title: Clinical, magnetic resonance imaging and endocrinological differences between delusional and non-delusional depression in the elderly.
abstract: OBJECTIVE
  To investigate neuroradiological, endocrinological and clinical differences between delusional and non-delusional depression.
  
  
  METHODS
  A cross-sectional study of depressed subjects.
  
  
  METHODS
  Melbourne, Australia.
  
  
  METHODS
  Sixty-one subjects (inpatients) over the age of 55 meeting DSM-III-R criteria for major depression of whom 22 had delusional subtype of depression.
  
  
  METHODS
  Clinical assessment, including documentation of vascular risk factors. Cognitive assessment by the Cambridge Cognitive Examination (CAMCOG). Magnetic resonance imaging (MRI) scans were performed on a 0.3 Tesla scanner with temporal lobe atrophy, periventricular lesions (PVL) and deep white matter lesions (DWML) rated visually on 4-point scales. A standard 1 mg dexamethasone suppression test (DST) was performed.
  
  
  RESULTS
  Subjects with delusional depression had significantly more vascular risk factors than those without delusions. There were no differences in measures of temporal lobe atrophy, PVL, DST results or cognitive test scores, though there was a non-significant trend for DWML to be more prevalent in those with delusions. Delusional depression was associated with a shorter duration of history and more frequent treatment with ECT.
  
  
  CONCLUSIONS
  The increase in vascular risk factors and trend towards greater DWML on MRI suggests an organic contribution to delusional depression in the elderly. In contrast to some previous reports, we found no differences in cortical MRI appearance or neuroendocrine measures between groups.
authors.affiliation: Brighton Clinic, Newcastle General Hospital, Newcastle upon Tyne, UK.
authors.forename: J T
authors.initials: JT
authors.lastname: O'Brien
authors.forename: D
authors.initials: D
authors.lastname: Ames
authors.forename: I
authors.initials: I
authors.lastname: Schweitzer
authors.forename: P
authors.initials: P
authors.lastname: Desmond
authors.forename: P
authors.initials: P
authors.lastname: Coleman
authors.forename: B
authors.initials: B
authors.lastname: Tress
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology*; D003702:Delusions / Q000175:diagnosis*; D003704:Dementia / Q000097:blood / Q000175:diagnosis* / Q000523:psychology; D015140:Dementia, Vascular / Q000175:diagnosis; D003866:Depressive Disorder / Q000097:blood / Q000175:diagnosis* / Q000523:psychology; D003907:Dexamethasone; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008279:Magnetic Resonance Imaging; D008297:Male; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors
chemical_list: D003907:Dexamethasone; D006854:Hydrocortisone