Measuring psychotic depression

Authors

  • S. D. Østergaard,

    Corresponding author
    1. Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aalborg University hospital, Aalborg, Denmark
    2. Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
    • Søren Dinesen Østergaard, Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aalborg University Hospital, Mølleparkvej 10, DK-9000 Aalborg, Denmark.

      E-mail: sdo@rn.dk

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  • B. S. Meyers,

    1. Department of Psychiatry, Weill Medical College of Cornell University and New York Presbyterian Hospital, Westchester Division, White Plains, NY, USA
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  • A. J. Flint,

    1. Department of Psychiatry, University Health Network, Toronto, ON, Canada
    2. Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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  • B. H. Mulsant,

    1. Department of Psychiatry, University of Toronto, Toronto, ON, Canada
    2. Centre for Addiction and Mental Health, Toronto, ON, Canada
    3. Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
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  • E. M. Whyte,

    1. Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
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  • C. M. Ulbricht,

    1. University of Massachusetts Medical School, Worcester, MA, USA
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  • P. Bech,

    1. Psychiatric Research Unit, Psychiatric Center North Zealand, Copenhagen University Hospital, Hillerød, Denmark
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  • A. J. Rothschild,

    1. University of Massachusetts Medical School and University of Massachusetts Memorial Health Care, Worcester, MA, USA
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  • on behalf of the STOP-PD Study Group


Abstract

Objective

Psychotic depression (PD) is a highly debilitating condition, which needs intensive monitoring. However, there is no established rating scale for evaluating the severity of PD. The aim of this analysis was to assess the psychometric properties of established depression rating scales and a number of new composite rating scales, covering both depressive and psychotic symptoms, in relation to PD.

Method

The psychometric properties of the rating scales were evaluated based on data from the Study of Pharmacotherapy of Psychotic Depression.

Results

A rating scale consisting of the 6-item Hamilton melancholia subscale (HAM-D6) plus five items from the Brief Psychiatric Rating Scale (BPRS), named the HAMD-BPRS11, displayed clinical validity (Spearman's correlation coefficient between HAMD-BPRS11 and Clinical Global Impression – Severity (CGI-S) scores = 0.79–0.84), responsiveness (Spearman's correlation coefficient between change in HAMD-BPRS11 and Clinical Global Impression – Improvement (CGI-I) scores = −0.74–−0.78) and unidimensionality (Loevinger's coefficient of homogeneity = 0.41) in the evaluation of PD. The HAM-D6 fulfilled the same criteria, whereas the full 17-item Hamilton Depression Scale failed to meet criteria for unidimensionality.

Conclusion

Our results suggest that the HAMD-BPRS11 is a more valid measure than pure depression scales for evaluating the severity of PD.

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