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Unipolar major depression with psychotic features: Epidemiology, clinical features, assessment, and diagnosis

Anthony J Rothschild, MD
Section Editor
Peter P Roy-Byrne, MD
Deputy Editor
David Solomon, MD


Unipolar major depression with psychotic features is a severe subtype of unipolar major depression (major depressive disorder) [1]. The psychotic symptoms are delusions and/or hallucinations that are frequently consistent with depressive themes of guilt and worthlessness [2]. 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. (See "Unipolar major depression with psychotic features: Acute treatment" and "Unipolar major depression with psychotic features: Maintenance treatment and course of illness".)  


The lifetime prevalence rate of unipolar major depression with psychotic features varies depending upon the setting.

General population — 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 [3,4]. The mean age of onset of unipolar major depression among individuals with psychotic depression is 29 years [1].

Studies of risk factors have found that unipolar psychotic depression is [1,3-6]:

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Literature review current through: Nov 2017. | This topic last updated: Sep 25, 2017.
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