary psychotic disorders. […] There are a number of biological features that may distinguish psychotic depression from non-psychotic depression. The most significant difference may be the presence of an abnormality in the hypothalamic pituitary adrenal axis (HPA). […] The HPA axis appears to be dysregulated in psychotic depression, with dexamethasone suppression tests demonstrating higher levels of cortisol following dexamethasone administration (i.e. lower cortisol suppression). […] Research has shown that psychotic depression differs from non-psychotic depression in a number of ways: potential precipitating factors, underlying biology, symptomatology beyond psychotic symptoms, long-term prognosis, and responsiveness to psychopharmacological treatment and ECT.

• #9 Psychotic depression – Wikipedia

  https://en.wikipedia.org/wiki/Psychotic_depression

  Psychotic depression, also known as depressive psychosis, is a major depressive episode that is accompanied by psychotic symptoms. […] Psychotic symptoms tend to develop after an individual has already had several episodes of depression without psychosis. […] The prognosis for psychotic depression is not considered to be as poor as for schizoaffective disorders or primary psychotic disorders. […] There are a number of biological features that may distinguish psychotic depression from non-psychotic depression. The most significant difference may be the presence of an abnormality in the hypothalamic pituitary adrenal axis (HPA). […] The HPA axis appears to be dysregulated in psychotic depression, with dexamethasone suppression tests demonstrating higher levels of cortisol following dexamethasone administration (i.e. lower cortisol suppression). […] Research has shown that psychotic depression differs from non-psychotic depression in a number of ways: potential precipitating factors, underlying biology, symptomatology beyond psychotic symptoms, long-term prognosis, and responsiveness to psychopharmacological treatment and ECT.

• #10 Major Depressive Disorder: Advances in Neuroscience Research and Translational Applications | Neuroscience Bulletin

  https://link.springer.com/article/10.1007/s12264-021-00638-3

  Stress is causative or a contributing factor to depression. […] About 40%–60% of patients with depression display a disturbed HPA axis, including hypercortisolemia, decreased rhythmicity, and elevated cortisol levels. […] Mounting evidence has shown that stress-induced abnormality of the HPA axis is associated with depression and cognitive impairment, which is due to the increased secretion of cortisol and the insufficient inhibition of glucocorticoid receptor regulatory feedback. […] The neurotrophic hypothesis of depression postulates that a deficit of neurotrophic support leads to neuronal atrophy, the reduction of neurogenesis, and the destruction of glia support, while antidepressants attenuate or reverse these pathophysiological processes. […] The immune-inflammation hypothesis has attracted much attention, suggesting that the interactions between inflammatory pathways and neural circuits and neurotransmitters are involved in the pathogenesis and pathophysiological processes of depression.

• #11 Major Depressive Disorder: Advances in Neuroscience Research and Translational Applications | Neuroscience Bulletin

  https://link.springer.com/article/10.1007/s12264-021-00638-3

  Stress is causative or a contributing factor to depression. […] About 40%–60% of patients with depression display a disturbed HPA axis, including hypercortisolemia, decreased rhythmicity, and elevated cortisol levels. […] Mounting evidence has shown that stress-induced abnormality of the HPA axis is associated with depression and cognitive impairment, which is due to the increased secretion of cortisol and the insufficient inhibition of glucocorticoid receptor regulatory feedback. […] The neurotrophic hypothesis of depression postulates that a deficit of neurotrophic support leads to neuronal atrophy, the reduction of neurogenesis, and the destruction of glia support, while antidepressants attenuate or reverse these pathophysiological processes. […] The immune-inflammation hypothesis has attracted much attention, suggesting that the interactions between inflammatory pathways and neural circuits and neurotransmitters are involved in the pathogenesis and pathophysiological processes of depression.

• #12 HPA Axis in the Pathomechanism of Depression and Schizophrenia: New Therapeutic Strategies Based on Its Participation

  https://www.mdpi.com/2076-3425/11/10/1298

  The relationship between stress, cortisol and the development of depression can also be investigated by exogenous administration of corticosterone (CORT) in animal models. […] Abnormal functioning of the HPA axis, in the form of cortisol hypersecretion, can exacerbate symptoms of psychiatric disorders. […] HPA axis dysfunction in patients with schizophrenia is associated with an impaired response to psychosocial stressors. […] The role of HPA axis hyperactivity in the pathomechanism of schizophrenia is also indicated by the fact that glucocorticoid antagonists are effective in relieving psychotic symptoms. […] The HPA axis may play an important role in the pathogenesis of schizophrenia. Elevated blood cortisol levels are thought to contribute to cognitive decline in older people. […] The increased HPA axis activity is particularly prevalent at the onset of illness.

• #13 Clinical and Biological Effects of Mifepristone Treatment for Psychotic Depression | Neuropsychopharmacology

  https://www.nature.com/articles/1300884

  By contrast, GR mediates feedback changes when cortisol levels are high such as in response to stress or during the late night and early morning. […] Novel agents that act directly on the regulation of the HPA axis may offer a new approach to the treatment of psychiatric conditions marked by overactivity of this pathway. […] We have hypothesized that mifepristone could exert two major effects on HPA axis activity. Mifepristone in vivo is a competitive inhibitor of GR but is inactive at MR. […] Hence, one major effect of mifepristone may be to block GR, which is found in key brain regions and in monaminergic nuclei and this could then directly lead to symptomatic and cognitive improvement. […] The other effect would be to block GR and indirectly allow cortisol to ‘flood’ MR, which may lead to its downregulation and resetting of the HPA axis.

• #14 Clinical and Biological Effects of Mifepristone Treatment for Psychotic Depression | Neuropsychopharmacology

  https://www.nature.com/articles/1300884

  In this study, PMD patients were treated with mifepristone or placebo for 8 days under double-blind conditions. […] As expected, mifepristone produced significantly elevated cortisol and ACTH levels and steepened ascending slopes from 1800 to 0100 and from 0100 to 0900 as compared to placebo. […] The finding of elevated cortisol levels without an associated increase in ACTH levels during the evening may be related to several factors. […] Overall, these studies suggest GR and MR as being of potential etiologic importance in disorders marked by HPA axis dysfunction, and that GR modification may offer a new target for therapeutic intervention in psychiatric disorders such as PMD and bipolar disorder.

• #15 Understanding the Role of Sigma-1 Receptors in Psychotic Depression

  https://www.psychiatrictimes.com/view/understanding-role-sigma-1-receptors-psychotic-depression

  Selective serotonin reuptake inhibitors have been shown effective in the treatment of depression with psychosis. This efficacy appears to correlate with the SSRIs’ level of affinity at the sigma-1 receptors in the brain. […] Psychotic depression is a clinical subtype of major depressive disorder and is characterized by psychosis accompanied by greater severity of depressive symptoms that include psychomotor impairment (retardation or agitation), morbid cognition (involving guilt and a sense of deserving punishment), suicidal idea and neuropsychological impairment. […] Although several reports suggest abnormalities of endocrine, dopaminergic and/or serotonergic systems in psychotic depression, pathophysiology of psychotic depression is still unclear. […] The efficacy of SSRIs in combination with antipsychotics, especially the atypicals, in treating psychotic depression has been reported.

• #16 Psychotic Depression: What Is It, Symptoms, Causes, and MoreHealthline

  https://www.healthline.com/health/depression/psychotic-depression

  Psychotic depression refers to major depressive disorder (MDD) with features of psychosis, a specific presentation of depression. It involves symptoms of psychosis during an episode of depression. […] Estimates based on community samples suggest MDD with psychosis affects anywhere from 10 to 19 percent of people having an episode of major depression. Among people receiving inpatient care for depression, this rate increases to: […] Some experts believe MDD with psychosis may actually occur at higher rates, since clinicians don’t always recognize psychosis when diagnosing depression. […] Researchers have yet to identify a single specific cause of MDD with psychosis, or any type of depression, for that matter. […] Possible causes include: […] Imbalances in brain chemicals like dopamine and serotonin play a role in many mental health conditions, including depression and psychosis.

• #17 A Case of Psychotic Depression Treated with Fluvoxamine Monotherapy

  https://www.cpn.or.kr/journal/view.html?uid=80&vmd=Full

  Psychotic depression is a clinical subtype of major depressive disorder and is characterized by psychosis accompanied by relatively severe depressive symptoms that include psychomotor impairment (retardation or agitation), morbid cognition (cognition involving guilt and a sense of deserving punishment), suicidal ideation and neuropsychological impairment. […] A number of clinical studies have demonstrated the efficacy of the combination of an antidepressant (e.g., a tricyclic antidepressant or selective serotonin reuptake inhibitor) and an atypical antipsychotic or electroconvulsive therapy (ECT) in treating psychotic depression. […] The sigma-1 receptors of the endoplasmic reticulum have been implicated in the pathophysiology of depression and in the mechanisms of action of antidepressants.

• #18 A Case of Psychotic Depression Treated with Fluvoxamine Monotherapy

  https://www.cpn.or.kr/journal/view.html?uid=80&vmd=Full

  Based on these findings, Stahl proposed a hypothesis that the sigma-1 receptors may be implicated in the efficacy of fluvoxamine in patients with psychotic depression. […] However, further studies using large numbers of patients are needed before it can be concluded that fluvoxamine monotherapy is effective in patients with psychotic depression. […] In addition, this study did not clarify the action of fluvoxamine. To confirm the role of sigma-1 receptors in the treatment of psychotic depression, a randomized double-blind study of fluvoxamine and paroxetine in patients with psychotic depression might be necessary. […] In addition, a randomized double-blind study of selective sigma-1 receptor agonists in patients with psychotic depression would be of interest.

• #19 Understanding the Role of Sigma-1 Receptors in Psychotic Depression

  https://www.psychiatrictimes.com/view/understanding-role-sigma-1-receptors-psychotic-depression

  Selective serotonin reuptake inhibitors have been shown effective in the treatment of depression with psychosis. This efficacy appears to correlate with the SSRIs’ level of affinity at the sigma-1 receptors in the brain. […] Psychotic depression is a clinical subtype of major depressive disorder and is characterized by psychosis accompanied by greater severity of depressive symptoms that include psychomotor impairment (retardation or agitation), morbid cognition (involving guilt and a sense of deserving punishment), suicidal idea and neuropsychological impairment. […] Although several reports suggest abnormalities of endocrine, dopaminergic and/or serotonergic systems in psychotic depression, pathophysiology of psychotic depression is still unclear. […] The efficacy of SSRIs in combination with antipsychotics, especially the atypicals, in treating psychotic depression has been reported.

• #20 Understanding the Role of Sigma-1 Receptors in Psychotic Depression

  https://www.psychiatrictimes.com/view/understanding-role-sigma-1-receptors-psychotic-depression

  Based on these findings, Stahl (2005) very recently proposed that σ-1 receptors might be involved in pathophysiology of psychotic depression and that the action of SSRIs, especially those of fluvoxamine, may be related to their high affinities for σ-1 receptors. […] Certain studies have demonstrated the possible link of psychotic depression to dysregulation of neurotransmitters, such as dopamine and serotonin; abnormality of brain lipid ganglioside; or hyperactivation of the neuroendocrine system. […] The rapid and potent efficacy of mifepristone for psychotic depression further strengthens this hypothesis. […] The possible involvement of σ-1 receptors in the unique action of fluvoxamine in psychotic depression has been recently proposed.

• #21 Structural brain networks in remitted psychotic depression – PMC Lock

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7235256/

  Major depressive disorder with psychotic features (psychotic depression) is a severe disorder. […] The pathogenesis of psychotic depression is unknown, although several lines of neurobiological inquiry have been pursued. […] Brain imaging with computed tomography has also demonstrated increased ventricular volume. […] Functional MRI (fMRI) studies of psychotic depression have examined several aspects of task-related cognition. […] Structural MRI (sMRI) studies of specific brain regions have reported reductions in gray matter volume in brain regions including the amygdala and SCC. […] A network-level approach may better capture these distributed abnormalities while more directly relating to the functional abnormalities observed in psychotic depression. […] Overall, NMF allows for the examination of distributed structural abnormalities that may relate to functional connectivity abnormalities observed in patients with psychotic depression.

• #22 Structural brain networks in remitted psychotic depression – PMC Lock

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7235256/

  Major depressive disorder with psychotic features (psychotic depression) is a severe disorder. […] The pathogenesis of psychotic depression is unknown, although several lines of neurobiological inquiry have been pursued. […] Brain imaging with computed tomography has also demonstrated increased ventricular volume. […] Functional MRI (fMRI) studies of psychotic depression have examined several aspects of task-related cognition. […] Structural MRI (sMRI) studies of specific brain regions have reported reductions in gray matter volume in brain regions including the amygdala and SCC. […] A network-level approach may better capture these distributed abnormalities while more directly relating to the functional abnormalities observed in psychotic depression. […] Overall, NMF allows for the examination of distributed structural abnormalities that may relate to functional connectivity abnormalities observed in patients with psychotic depression.

• #23 Structural brain networks in remitted psychotic depression – PMC Lock

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7235256/

  We found that patients with remitted psychotic depression had significantly thinner cortex in five networks (insular-limbic, occipito-temporal, temporal, parahippocampal-limbic, and inferior fronto-temporal) and confirmed our hypothesis that affected networks incorporated cortico-limbic regions. […] This network also predicted final CGI severity scores better than the CGI severity scores at the time of scanning, providing evidence for a clinically relevant brain-behavior relationship. […] Our results partly fit with previous structural findings, although it is noteworthy that the smaller sample size and region of interest-based approaches of previous studies have rendered inconsistent results. […] NMF has been used to identify networks implicated in brain-behavior relationships. […] Our findings can be viewed through a limbic system or central autonomic network (CAN) lens. […] Thus, the insular-limbic network may hold translational potential for brain stimulation, pharmacotherapy, or even as a treatment-independent biomarker for symptomatic improvement specific to psychotic depression.

• #24 Diagnosing Melancholic and Psychotic Depression

  https://psychscenehub.com/psychinsights/melancholic-and-psychotic-depression-diagnosis-and-management/

  Melancholic and psychotic depressions are severe forms of depression associated with high morbidity and suicide risk. [Wilhelm K., 2009] […] Psychotic major depression (PMD) is a severe form of depression with significant morbidity and mortality. Patients with psychotic depression have double the risk of dying than non-psychotic depression and higher odds of completed suicide. [Vythilingam M et al., 2003]., [Gournellis R et al., 2018] […] Psychotic depression is best conceptualised as melancholic depression with psychotic features (e.g. delusions, hallucinations, guilty ruminations). […] Psychotic depression is associated with lower amygdala and subcallosal region of the anterior cingulate cortex (scACC) volumes and may be a marker of future risk of psychotic depression. [Keller J et al., 2008], [Bijanki K et al., 2014]

• #25 Diagnosing Melancholic and Psychotic Depression

  https://psychscenehub.com/psychinsights/melancholic-and-psychotic-depression-diagnosis-and-management/

  Patients with psychotic depression also show a significant reduction in hippocampal volume bilaterally, perhaps due to high cortisol states associated with psychotic depression. [Bijanki K et al., 2014] […] The treatment of psychotic depression has not been studied to the same extent as other psychiatric disorders, and it remains an underdiagnosed and undertreated psychiatric disorder. […] A systematic review and meta-analysis showed that an antidepressant and antipsychotic combination is significantly more effective than either antidepressant monotherapy or antipsychotic monotherapy for the acute treatment of psychotic depression. [Farhani A & Correll C, 2012]. […] Despite the recommendations of combination AD and AP treatment in psychotic depression, the STOP-PD study (2007) showed that only 5% of patients with psychotic depression receive an adequate combination of an antidepressant and an antipsychotic. [Andreescu C, et al., 2007]

• #26 Major Depressive Disorder: Advances in Neuroscience Research and Translational Applications | Neuroscience Bulletin

  https://link.springer.com/article/10.1007/s12264-021-00638-3

  Stress is causative or a contributing factor to depression. […] About 40%–60% of patients with depression display a disturbed HPA axis, including hypercortisolemia, decreased rhythmicity, and elevated cortisol levels. […] Mounting evidence has shown that stress-induced abnormality of the HPA axis is associated with depression and cognitive impairment, which is due to the increased secretion of cortisol and the insufficient inhibition of glucocorticoid receptor regulatory feedback. […] The neurotrophic hypothesis of depression postulates that a deficit of neurotrophic support leads to neuronal atrophy, the reduction of neurogenesis, and the destruction of glia support, while antidepressants attenuate or reverse these pathophysiological processes. […] The immune-inflammation hypothesis has attracted much attention, suggesting that the interactions between inflammatory pathways and neural circuits and neurotransmitters are involved in the pathogenesis and pathophysiological processes of depression.

• #27 Major Depressive Disorder: Advances in Neuroscience Research and Translational Applications | Neuroscience Bulletin

  https://link.springer.com/article/10.1007/s12264-021-00638-3

  Stress is causative or a contributing factor to depression. […] About 40%–60% of patients with depression display a disturbed HPA axis, including hypercortisolemia, decreased rhythmicity, and elevated cortisol levels. […] Mounting evidence has shown that stress-induced abnormality of the HPA axis is associated with depression and cognitive impairment, which is due to the increased secretion of cortisol and the insufficient inhibition of glucocorticoid receptor regulatory feedback. […] The neurotrophic hypothesis of depression postulates that a deficit of neurotrophic support leads to neuronal atrophy, the reduction of neurogenesis, and the destruction of glia support, while antidepressants attenuate or reverse these pathophysiological processes. […] The immune-inflammation hypothesis has attracted much attention, suggesting that the interactions between inflammatory pathways and neural circuits and neurotransmitters are involved in the pathogenesis and pathophysiological processes of depression.

• #28 Major Depressive Disorder: Advances in Neuroscience Research and Translational Applications | Neuroscience Bulletin

  https://link.springer.com/article/10.1007/s12264-021-00638-3

  Patients with depression show the core feature of the immune-inflammatory response, that is, increased concentrations of pro-inflammatory cytokines and their receptors, chemokines, and soluble adhesion molecules in peripheral blood and cerebrospinal fluid. […] The microbiota-gut-brain axis has recently gained more attention because of its ability to regulate brain activity. […] Many studies have shown that the microbiota-gut-brain axis plays an important role in regulating mood, behavior, and neuronal transmission in the brain. […] The pathogenesis of depression is complex and all the hypotheses should be integrated to consider the many interactions between various systems and pathways.

• #29 Major Depressive Disorder: Advances in Neuroscience Research and Translational Applications | Neuroscience Bulletin

  https://link.springer.com/article/10.1007/s12264-021-00638-3

  Patients with depression show the core feature of the immune-inflammatory response, that is, increased concentrations of pro-inflammatory cytokines and their receptors, chemokines, and soluble adhesion molecules in peripheral blood and cerebrospinal fluid. […] The microbiota-gut-brain axis has recently gained more attention because of its ability to regulate brain activity. […] Many studies have shown that the microbiota-gut-brain axis plays an important role in regulating mood, behavior, and neuronal transmission in the brain. […] The pathogenesis of depression is complex and all the hypotheses should be integrated to consider the many interactions between various systems and pathways.

• #30 Major Depressive Disorder: Advances in Neuroscience Research and Translational Applications | Neuroscience Bulletin

  https://link.springer.com/article/10.1007/s12264-021-00638-3

  Patients with depression show the core feature of the immune-inflammatory response, that is, increased concentrations of pro-inflammatory cytokines and their receptors, chemokines, and soluble adhesion molecules in peripheral blood and cerebrospinal fluid. […] The microbiota-gut-brain axis has recently gained more attention because of its ability to regulate brain activity. […] Many studies have shown that the microbiota-gut-brain axis plays an important role in regulating mood, behavior, and neuronal transmission in the brain. […] The pathogenesis of depression is complex and all the hypotheses should be integrated to consider the many interactions between various systems and pathways.

• #31 Reappraisal of the interplay between psychosis and depression symptoms in the pathogenesis of psychotic syndromes: results from a twenty-year prospective community study | European Archives of Psychiatry and Clinical Neuroscience

  https://link.springer.com/article/10.1007/s00406-010-0123-0

  The interplay of psychotic and affective symptoms is a crucial challenge in understanding the pathogenesis of psychosis. […] The interplay between the two subclinical psychosis symptoms dimensions and the depression symptoms dimension includes several intertwined pathways. […] The main driving force within the dynamic interplay between depression and psychosis symptoms is a schizotypal symptoms dimension, which represents social and interpersonal deficiencies, ideas of reference, suspiciousness, paranoid ideation, and odd behavior. It does not only directly influence subclinical nuclear schizophrenia symptoms but also the symptoms of depression.

• #32 Reappraisal of the interplay between psychosis and depression symptoms in the pathogenesis of psychotic syndromes: results from a twenty-year prospective community study

  https://www.zora.uzh.ch/id/eprint/44263/

  The interplay of psychotic and affective symptoms is a crucial challenge in understanding the pathogenesis of psychosis. […] The interplay between the two subclinical psychosis symptoms dimensions and the depression symptoms dimension includes several intertwined pathways. The schizotypal symptoms dimension has strong direct effects on the schizophrenia nuclear symptoms dimension, but also on the depression symptoms dimension. The latter has for its part an effect on the schizophrenia nuclear symptoms dimension. The main driving force within the dynamic interplay between depression and psychosis symptoms is a schizotypal symptoms dimension, which represents social and interpersonal deficiencies, ideas of reference, suspiciousness, paranoid ideation, and odd behavior. It does not only directly influence subclinical nuclear schizophrenia symptoms but also the symptoms of depression.

• #33 Reappraisal of the interplay between psychosis and depression symptoms in the pathogenesis of psychotic syndromes: results from a twenty-year prospective community study | European Archives of Psychiatry and Clinical Neuroscience

  https://link.springer.com/article/10.1007/s00406-010-0123-0

  The interplay of psychotic and affective symptoms is a crucial challenge in understanding the pathogenesis of psychosis. […] The interplay between the two subclinical psychosis symptoms dimensions and the depression symptoms dimension includes several intertwined pathways. […] The main driving force within the dynamic interplay between depression and psychosis symptoms is a schizotypal symptoms dimension, which represents social and interpersonal deficiencies, ideas of reference, suspiciousness, paranoid ideation, and odd behavior. It does not only directly influence subclinical nuclear schizophrenia symptoms but also the symptoms of depression.

• #34 Reappraisal of the interplay between psychosis and depression symptoms in the pathogenesis of psychotic syndromes: results from a twenty-year prospective community study

  https://www.zora.uzh.ch/id/eprint/44263/

  The interplay of psychotic and affective symptoms is a crucial challenge in understanding the pathogenesis of psychosis. […] The interplay between the two subclinical psychosis symptoms dimensions and the depression symptoms dimension includes several intertwined pathways. The schizotypal symptoms dimension has strong direct effects on the schizophrenia nuclear symptoms dimension, but also on the depression symptoms dimension. The latter has for its part an effect on the schizophrenia nuclear symptoms dimension. The main driving force within the dynamic interplay between depression and psychosis symptoms is a schizotypal symptoms dimension, which represents social and interpersonal deficiencies, ideas of reference, suspiciousness, paranoid ideation, and odd behavior. It does not only directly influence subclinical nuclear schizophrenia symptoms but also the symptoms of depression.

• #35 Clinical and Molecular Genetics of Psychotic Depression – PMC Lock

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3686457/

  Genetic factors are suggested to contribute to the disease risk of psychotic depression in partial overlap with disorders along the affective-psychotic spectrum. […] Thus, genetic research focusing on psychotic depression might inspire a more dimensional, neurobiologically and symptom-oriented taxonomy of affective and psychotic disorders challenging the dichotomous Kraepelinian view. […] Additionally, pharmacogenetic studies might aid in the development of a more personalized treatment of psychotic depression with an individually tailored antidepressive/antipsychotic pharmacotherapy according to genotype.

• #36 Clinical and Molecular Genetics of Psychotic Depression – PMC Lock

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3686457/

  Genetic factors are suggested to contribute to the disease risk of psychotic depression in partial overlap with disorders along the affective-psychotic spectrum. […] Thus, genetic research focusing on psychotic depression might inspire a more dimensional, neurobiologically and symptom-oriented taxonomy of affective and psychotic disorders challenging the dichotomous Kraepelinian view. […] Additionally, pharmacogenetic studies might aid in the development of a more personalized treatment of psychotic depression with an individually tailored antidepressive/antipsychotic pharmacotherapy according to genotype.

• #37 Clinical and Molecular Genetics of Psychotic Depression – PMC Lock

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3686457/

  This review provides a comprehensive overview of clinical and molecular genetic as well as pharmacogenetic studies regarding the clinical phenotype of “psychotic depression.” Results are discussed with regard to the long-standing debate on categorical vs dimensional disease models of affective and psychotic disorders on a continuum from unipolar depression over bipolar disorder and schizoaffective disorder to schizophrenia. Clinical genetic studies suggest a familial aggregation and a considerable heritability (39%) of psychotic depression partly shared with schizoaffective disorder, schizophrenia, and affective disorders. […] Molecular genetic studies point to potential risk loci of psychotic depression shared with schizoaffective disorder (1q42, 22q11, 19p13), depression, bipolar disorder, and schizophrenia (6p, 8p22, 10p13-12, 10p14, 13q13-14, 13q32, 18p, 22q11-13) and several vulnerability genes possibly contributing to an increased risk of psychotic symptoms in depression (eg, BDNF, DBH, DTNBP1, DRD2, DRD4, GSK-3beta, MAO-A).

• #38 Redefining Psychotic Depression: Advocating for a Separate Diagnostic Category? | The BMJ

  https://www.bmj.com/content/384/bmj.p2777/rr

  Psychotic Depression (PMD) has traditionally been viewed as an extreme form of Major Depressive Disorder (MDD). Recent clinical experiences and research, however, increasingly advocate for its recognition as a distinct clinical entity. This distinction is particularly pronounced in PMD’s unique response to pharmacological treatments, setting it apart from both MDD and schizophrenia. […] PMD’s specific challenges in clinical practice stem notably from the recurrence of psychotic symptoms following the discontinuation of antipsychotic medication, despite ongoing antidepressant therapy. This phenomenon, as highlighted in studies like Dubovsky et al. (2021), points to a distinct pathophysiology. […] The absence of comprehensive, evidence-based treatment protocols for PMD underscores the theory of its unique biological basis.

• #39 Psychotic Depression: What Is It, Symptoms, Causes, and MoreHealthline

  https://www.healthline.com/health/depression/psychotic-depression

  Some people diagnosed with MDD with psychosis later receive a diagnosis of schizophrenia or bipolar disorder with psychosis. This appears more likely for people: […] MDD with psychosis can sometimes resemble schizophrenia, another mental health condition that involves psychosis. The main difference lies in when psychosis shows up: […] MDD with psychosis is a serious mental health condition that requires prompt treatment from a trained mental health professional.

• #40 Clinical characteristics and sociodemographic features of psychotic major depression | Annals of General Psychiatry | Full Text

  https://annals-general-psychiatry.biomedcentral.com/articles/10.1186/s12991-021-00341-7

  PMD is a serious mental disorder, where patients suffer from a combination of low mood and psychosis. PMD is a subtype of major depressive disorder according to the classification systems of psychiatric diseases, the DSM-V and ICD-10, and accounts for about 14.7%–18.5% of patients with major depression. However, compared with major depression without psychotic features, PMD is associated with longer duration, greater morbidity and mortality, lower response to antidepressants and psychotherapy, higher rate of suicide risk, higher comorbidity of anxiety disorders, cognitive dysfunction, somatic disorders, and personality disorders. […] A longitudinal study of patients with PMD admitted to hospital for the first time showed that 41% of patients who were initially diagnosed with PMD met DSM-IV criteria for bipolar disorder or schizoaffective disorder within 2 years.

• #41 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. […] Diagnosis […] PMD is often considered interchangeable with delusional depression because the vast majority of patients with psychosis have delusional ideation, whereas hallucinations without delusions are less common. Delusions are fixed beliefs that are resistant to the laws of logic and evidence to the contrary. […] In STOP-PD, 27% of patients who had delusions did not receive a diagnosis of PMD. […] An association between an index episode of unipolar PMD and the subsequent development of bipolar disorder has been established. Conversion rates from an index PMD to bipolar disorder as high as 20% and 37% have been reported in clinical samples, particularly if the initial episode occurs in young adulthood or adolescence.

• #42 What Causes Psychotic Depression, and How Is It Treated? – BrightQuest Treatment Centers

  https://www.brightquest.com/blog/what-causes-psychotic-depression-and-how-is-it-treated/

  We can explore the causes and risk factors for psychotic depression and then turn our attention to the solutions. The treatment options for major depressive disorder with psychotic features are comprehensive and successful, especially when established in a long-term in-patient treatment setting. […] Researchers are still working to better understand mood disorders such as depression and their causes—as well as psychotic symptoms and their causes. But mood disorders can be linked directly to chemical imbalances in the brain and, generally, to biological, genetic, psychological, and environmental factors. […] While there isn’t a medication that is indicated for psychotic depression specifically, a combination of antidepressants and antipsychotics has shown to be effective with clients. But medication management must be handled very carefully to find the precise prescriptions and dosage balance for the individual. Medication is a primary approach to psychotic depression care, but for treatment-resistant clients, electroconvulsive therapy (ECT) may be a secondary treatment option.

• #43 Psychotic depression: causes, symptoms and treatment – Priory

  https://www.priorygroup.com/mental-health/depression-treatment/psychotic-depression

  Psychotic depression, which is sometimes known as ‘severe depression with psychotic symptoms’ is a type of depression that causes people to experience symptoms of psychosis, including delusions and hallucinations, as well as many of the other common symptoms of depression. […] Psychotic depression is a complex illness. As is the case with depression, it’s likely there are a number of factors that contribute to the chances of someone developing it, instead of it being down to a single cause. […] Some common factors of depression may include: Genetics – having a close family member who struggles with psychotic depression can make you more vulnerable to suffering with it. […] If you already suffer with a mental health condition, or have done in the past, this can increase your chances of developing psychotic depression.

• #44 Psychotic depression: causes, symptoms and treatment – Priory

  https://www.priorygroup.com/mental-health/depression-treatment/psychotic-depression

  Psychotic depression, which is sometimes known as ‘severe depression with psychotic symptoms’ is a type of depression that causes people to experience symptoms of psychosis, including delusions and hallucinations, as well as many of the other common symptoms of depression. […] Psychotic depression is a complex illness. As is the case with depression, it’s likely there are a number of factors that contribute to the chances of someone developing it, instead of it being down to a single cause. […] Some common factors of depression may include: Genetics – having a close family member who struggles with psychotic depression can make you more vulnerable to suffering with it. […] If you already suffer with a mental health condition, or have done in the past, this can increase your chances of developing psychotic depression.

• #45 Depressive Psychosis: Causes, Symptoms, and DiagnosisHealthline

  https://www.healthline.com/health/depression/major-depression-with-psychotic-features

  According to the National Alliance on Mental Illness (NAMI), an estimated 20 percent of people who have major depression also have psychotic symptoms. This combination is known as depressive psychosis. […] Depressive psychosis doesn’t have a known cause. In some people, it’s thought that a chemical imbalances in the brain is a factor. However, researchers haven’t identified a specific cause. […] According to NAMI, depressive psychosis may have a genetic component. While researchers haven’t identified the specific gene, they do know that having a close family member, such as a mom, dad, sister, or brother, increases your chances of having psychotic depression. […] Psychotic depression is often considered a psychiatric emergency because you’re at an increased risk for suicidal thoughts and behavior, especially if you hear voices telling you to hurt yourself.

• #46 Psychotic depression: causes, symptoms and treatment – Priory

  https://www.priorygroup.com/mental-health/depression-treatment/psychotic-depression

  Psychotic depression, which is sometimes known as ‘severe depression with psychotic symptoms’ is a type of depression that causes people to experience symptoms of psychosis, including delusions and hallucinations, as well as many of the other common symptoms of depression. […] Psychotic depression is a complex illness. As is the case with depression, it’s likely there are a number of factors that contribute to the chances of someone developing it, instead of it being down to a single cause. […] Some common factors of depression may include: Genetics – having a close family member who struggles with psychotic depression can make you more vulnerable to suffering with it. […] If you already suffer with a mental health condition, or have done in the past, this can increase your chances of developing psychotic depression.

• #47 Psychotic depression: causes, symptoms and treatment – Priory

  https://www.priorygroup.com/mental-health/depression-treatment/psychotic-depression

  Stressful life events – going through something stressful or traumatic, such as a bereavement, divorce, or losing your job, can sometimes be a trigger for psychotic depression. […] Experiencing abuse and/or neglect, especially if this happened when you were a child, can increase your susceptibility to developing mental health problems in later life. This can include psychotic depression. […] Certain personality traits, such as being a perfectionist or having low self-esteem, can make it more likely you’ll develop psychotic depression. […] Psychotic depression can be difficult to cope with, but effective treatment is available. […] One of the most widely used techniques is cognitive behavioural therapy (CBT), which has been found to be effective in treating psychotic depression. […] We can also offer medication to help you with psychotic depression. This is usually a combination of antidepressants (to treat your depressive symptoms) and antipsychotics (to treat your psychotic symptoms).

• #48 Psychotic depression: causes, symptoms and treatment – Priory

  https://www.priorygroup.com/mental-health/depression-treatment/psychotic-depression

  Stressful life events – going through something stressful or traumatic, such as a bereavement, divorce, or losing your job, can sometimes be a trigger for psychotic depression. […] Experiencing abuse and/or neglect, especially if this happened when you were a child, can increase your susceptibility to developing mental health problems in later life. This can include psychotic depression. […] Certain personality traits, such as being a perfectionist or having low self-esteem, can make it more likely you’ll develop psychotic depression. […] Psychotic depression can be difficult to cope with, but effective treatment is available. […] One of the most widely used techniques is cognitive behavioural therapy (CBT), which has been found to be effective in treating psychotic depression. […] We can also offer medication to help you with psychotic depression. This is usually a combination of antidepressants (to treat your depressive symptoms) and antipsychotics (to treat your psychotic symptoms).

• #49 Psychotic depression: causes, symptoms and treatment – Priory

  https://www.priorygroup.com/mental-health/depression-treatment/psychotic-depression

  Stressful life events – going through something stressful or traumatic, such as a bereavement, divorce, or losing your job, can sometimes be a trigger for psychotic depression. […] Experiencing abuse and/or neglect, especially if this happened when you were a child, can increase your susceptibility to developing mental health problems in later life. This can include psychotic depression. […] Certain personality traits, such as being a perfectionist or having low self-esteem, can make it more likely you’ll develop psychotic depression. […] Psychotic depression can be difficult to cope with, but effective treatment is available. […] One of the most widely used techniques is cognitive behavioural therapy (CBT), which has been found to be effective in treating psychotic depression. […] We can also offer medication to help you with psychotic depression. This is usually a combination of antidepressants (to treat your depressive symptoms) and antipsychotics (to treat your psychotic symptoms).

• #50 Clinical characteristics and sociodemographic features of psychotic major depression | Annals of General Psychiatry | Full Text

  https://annals-general-psychiatry.biomedcentral.com/articles/10.1186/s12991-021-00341-7

  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). […] 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. […] 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.

• #51 Clinical characteristics and sociodemographic features of psychotic major depression | Annals of General Psychiatry | Full Text

  https://annals-general-psychiatry.biomedcentral.com/articles/10.1186/s12991-021-00341-7

  PMD is a serious mental disorder, where patients suffer from a combination of low mood and psychosis. PMD is a subtype of major depressive disorder according to the classification systems of psychiatric diseases, the DSM-V and ICD-10, and accounts for about 14.7%–18.5% of patients with major depression. However, compared with major depression without psychotic features, PMD is associated with longer duration, greater morbidity and mortality, lower response to antidepressants and psychotherapy, higher rate of suicide risk, higher comorbidity of anxiety disorders, cognitive dysfunction, somatic disorders, and personality disorders. […] A longitudinal study of patients with PMD admitted to hospital for the first time showed that 41% of patients who were initially diagnosed with PMD met DSM-IV criteria for bipolar disorder or schizoaffective disorder within 2 years.

• #52 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%. […] HAMD, TSH, TC, and severe anxiety were independently associated with psychotic symptoms in young adult MDD patients. […] 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.

• #53 What is Psychotic Depression? – Symptoms, Causes & Treatment

  https://www.cadabamshospitals.com/an-overview-on-psychotic-depression/

  Psychotic depression, a distinctive variant of major depression, manifests when severe depressive episodes intertwine with elements of psychosis. This state of psychosis might manifest through unsettling hallucinations, like hearing deprecating voices, or distressing delusions, such as an overwhelming sense of failure or guilt. […] The precise origins of psychotic depression remain elusive, as it is widely recognized that depression, in general, stems from multifaceted triggers rather than a solitary cause. Genetic factors likely contribute to its development, with evidence suggesting a familial predisposition to severe depression. […] The intricate interplay of neurotransmitters lies at the heart of understanding psychotic depression. This mental health condition, characterized by severe depression and psychosis, hinges on disrupted neurotransmitter activity.

• #54 What is Psychotic Depression? – Symptoms, Causes & Treatment

  https://www.cadabamshospitals.com/an-overview-on-psychotic-depression/

  Serotonin, a neurotransmitter linked to mood regulation, plays a pivotal role. In psychotic depression, imbalances in serotonin can intensify feelings of despair and hopelessness, contributing to the severity of depressive symptoms. […] Dopamine, associated with perception and reality processing, also comes into play. Irregular dopamine levels can amplify hallucinations and delusions, further distorting an individual’s grasp of reality. […] The reasons underlying why some individuals experience this complex intersection remain shrouded in uncertainty, necessitating ongoing research to unravel the intricate web of causes and risk factors in psychotic depression.

• #55 Exploring resting state connectivity in patients with psychotic depression | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0209908

  Psychotic depression is a severe psychiatric disorder associated with high morbidity and mortality. […] There is some evidence to suggest that impaired structural and functional brain connectivity is a significant contributor to the disease mechanism of depression and psychosis. […] Psychotic depression may be associated with decreased FC of the frontoparietal network, which is involved in cognitive control processes, such as attention and emotion regulation. […] These findings suggest that FC in the frontoparietal network may be related to the subtype of depression, i.e. presence of psychotic symptoms, rather than severity of depression. […] Psychotic features, not the severity of depression, were associated with FC of the resting-state frontoparietal network in the patient sample of site one. This result was not observed in the patient sample of site two.

• #56 Exploring resting state connectivity in patients with psychotic depression | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0209908

  Psychotic depression is a severe psychiatric disorder associated with high morbidity and mortality. […] There is some evidence to suggest that impaired structural and functional brain connectivity is a significant contributor to the disease mechanism of depression and psychosis. […] Psychotic depression may be associated with decreased FC of the frontoparietal network, which is involved in cognitive control processes, such as attention and emotion regulation. […] These findings suggest that FC in the frontoparietal network may be related to the subtype of depression, i.e. presence of psychotic symptoms, rather than severity of depression. […] Psychotic features, not the severity of depression, were associated with FC of the resting-state frontoparietal network in the patient sample of site one. This result was not observed in the patient sample of site two.

• #57 Structural brain networks in remitted psychotic depression – PMC Lock

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7235256/

  We found that patients with remitted psychotic depression had significantly thinner cortex in five networks (insular-limbic, occipito-temporal, temporal, parahippocampal-limbic, and inferior fronto-temporal) and confirmed our hypothesis that affected networks incorporated cortico-limbic regions. […] This network also predicted final CGI severity scores better than the CGI severity scores at the time of scanning, providing evidence for a clinically relevant brain-behavior relationship. […] Our results partly fit with previous structural findings, although it is noteworthy that the smaller sample size and region of interest-based approaches of previous studies have rendered inconsistent results. […] NMF has been used to identify networks implicated in brain-behavior relationships. […] Our findings can be viewed through a limbic system or central autonomic network (CAN) lens. […] Thus, the insular-limbic network may hold translational potential for brain stimulation, pharmacotherapy, or even as a treatment-independent biomarker for symptomatic improvement specific to psychotic depression.

• #58 Structural brain networks in remitted psychotic depression – PMC Lock

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7235256/

  We found that patients with remitted psychotic depression had significantly thinner cortex in five networks (insular-limbic, occipito-temporal, temporal, parahippocampal-limbic, and inferior fronto-temporal) and confirmed our hypothesis that affected networks incorporated cortico-limbic regions. […] This network also predicted final CGI severity scores better than the CGI severity scores at the time of scanning, providing evidence for a clinically relevant brain-behavior relationship. […] Our results partly fit with previous structural findings, although it is noteworthy that the smaller sample size and region of interest-based approaches of previous studies have rendered inconsistent results. […] NMF has been used to identify networks implicated in brain-behavior relationships. […] Our findings can be viewed through a limbic system or central autonomic network (CAN) lens. […] Thus, the insular-limbic network may hold translational potential for brain stimulation, pharmacotherapy, or even as a treatment-independent biomarker for symptomatic improvement specific to psychotic depression.

• #59 Diagnosing Melancholic and Psychotic Depression

  https://psychscenehub.com/psychinsights/melancholic-and-psychotic-depression-diagnosis-and-management/

  Patients with psychotic depression also show a significant reduction in hippocampal volume bilaterally, perhaps due to high cortisol states associated with psychotic depression. [Bijanki K et al., 2014] […] The treatment of psychotic depression has not been studied to the same extent as other psychiatric disorders, and it remains an underdiagnosed and undertreated psychiatric disorder. […] A systematic review and meta-analysis showed that an antidepressant and antipsychotic combination is significantly more effective than either antidepressant monotherapy or antipsychotic monotherapy for the acute treatment of psychotic depression. [Farhani A & Correll C, 2012]. […] Despite the recommendations of combination AD and AP treatment in psychotic depression, the STOP-PD study (2007) showed that only 5% of patients with psychotic depression receive an adequate combination of an antidepressant and an antipsychotic. [Andreescu C, et al., 2007]

• #60 Fluvoxamine monotherapy for psychotic depression: the potential role of sigma-1 receptors | springermedizin.deChevron down iconChevron up iconChevron down iconChevron up iconChevron down iconChevron up iconChevron down iconChevron up iconChevron down icon

  https://www.springermedizin.de/fluvoxamine-monotherapy-for-psychotic-depression-the-potential-r/9615554

  Psychotic depression is a clinical subtype of major depressive disorder and is characterized by psychosis accompanied by relatively severe depressive symptoms that include psychomotor impairment, morbid cognition, suicidal ideation and neuropsychological impairment. […] Several pieces of evidence suggest that the endoplasmic reticulum protein sigma-1 receptors play a role in the pathophysiology of depression and in the active mechanisms of antidepressants. […] A hypothesis has been proposed that the sigma-1 receptors may be implicated in the efficacy of fluvoxamine for psychotic depression. […] It seems that serotonin reuptake inhibition as well as sigma-1 receptor agonism may be involved in the active mechanism of fluvoxamine, since paroxetine had a lesser effect in psychotic depression.

• #61 Fluvoxamine monotherapy for psychotic depression: the potential role of sigma-1 receptors | springermedizin.deChevron down iconChevron up iconChevron down iconChevron up iconChevron down iconChevron up iconChevron down iconChevron up iconChevron down icon

  https://www.springermedizin.de/fluvoxamine-monotherapy-for-psychotic-depression-the-potential-r/9615554

  To confirm the role of sigma-1 receptor agonism in the treatment of psychotic depression, a randomized double-blind study of fluvoxamine (a sigma-1 receptor agonist) and sertraline (a sigma-1 receptor antagonist) in patients with psychotic depression might be helpful. […] More detailed double-blind studies should be performed to clarify the role of sigma-1 receptors in the efficacy of fluvoxamine for psychotic depression.

• #62 Psychotic Depression: Facts, Causes, Diagnosis, Treatments

  https://www.verywellhealth.com/psychotic-depression-5193047

  A combination of an antipsychotic and an antidepressant medication is usually more effective for treating psychotic depression than treatment with either medication alone. […] It is rare for psychotic depression to resolve without treatment. […] ECT is considered a safe and effective treatment for psychotic depression. It may be more effective than medication, and it is recommended as a first-line treatment in many guidelines because of its quick results. […] Psychotic depression can be intrusive and scary, greatly affecting a person’s ability to function and their relationships with others.

• #63 Clinical and Molecular Genetics of Psychotic Depression – PMC Lock

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3686457/

  Genetic factors are suggested to contribute to the disease risk of psychotic depression in partial overlap with disorders along the affective-psychotic spectrum. […] Thus, genetic research focusing on psychotic depression might inspire a more dimensional, neurobiologically and symptom-oriented taxonomy of affective and psychotic disorders challenging the dichotomous Kraepelinian view. […] Additionally, pharmacogenetic studies might aid in the development of a more personalized treatment of psychotic depression with an individually tailored antidepressive/antipsychotic pharmacotherapy according to genotype.

• #64 Redefining Psychotic Depression: Advocating for a Separate Diagnostic Category? | The BMJ

  https://www.bmj.com/content/384/bmj.p2777/rr

  Psychotic Depression (PMD) has traditionally been viewed as an extreme form of Major Depressive Disorder (MDD). Recent clinical experiences and research, however, increasingly advocate for its recognition as a distinct clinical entity. This distinction is particularly pronounced in PMD’s unique response to pharmacological treatments, setting it apart from both MDD and schizophrenia. […] PMD’s specific challenges in clinical practice stem notably from the recurrence of psychotic symptoms following the discontinuation of antipsychotic medication, despite ongoing antidepressant therapy. This phenomenon, as highlighted in studies like Dubovsky et al. (2021), points to a distinct pathophysiology. […] The absence of comprehensive, evidence-based treatment protocols for PMD underscores the theory of its unique biological basis.

• #65 Redefining Psychotic Depression: Advocating for a Separate Diagnostic Category? | The BMJ

  https://www.bmj.com/content/384/bmj.p2777/rr

  The diagnostic stability of PMD varies significantly, likely due to differences in diagnostic tools and study parameters. This inconsistency has profound implications for understanding PMD’s etiology and necessitates the development of more robust, uniform diagnostic criteria. […] Additionally, the notably higher mortality rate among individuals with PMD, including increased suicide risks, underscores the urgency for focused research on this specific depression subgroup. […] In conclusion, the proposed hypothesis of distinct nature of PMD’s clinical manifestations, treatment responses, and mortality rates necessitates its recognition as a separate category within mood disorders. This reclassification will not only improve diagnostic accuracy but also facilitate more effective, targeted treatments and research, ultimately enhancing patient outcomes.

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

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

  Acute and postremission treatment of PMD […] 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. […] Future directions […] Knowledge about the diagnosis and treatment of PMD has increased markedly over the past 35 years. Nevertheless, advances in the understanding of underlying pathophysiology of one of the few spontaneously occurring and fully reversible psychotic conditions have emerged slowly. The cortisol dysregulation hypothesis continues to gain support, with an increasing focus on genes that regulate central glucocorticoid receptors.

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

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

  Psychotic thinking would be a more focused domain than positive symptoms for inclusion in the NIMH Research Domain Criteria (RDoC) project. Irrational thought processing meets the RDoC project criteria of both being a dimensional pathology and occurring across multiple psychiatric diagnoses. Including irrational thinking as a specific domain would facilitate research into the underlying neuro-biological and neuropsychological mechanisms of delusional thinking and further our ability to characterize and treat this important area of psychopathology.

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