Psychotic symptoms associated with poor outcomes in patients with depression

Publication date: 6-Dec-2010
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Contact: Sue McGreevey
smcgreevey@Partners.org
617-724-2764
JAMA and daily files

Among patients with depression, the presence of many aspects of the disease that may be associated with bipolar disorder do not seem to be associated with treatment against the common assumption that some cases difficult to treat depression are really not recognised resistance?evidence bipolar disorder, according to a report published online today that will appear in the edition of April 2011 printing of archives of General Psychiatry, one of the files/JAMA journals. However, many patients with depression also inform psychotic symptoms, such as hearing voices or believe are being spied upon or conspired against, and those who do have less likely to respond to treatment.

"The distinction between major depressive disorder and bipolar disorder remains a difficult clinical problem when individuals have a major depressive episode" authors written as background information in the article. "Identification of persons at risk for bipolar disorder is important academic as treatment can be markedly different;" "in particular, antidepressants have suggested to exacerbate the course of the disease for at least a subset of bipolar individuals."

To assess the association between the characteristics of bipolar disorder and treatment for depression outcomes, Roy H. Perlis, M.D., M.Sc., Massachusetts General Hospital, Harvard Medical School, Boston, and colleagues studied 4,041 adults with a diagnosis of depression. Patients were treated with the antidepressants, citalopram followed by up to three treatments of next step as needed depending on your response.

At the beginning of the study, patients were asked by psychotic symptoms?including beliefs about be controlled with special powers or faces to. Almost a third (1,198, or 30 percent) patients reported having at least one symptom of such in the previous six months. Those who did were significantly less likely to go into remission in all treatment sessions

Also asked participants of other characteristic features of the disorder bipolar; 1,524 (38.1%) patients with depression described at least one symptom of similar maniacs. One of them, irritability, also partnered with results of ill-treatment. "In addition, several indicators systematically associated with bipolar available literature, including the history of manic symptoms and a family history of bipolar disorder, not teamed up with treatment outcome with antidepressants in the STAR * D study," write the authors. "Short duration of the episode, suggested to represent a bookmark to bipolarity, risk associated with increased likelihood of referral".

"Considered as a whole, our results cast doubt on the frequent assertion that unrecognized bipolar disorder is widespread in clinical practice and particularly in major depressive disorder, treatment-resistant", concludes. "Screening for bipolar disorder among psychiatric patients remains important, as does taking into account the individual factors of risk such as family history or age at the beginning." "However, our findings indicate that, in the majority of individuals presents a greater without a previous episode of hypomania, or manic depressive episode unrecognized bipolar does not seem to be a determining factor of resistance to the treatment."

(Psychiatry arc build.) Published online on December 6, 2010. DOI:10.1001/archgenpsychiatry.2010.179. (Available for media at www.jamamedia.org pre-embargo.)

Editor's Note: The STAR * D study is supported by the national institutes of mental health grants. See the article for more information, including other authors, author contributions and affiliations, disclosures financial funding and support, etc..

To contact with Roy H. Perlis, M.D., M.Sc., please call Sue McGreevey the smcgreevey@partners.org 617-724-2764 or e-mail.

For more information, please contact relationships with media JAMA/files in 464/312-JAMA (5262) or e-mail mediarelations@jama-archives.org.

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