Aysel MİLANLIOGLU, Pınar Güzel ÖZDEMİR, Zafer TAPANCİ, Damla TİMUCİN KEMENT, Osman OZDEMİR

Is Major Depressive Disorder with Psychotic Features More Likely in Elderly Than Adulthood?

Amaç: Psikotik depresyon ileri yaş hastalar arasında sıkgörülmesine rağmen yapılan çalışmalarda psikotik vepsikotik olmayan hasta grupları arasında sosyodemografiközellikler açısından belirgin fark gösterilememiştir. Buçalışmada psikotik olan ve olmayan depresyon hastaların yaşlarının karşılaştırılması amaçlanmıştır. Çalışmanınhastalığın daha iyi anlaşılmasına ve yönetimine katkıdabulunabileceği düşünülmektedir. Yöntem: Çalışmaya 25 psikotik depresyon 25 psikotikolmayan depresyon olmak üzere toplam 50 yatan depresyon hastası dahil edilmiştir. Hastaların tanısı iki psikiyatriuzmanının ortak kararıyla DSM-IV Eksen I Bozuklukları içinYapılandırılmış Klinik Görüşme (SCID-I) uygulanarak konulmuştur. Depresyon şiddeti Hamilton depresyon ölçeği veHamilton anksiyete ölçeği ile değerlendirilmiştir. Bulgular: Psikotik depresyon hastalarının yaş ortalaması(46,6±15.4 yıl) psikotik olmayan hastaların yaş ortalamasından (35,1±15.2 yıl) anlamlı oranda yüksek saptanmıştır.Ayrıca, Hamilton depresyon ve Hamilton anksiyete ölçekleri psikotik depresyon grubunda daha yüksek bulunmuştur.Her iki grupta hastaların epizod sayıları ve hastalık süreleriarasında anlamlı fark bulunmamıştır.Sonuç: Çalışmamızın bulguları psikotik özellikli depresyonun ileri yaşlarda daha sık görüldüğünü düşündürmektedir.

Psikotik özellikli depresyon ileri yaşlarda yetişkinlikten daha mı sık görülüyor?

Objective: Although psychotic depression is very commonamong old depressed patients, studies have generallyfailed to find any socio-demographic differences betweenpsychotic depressed patients and non-psychotic patients.Comparison of the age related factors in psychoticdepression and non-psychotic depression patients couldcontribute to a better understanding of the clinical featuresof psychotic depression and its management.Method: The sample comprised of 50 inpatients; 25 ofthem major depressive disorder with psychotic features,and the other 25 major depressive disorder without psy- chotic features. The diagnosis made after consensus of twopsychiatrists by Structured Clinical Interview for DSM-IVAxis I Disorder (SCID-IV). The severity of depression mea- sured with the Hamilton Depression Rating Scale (HDRS),and concomitantly Hamilton Anxiety Rating Scale (HARS)were performed. Results: The average age of the patients with psychoticdepression (46,6±15.4 years) was higher than that ofnon-psychotic depressed patients (35,1±15.2 years). Also,patients with psychotic depression had higher mean oftotal HDRS and HARS scores. There were no significantdifferences between the patient groups in number ofepisodes and duration of illness. Conclusion: These findings suggest that major depressivedisorder with psychotic features is more likely in elderlythan adulthood.

PDF

___

1. Fleming SK, Blasey C, Schatzberg AF. Neuropsychological correlates of psychotic features in major depressive disorders: a review and meta-analysis. J Psychiatr Res. 2004;38:27-35.
2. Lee TW, Tsai SJ, Yang CH, Hwang JP. Clinical and phenomenological comparisons of delusional and non-delusional major depression in the Chinese elderly. Int J Geriatr Psychiatry. 2003;18:486-90.
3. Thakur M, Hays J, Krishnan KR. Clinical, demographic and social characteristics of psychotic depression. Psychiatry Res. 1999;86:99-106.
4. Keller J, Gomez RG, Kenna HA, Poesner J, DeBattista C, Flores B, Schatzberg AF. Detecting psychotic major depression using psychiatric rating scales. J Psychiatr Res. 2006;40:22-9.
5. Gaudiano BA, Dalrymple KL, Zimmerman M. Prevalence and clinical characteristics of psychotic versus nonpsychotic major depression in a general psychiatric outpatient clinic. Depress Anxiety. 2009;26:54-64.
6. Rothschild AJ. Challenges in the treatment of major depressive disorder with psychotic features. Schizophr Bull. 2013;39:787-96.
7. Gournellis R, Oulis P, Rizos E, Chourdaki E, Gouzaris A, Lykouras L. Clinical correlates of age of onset in psychotic depression. Arch Gerontol Geriat. 2011;52:94-8.
8. Stage KB, Bech P, Kragh-Sørensen P, Nair NP, Katona C. Differences in symptomatology and diagnostic profile in younger and elderly depressed inpatients. J Affect Disord. 2001;64:239-48.
9. Brodaty H, Luscombe G, Parker G, Wilhelm K, Hickie I, Austin MP, Mitchell P. Increased rate of psychosis and psychomotor change in depression with age. Psychol Med. 1997;27:1205-13.
10. Hegeman JM, Kok RM, van der Mast RC, Giltay EJ. Phenomenology of depression in older compared with younger adults: meta- analysis. Br J Psychiatry. 2012;200:275-81.
11. Garvey MJ, Schaffer CB. Are some symptoms of depression age dependent? J Affect Disord. 1994;32:247-51.
12. Gallo JJ, Anthony JC, Muthén BO. Age differences in the symptoms of depression: a latent trait analysis. J Gerontol. 1994;49:251-64.
13. Christensen H, Jorm AF, MacKinnon AJ, Korten AE, Jacomb PA, Henderson AS, Rodgers B. Age differences in depression and anxiety symptoms: a structural equation modelling analysis of data from a general population sample. Psychol Med. 1999;29:32539.
14. Gatz M, Hurwicz M. Are old people more depressed? Cross- sectional data on Center for Epidemiologic Studies Depression scale factors. Psychol Aging. 1990;5:284-90.
15. Blazer D, Bachar JR, Hughes DC. Major depression with melancholia: a comparison of middle-aged and elderly adults.J Am Geriatr Soc. 1987;35:927-32.
16. Baldwin RC. Delusional depression in elderly patients: characteristics and relationship to age at onset. Int J Geriatr Psychiatry. 1995;10:9815.
17. Krishnan K, Hays J, Tupler L, George L, Blazer D. Clinical and phenomenological comparisons of late-onset and early-onset depression. Am J Psychiatry. 1995;152:7858.
18. Corruble E, Gorwood P, Falissard B. Association between age of onset and symptom profiles of late-life depression.Acta Psychiatr Scand. 2008;118:389-94.
19. Lykouras L, Gournellis R, Fortos A, Oulis P, Christodoulou GN. Psychotic (delusional) major depression in the elderly and suicidal behaviour. J Affect Disord. 2002;69:225-9.
20. Meyers BS, Greenberg R. Late-life delusional depression. J Affect Disord. 1986;11:133-7.
21. Kessing LV. Differences in diagnostic subtypes among patients with late and early onset of a single depressive episode. Int J Geriatr Psychiatry. 2006;21:1127-31.
22. Brodaty H, Luscombe G, Parker G, Wilhelm K, Hickie I, Austin MP, Mitchell P. Increased rate of psychosis and psychomotor change in depression with age. Psychol Med. 1997;27:1205-13.
23. Leckman JF, Weissman MM, Prusoff BA, et al. Subtypes of depression: family study perspective. Arch Gen Psychiatry. 1984;41:833-9.
24. Alexopoulos GS, Young RC, Meyers BS, Abrams RC, Shamoian CA. Late-onset depression. Psychiatr Clin N Am. 1988:11;101-15.
25. Rothschild AJ. Challenges in the treatment of depression with psychotic features. Biol Psychiatry. 2003;53:680-90.
26. Gaudiano BA, Young D, Chelminski I, Zimmerman M. Depressive symptom profiles and severity patterns in outpatients with psychotic vs nonpsychotic majordepression. Compr Psychiatry. 2008;49:421-9.
27. Holroyd S, Duryee JJ. Differences in geriatric psychiatry outpatients with early- vs late-onset depression. Int J Geriatr Psychiatry. 1997;12:1100-6.
28. Roose SP, Glassman AH, Walsh BT, Woodring S, Vital-Herne J. Depression, delusions, and suicide. Am J Psychiatry. 1983;1159-62.
29. Alexopoulos GS. Depression in the elderly. Lancet. 2005;365:1961-70.