PubMed · 11630287
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T Pieper. 1994. [Not Available].. https://pubmed.ncbi.nlm.nih.gov/11630287/
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OBJECTIVE: Major depressive disorder is associated with elevated mortality rates that increase with the severity of depression. The authors hypothesized that patients with psychotic depression would have higher mortality rates than patients with nonpsychotic depression. METHOD: Survival analytic techniques were used to compare the vital status of 61 patients with psychotic major depression with that of 59 patients with nonpsychotic major depression up to 15 years after hospital admission. Medical status was assessed with the Cumulative Illness Rating Scale. Dexamethasone suppression test (DST) data were available for 101 patients. RESULTS: The mortality rate for subjects with psychotic depression was significantly greater than that for those with nonpsychotic depression, with 41% versus 20%, respectively, dying within 15 years after hospital admission. A proportional hazards model with age and medical status entered as covariates confirmed a significantly higher mortality rate in patients with psychotic depression (hazards ratio=2.31). A positive DST result was associated with psychotic depression but was not related to vital status. CONCLUSIONS: Patients with psychotic depression have a two-fold greater risk of death than do patients with severe, nonpsychotic major depression.
We describe the case of a 65-year-old woman with long-standing, atypical facial pain and fluctuating mental symptoms. A variety of psychiatric diagnoses were made over a period of nine years but no effective treatment was found. Ultimately, the patient was found to suffer from a psychotic depression indicating Cotard's syndrome. Two series of ECT were then given with temporary short remissions. Subsequently, continuation ECT was introduced. To our knowledge, continuation ECT in Cotard's syndrome is rarely, if ever, described in the literature.
Postpartum psychiatric illness consists of a highly prevalent group of disorders, which can result in serious dysfunction and require treatment. Patients are more likely to seek help for these disorders from their primary care physicians rather than mental health professionals. While severe postpartum depression and psychoses are easily recognized, milder or more insidious forms of depressive illness frequently are missed. Heightened sensitivity to and screening for the presence of these prevalent psychiatric disorders facilitates and enhances recognition of postpartum disorders and leads to more expeditious treatment.