Unipolar major depression with psychotic features: Acute treatment
- Anthony J Rothschild, MD
Anthony J Rothschild, MD
- Irving S. and Betty Brudnick Endowed Chair and Professor of Psychiatry
- University of Massachusetts Medical School
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 acute treatment of unipolar major depression with psychotic features. Maintenance treatment and prognosis are discussed elsewhere, as are the epidemiology, pathogenesis, clinical features, assessment, and diagnosis of psychotic depression. (See "Unipolar major depression with psychotic features: Maintenance treatment and course of illness" and "Unipolar major depression with psychotic features: Epidemiology, clinical features, assessment, and diagnosis".)
Unipolar major depression with psychotic features is characterized by an episode of unipolar major depression that includes delusions and/or hallucinations .
Unipolar major depression (major depressive disorder) is diagnosed in patients who have suffered at least one major depressive episode (table 1) and have no history of mania (table 2) or hypomania (table 3) . A major depressive episode is a two week or longer period with five or more of the following symptoms: depressed mood, loss of interest or pleasure in most activities, insomnia or hypersomnia, change in appetite or weight, psychomotor retardation or agitation, low energy, poor concentration, guilt, and recurrent thoughts about death or suicide. The clinical presentation and diagnosis of unipolar major depression are discussed further elsewhere. (See "Unipolar depression in adults: Assessment and diagnosis".)
The primary distinction between unipolar major depression with psychotic features and unipolar major depression without psychotic features is that psychotic depression includes :
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- General principles
- First line
- - Choosing a treatment
- - Antidepressant plus antipsychotic
- Choosing a combination
- Duration of therapy and switching drugs
- Evidence of efficacy
- - Electroconvulsive therapy
- Resistant patients
- - Lithium
- - Psychotherapy
- Refractory patients
- Family support
- TIME TO RECOVERY
- Functional recovery
- SUMMARY AND RECOMMENDATIONS