First-episode psychosis: an epidemiological survey comparing psychotic depression with schizophrenia

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.

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

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.

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.

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.

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.