Just under 10% of patients having a first episode of major depressive disorder (MDD) also experience psychotic symptoms, according to a report in Depression and Anxiety. Moreover, there was a strong correlation between psychotic symptoms and anxiety and suicide attempts.
“[W]e found a close association between suicide and psychotic MDD, suggesting that the risk of suicide in psychotic MDD patients should be regularly assessed in clinical practice to better identify suicide risk and prevent suicide from the very beginning of illness course,” wrote Xuerong Luo, M.D., of the Department of Psychiatry at Second Xiangya Hospital in Hunan, China, and colleagues.
The research team enrolled 573 outpatients aged 16 to 45 at a psychiatric clinic in a general hospital. Patients were diagnosed as having MDD if they had a score of 24 or greater on the 17‐item Hamilton Rating Scale for Depression. Patients were defined as having severe anxiety symptoms if they had a score of 29 or higher on the 14‐item Hamilton Anxiety Rating Scale. Patients with a total positive subscale score of 15 or greater on the Positive and Negative Symptom Scale were defined as having psychotic symptoms.
The researchers interviewed all participants using the Structured Clinical Interview for DSM-IV (SCID) at the start of the study and again three to six months later. The patients were also asked if they had ever attempted suicide, and those who responded yes were asked to provide further details.
The researchers found that 56 of the 573 patients (9.8%) had psychotic symptoms. Moreover, the rate of severe anxiety was significantly higher among patients with psychotic symptoms than those without psychotic symptoms (67.9% vs. 6.0%).
The frequency of attempted suicide was 50% for the patients with psychotic symptoms compared with 16.6% for the patients without psychotic symptoms.
“The strong association between psychotic MDD and anxiety or suicide attempts demonstrates the importance of reducing anxiety,” the researchers wrote.