CLINICAL, MAGNETIC-RESONANCE-IMAGING AND ENDOCRINOLOGIC DIFFERENCES BETWEEN DELUSIONAL AND NONDELUSIONAL DEPRESSION IN THE ELDERLY

Objective. To investigate neuroradiological, endocrinological and clin ical differences between delusional and non-delusional depression. Des ign. A cross-sectional study of depressed subjects. Setting. Melbourne , Australia. Participants. Sixty-one subjects (inpatients) over the ag e of 55 meeting DSM-III-R criteria for major depression of whom 22 had delusional subtype of depression. Measures. Clinical assessment, incl uding documentation of vascular risk factors, Cognitive assessment by the Cambridge Cognitive Examination (CAMCOG). Magnetic resonance imagi ng (MRI) scans were performed on a 0.3 Tesla scanner with temporal lob e atrophy, periventricular lesions (PVL) and deep white matter lesions (DWML) rated visually on 4-point scales. A standard 1 mg dexamethason e suppression test (DST) was performed. Results. Subjects with delusio nal depression had significantly more vascular risk factors than those without delusions. There were no differences in measures of temporal lobe atrophy, PVL, DST results or cognitive test scores, though there was a non-significant trend for DWML to be more prevalent in those wit h delusions. Delusional depression was associated with a shorter durat ion of history and more frequent treatment with ECT. Conclusions. The increase in vascular risk factors and trend towards greater DWML on MR I suggests an organic contribution to delusional depression in the eld erly. In contrast to some previous reports, we found no differences in cortical MRI appearance or neuroendocrine measures between groups.