Psychotic depression: a separate entity?
Psychotic depression: a separate entity?
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精神病性抑郁症：一个独立的实体？
DOI：
10.1176/ajp.138.6.831
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发表时间：
1981
期刊：
影响因子：
--
通讯作者：
J. Mann
中科院分区：
文献类型：
--
作者：
A. Frances;Richard P. Brown;J. Kocsis;J. Mann
许多作者报道，精神病性和非精神病性抑郁症患者对躯体治疗的反应不同。精神病性抑郁症对三环类抗抑郁药的反应较低（1），通常需要抗精神病药和抗抑郁药的联合治疗（2）和ECT（3）。精神病性抑郁症的疾病分类地位仍有疑问。精神病性抑郁症是否最好被认为是重性抑郁症的一种严重变异，还是作为一个单独的实体，具有人口统计学和症状特征、家族史、病程、生化特征和对治疗的反应的特征性模式？关于这个问题的数据有限且不一致，但精神病性抑郁症和非精神病性抑郁症之间存在一些差异。纳尔逊和Bowers（2）报告精神病性抑郁患者的精神障碍和既往发作比非精神病性抑郁患者多。相反，Glassman和鲁塞（4）发现精神病性抑郁患者的精神发育迟滞更多，安慰剂反应性更低，既往发作次数更少。一些初步的生化和生理发现似乎可以区分精神病性和非精神病性抑郁症患者。Meltzen及其同事（5）报道，精神病患者血清肌酐磷酸激酶和醛缩酶升高，骨骼肌异常，血清多巴胺3-羟化酶降低。Sweeney及其同事（6）报告尿3-甲氧基-4-羟基苯乙二醇较低，CSF高香草酸较高。这些作者都使用研究诊断标准（RDC）对精神病性重性抑郁障碍的定义来定义他们的队列。Mendels及其同事使用精神病性抑郁的临床判断定义，发现CSF 5-羟吲哚乙酸减少（7），4期和REM睡眠减少（8）。如果精神病性抑郁症只是非精神病性抑郁症的一种严重变异，那么除了精神病性症状的存在外，它应该具有相似的临床特征。Guze和同事（9）研究了253名原发性和继发性情感障碍患者的115个变量，发现妄想性unipolan患者仅通过更频繁的精神病住院来区分。大部分的瓦尼亚-
Many authors report that patients with psychotic and nonpsychotic major depressions differ in their response to somatic treatment. Psychotic depression is less responsive to tnicyclic antidepressants (1) and often requires a combined regimen of antipsychotics and antidepressants (2) on ECT (3). The nosological status of psychotic depression remains in question. Is psychotic depression best considered as a severe variant of major depression on as a separate entity with a characteristic pattern of demographic and symptom features, family history, course, biochemical profile, and response to treatment? There are limited and inconsistent data on this issue, but some differences between psychotic and nonpsychotic depression have been suggested. Nelson and Bowers (2) reported more psychomotor disturbance and previous episodes in psychotic depressive patients than in nonpsychotic depressive patients. In contrast Glassman and Roose (4) found more psychomotor retardation, less placebo responsiveness, and fewer previous episodes in psychotic depressive patients. Several preliminary biochemical and physiological findings seem to distinguish psychotic from nonpsychotic depressive patients. Meltzen and associates (5) reported that psychotic patients had increased serum creatinine phosphokinase and aldolase, skeletal musdc abnormalities, and lower serum dopamine 3-hydroxylase. Sweeney and associates (6) reported lower urine 3-methoxy-4-hydroxyphenethylene glycol and higher CSF homovanillic acid. These authors all used the Research Diagnostic Criteria (RDC) definition of psychotic major depressive disorder in defining their cohorts. Mendels and associates used a clinical judgment definition of psychotic depfession and found decreased CSF 5-hydnoxyindoleacetic acid (7) and decreased stage 4 and REM sleep (8). If psychotic depression is no more than a severe variant of nonpsychotic major depression, it should, aside from the presence of the psychotic symptoms, have similar clinical features. Guze and associates (9) studied 1 15 variables in 253 patients with primary and secondary affective disorder and found that delusional unipolan patients were distinguished only by more frequent psychiatric hospitalization. Most ofthe vania-