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Clinical characteristics and medication use patterns among hospitalized patients admitted with psychotic vs
Brandon A Gaudiano1, Lauren M Weinstock, Gary Epstein-Lubow
1Butler Hospital, Providence, Rhode Island, USA, Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Background:
In routine practice, major depressive disorder (MDD) with psychotic features often goes under-recognized and undertreated. Previous research has specified several demographic and clinical differences in MDD patients with psychotic features compared with those without psychosis in routine outpatient practice, but there is little systematic research in modern routine hospital settings.
Methods:
We conducted a retrospective electronic medical records chart review of 1,314 patients diagnosed with MDD who were admitted consecutively to a major psychiatric hospital over a 1-year period. We examined the prevalence of psychotic features in the sample and investigated the differences in demographic variables, clinical characteristics, and medication use patterns among patients with and without psychosis.
Results:
The prevalence of psychotic features was 13.2% in the current hospital sample. Patients with psychotic depression were more likely to be older, male, a member of a racial/ethnic minority, and have more medical comorbidities and certain Axis I disorders compared with nonpsychotic patients. In addition, patients with psychotic depression were more likely to be prescribed antipsychotics and hypnotics before admission.
Conclusions:
Several demographic and clinical characteristics differentiate MDD patients with psychosis from those without psychosis in hospital settings that may be helpful in identifying these patients. Comparisons with outpatient samples and treatments implications are discussed.
Insights
Psychotic features in major depressive disorder (MDD) affect 13.2% of hospitalized patients. Older males, minorities, and those with comorbidities are more likely to experience psychotic depression.
Area of Science:
- Psychiatry
- Clinical Psychology
- Epidemiology
Background:
- Major depressive disorder (MDD) with psychotic features is often underdiagnosed and undertreated in routine practice.
- Limited research exists on psychotic MDD in contemporary hospital settings compared to outpatient settings.
Purpose of the Study:
- To determine the prevalence of psychotic features in a hospital-based MDD sample.
- To identify demographic and clinical differences between MDD patients with and without psychotic features in a hospital setting.
Main Methods:
- Retrospective chart review of 1,314 consecutively admitted MDD patients.
- Analysis of electronic medical records to compare patients with and without psychotic features regarding demographics, clinical characteristics, and medication use.
Main Results:
- The prevalence of psychotic features in the hospital sample was 13.2%.
- Patients with psychotic depression were older, more likely to be male, belong to a racial/ethnic minority, and have more medical comorbidities and other Axis I disorders.
- Pre-admission use of antipsychotics and hypnotics was higher in patients with psychotic depression.
Conclusions:
- Specific demographic and clinical factors can help identify MDD patients with psychosis in hospital settings.
- Findings highlight differences between hospital and outpatient samples and suggest implications for treatment strategies.
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