Clinical Outcomes Assessed for Major Depressive Disorder With Psychotic Features

New study data published in CNS Neuroscience & Therapeutics indicate that major depressive disorder with psychotic features (MDDP) has qualitatively comparative functionality and quality of life outcomes as schizophrenia, schizoaffective disorder, and bipolar disorder.

The CAMFEPS (Cavan-Monaghan First Episode Psychosis Study) was a prospective study assessing the psychopathology, functioning, quality of life, and service engagement for 27 people with MDDP compared with the same factors in 60 people with schizophrenia, 27 people with schizoaffective disorder, and 35 people with bipolar disorder for a mean follow-up period of 6.4 years after first-episode psychosis. 

Positive and Negative Syndrome Scale scores differed among diagnoses (P <.001); scores were highest for schizophrenia, marginally lower for schizoaffective disorder, and lower for both bipolar disorder and MDDP (each P <.001 vs schizophrenia). Per the Global Assessment of Functioning scale, functioning was lowest for schizophrenia, higher for schizoaffective disorder (P <.05 vs schizophrenia), and highest for bipolar disorder and MDDP (both P <.001 vs schizophrenia). Quality of Life Scale scores also differed among diagnoses and were lowest for schizophrenia, higher for schizoaffective disorder (P <.05), and higher still for both bipolar disorder and MDDP each (both P <.01). However, subjectively determined quality of life was indistinguishable across diagnoses. Service engagement scores were highest (indicating worse engagement) for schizophrenia, lower for schizoaffective disorder (P <.05) and bipolar disorder (P <.01), and lower still for MDDP (P <.001). Functioning (P <.01), quality of life (P <.05), and service engagement (P =.07) levels were typically worse in men than in women in a manner unrelated to diagnosis.

Overall, long-term outcomes for those with MDPP were comparable to those of people with schizophrenia, schizoaffective disorder, and bipolar disorder. Apparent differences in Positive and Negative Syndrome Scale scores for psychopathology, functioning, quality of life, and service engagement among diagnoses were quantitative rather than qualitative, with considerable overlap. As such, researchers suggested that MDDP should be in the same diagnostic category as schizophrenia, schizoaffective disorder, and bipolar disorder in a “milieu of psychosis that transcends arbitrary boundaries.”

Reference

Kingston T, Scully PJ, Browne DJ, et al. Functional outcome and service engagement in major depressive disorder with psychotic features: comparisons with schizophrenia, schizoaffective disorder and bipolar disorder in a 6‐year follow‐up of the Cavan‐Monaghan First Episode Psychosis Study (CAMFEPS) [published online March 25, 2018]. CNS Neurosci Ther. doi:10.1111/cns.12836