First-episode psychosis: an epidemiological survey comparing psychotic depression with schizophrenia.
BACKGROUND
Compared with non-psychotic depression, psychotic depression is associated with poor prognosis, increased mortality, and severe symptomatology. Although the incidence of psychotic depression is similar to that of schizophrenia, little is known about presentation, course, costs and effects of treatment.


OBJECTIVE
To compare the incidence, course and treatment of first-episode psychotic depression with first-episode schizophrenia.


METHODS
An observational database was set up on all patients aged 16 and over with a first-episode psychosis living in a county in Northern England between October 1998 and October 2005. Data were collected at presentation and annual follow-up. Information on patients with an ICD-10 diagnosis of either psychotic depression (F32.3) or schizophrenia (F20) was compared.


RESULTS
Between 1998 and 2005 there was a higher incidence of psychotic depression than schizophrenia (p<0.05, 95% CI=1.09, 1.89, RR=1.44). More patients with psychotic depression self-harmed (p<0.01) and had physical health problems (p<0.01). Similar levels of hospitalisation were found in both groups. A consistent pharmacological treatment pattern was observed for patients with psychotic depression but only 18 out of 105 received ECT. All who received ECT responded well to this treatment.


CONCLUSIONS
Data collection relied on information in patients' medical notes, which sometimes had gaps. There is a potential under-representation of patient numbers due to the study relying on referral by consultant psychiatrists.


CONCLUSIONS
Psychotic depression is a common and costly condition, but with no accepted best practice guidance for its management. More attention needs to be focused on this largely under-researched group.
Crebbin
Kathleen
K
Northumberland, Tyne and Wear NHS Trust, United Kingdom.
Mitford
Emma
E
Paxton
Roger
R
Turkington
Douglas
D
D000293:Adolescent; D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D004565:Electroconvulsive Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D038801:International Classification of Diseases; D008297:Male; D008875:Middle Aged; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D018570:Risk Assessment; D012559:Schizophrenia / Q000175:diagnosis* / Q000453:epidemiology*; D012565:Schizophrenic Psychology; D013997:Time Factors; D016896:Treatment Outcome
D000928:Antidepressive Agents; D014150:Antipsychotic Agents