Psychotic subtyping of major depressive disorder and posttraumatic stress disorder

Background: Many studies have established that a large percentage of patien ts with posttraumatic stress disorder (PTSD) have comorbid major depressive disorder. Other studies have found that patients with PTSD or a history of childhood trauma have an increased rate of psychotic symptoms. In the pres ent report from the Rhode Island Methods to Improve Diagnosis and Services project, we examine whether an association exists between psychotic subtypi ng of major depressive disorder and PTSD, Method: Five hundred psychiatric outpatients were interviewed with the Stru ctured Clinical Interview for DSM-IV. Results: Almost half of the 500 patients had nonbipolar major depressive di sorder (N = 235, 47.0%), 45 (19.1%) of whom had PTSD. Nineteen patients had psychotic depression, 216 had nonpsychotic depression. Compared with patie nts with nonpsychotic depression, the patients with psychotic depression we re nearly 4 times more likely to have PTSD (57.9% vs. 15.7%, Fisher exact t est, p = .0001). Conclusion: The results of the present study suggest that the presence of p sychosis in psychiatric outpatients with major depressive disorder is assoc iated with concurrent PTSD. It is hypothesized that the poorer longitudinal course of psychotic versus nonpsychotic depression may be due to the under recognition of PTSD in psychotically depressed patients.