title: Psychotic subtyping of major depressive disorder and posttraumatic stress disorder.
abstract: BACKGROUND
  Many studies have established that a large percentage of patients with posttraumatic stress disorder (PTSD) have comorbid major depressive disorder. Other studies have found that patients with PTSD or a history of childhood trauma have an increased rate of psychotic symptoms. In the present report from the Rhode Island Methods to Improve Diagnosis and Services project, we examine whether an association exists between psychotic subtyping of major depressive disorder and PTSD.
  
  
  METHODS
  Five hundred psychiatric outpatients were interviewed with the Structured Clinical Interview for DSM-IV.
  
  
  RESULTS
  Almost half of the 500 patients had nonbipolar major depressive disorder (N = 235, 47.0%), 45 (19.1%) of whom had PTSD. Nineteen patients had psychotic depression, 216 had nonpsychotic depression. Compared with patients with nonpsychotic depression, the patients with psychotic depression were nearly 4 times more likely to have PTSD (57.9% vs. 15.7%, Fisher exact test, p = .0001).
  
  
  CONCLUSIONS
  The results of the present study suggest that the presence of psychosis in psychiatric outpatients with major depressive disorder is associated with concurrent PTSD. It is hypothesized that the poorer longitudinal course of psychotic versus nonpsychotic depression may be due to the underrecognition of PTSD in psychotically depressed patients.
authors.affiliation: Department of Psychiatry and Human Behavior, Brown University School of Medicine, Rhode Island Hospital, Providence 02905, USA. MZimmerman@lifespan.org
authors.forename: M
authors.initials: M
authors.lastname: Zimmerman
authors.forename: J I
authors.initials: JI
authors.lastname: Mattia
mesh_terms: D000328:Adult; D000341:Affective Disorders, Psychotic / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology*; D000553:Ambulatory Care; D001714:Bipolar Disorder / Q000175:diagnosis / Q000453:epidemiology; D015897:Comorbidity; D003866:Depressive Disorder / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D012237:Rhode Island / Q000453:epidemiology; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology*