정신병적 우울증과 비정신병적 우울증의 몇가지 임상변인 및 갑상선 기능에 관한 비교조사

Psychotic vs Nonpsychotic Depression: Comparison of Some Clinical Variables and Thyroid Function

The nosological status of major depression with psychotic features has been a matter of considerable controversy during the last 2 decades. To date, two hypotheses have been put forward : 1) that this condition represents a separate diagnostic entity : 2) that it is a more severe but not qualitatively different clinical form with respect to nonpsychotic depression. The validity of these hypotheses has been tested by comparing psychotic and nonpsychotic depressive patients with regard to a number o f variables or biological meaures. The results obtained have not been consistent. With these aspects in mind, we studied clinical variables and thyroid function in 46 psychotic and 76 nonpsychotic hospitalized depressives to elucidate whether psychotic depression represents a distinct subtype. The results were as follows : 1) The psychotic and nonpsychotic depressives did not differ significantly with respect to sex, age, marital status, family history, past history, bipolarity, and suicide attempt However, psychotic depressives had a lower age of onset than nonpsychotic patients. Also, psychotic patients had more past episodes than nonpsychotic patients. 2) The psychotic depressives had a significantly higher total score for Hamilton Depression Scale. A comparision of individual Hamilton item scores showed the psychotic group was significantly more depressed, guilty, suicidal and likely to complain of early insomnia. 3) There were no significant differences in mean serum levels of T3, T4, and TSH between psychotic depression and nonpsychotic depression. The psychotic and nonpsychotic depressives did not differ significantly with respect to TSH blunting. In light of our data, it seems less likely that psychotic depression is a separate diagnostic entity.