Association of biogenic amine metabolites with symptomatology in delusional (psychotic) and nondelusional depressed patients.

1. The levels of the main norepinephrine, serotonin, and dopamine metabolite excretion in the urine, MHPG, 5HIAA and HVA respectively, were measured in 84 patients with major depressive disorder, 34 delusional (psychotic) and 50 nondelusional (DSM-III-R criteria). 2. Associations with the 17 items of the HDRS were evaluated using the multiple regression analysis model. In the delusional group, MHPG excretion was positively related to the scores in the items of depressed mood (p = 0.04), middle insomnia (p = 0.008) and genital symptoms (p = 0.001). 5HIAA excretion was negatively associated with late insomnia (p = 0.02), work and interests (p = 0.001) and genital symptoms (p = 0.007). HVA was positively related to agitation (p = 0.043). In the nondelusional group the only association found was between agitation and HVA excretion (p = 0.03).

Shared delusions of doubles.

This is the first report of two partners in a folie à deux situation manifesting identical Capgras delusions. It is postulated that the Capgras syndrome developed as a result of interaction between a dominant patient with primarily paranoid psychopathology and a submissive one with primarily organic dysfunction. The submissive "neuro-organic" partner experienced a non-delusional misidentification that acquired a delusional component and developed into the Capgras syndrome as a result of elaboration by the dominant paranoid partner, who subsequently "imposed" the Capgras delusion on the submissive partner. The submissive patient, and, to a lesser extent the dominant patient, had evidence of organic cerebral dysfunction.

Biogenic amine metabolites in delusional (psychotic) depression and melancholia subtypes of major depression.

1. The levels of the urinary main metabolites of norepinephrine 3-methoxy-4-hydroxyphenylglycol (MHPG), of dopamine homovanillic acid (HVA) and of serotonin 5-hydroxyindoleacetic acid (5-HIAA) were measured in 84 patients with major depressive disorder, 34 delusional and 50 nondelusional. Melancholia subtype was also defined (N = 62). 2. MHPG was significantly higher in the delusional depressed group (p = 0.023). Female patients with delusional major depression also had significantly higher HVA excretion than female patients with non delusional major depression (p = 0.036). 5-HIAA excretion was similar in the two patient subgroups. 3. No significant differences in the three monoamine metabolites were found between the melancholic and nonmelancholic depressed patients.

The prognostic importance of delusions in depression: a 6-year prospective follow-up study.

The authors followed 32 delusional and 41 unipolar non-delusional depressed patients 6 years after hospital discharge. Long-term outcome, as determined by the frequency of the relapses, number of hospitalizations, chronic course of illness as well as clinical status and global functioning at the end of the 6-year period, failed to differentiate the two patient groups. Discontinuation of maintenance medication in both groups or of antipsychotics in the delusional group was associated with a high rate of relapses. Our findings indicate that delusional depression has a similar clinical course to that of non-delusional depression, underline the importance of psychoprophylactic treatment and question the efficacy of monotherapy with antidepressants in the prevention of relapses of delusional depression.

Thyrotropin responses to TRH and MHPG excretion before and after an electroconvulsive therapeutic course in depressed patients.

1. TSH response to TRH, and urinary MHPG were investigated before and after an ECT course in 12 female patients with endogenous depression. 2. The changes caused by ECT treatment on these parameters were not significant. 3. A positive correlation (r = 0.75, p = 0.005) was found between the changes in TSH response and the changes in urinary MHPG excretion.

Hormonal responses to clonidine and urinary MHPG in delusional and nondelusional melancholic patients: a placebo-controlled study.

The growth hormone (GH) and cortisol responses to intravenous clonidine (0.15 mg) treatment of 25 melancholic patients, 12 with and 13 without delusions, were studied with placebo control. The baseline concentrations of the main noradrenaline metabolite, 3-methoxy-4-hydroxyphenylglycol (MHPG) were also estimated in urine. Cortisol plasma levels decreased significantly and equally after both placebo and clonidine. Baseline cortisol levels correlated positively with urinary MHPG. Clonidine did not increase GH levels significantly over time compared with placebo. Delusional melancholic patients tended to have smaller GH responses to clonidine than nondelusionals (F = 2.18, P = 0.06). There were no differences in GH response to clonidine between high and low MHPG excretors.

Neurochemical variables in delusional depression.

The authors assayed plasma dopamine beta-hydroxylase activity, platelet monoamine oxidase (MAO) activity, plasma prolactin, the urinary monoamine metabolites 3-methoxy-4-hydroxyphenylglycol (MHPG), 5-hydroxyindoleacetic acid (5-HIAA), and homovanillic acid (HVA), and urinary cAMP from 18 delusional and 22 nondelusional depressed inpatients. No significant differences between the two groups were found.

Delusional depression: further evidence for genetic contribution.

To quantify the contribution of genetic factors in the pathogenesis of delusional depression, the incidence of major depression in the first degree relatives of 77 delusional, 76 nondelusional depressive patients, and 153 age- and sex-matched controls was calculated in a case-control study. The morbid risk for psychiatric disorders, including major depression and bipolar I disorder, did not distinguish the two proband groups. The segregation analysis showed that the model of multifactorial inheritance fits best to our results. Heritability was estimated on the basis of a threshold model for multifactorial inheritance, and a high contribution of genetic factors for both subgroups was found.

Delusional depression: phenomenology and response to treatment. A prospective study.

In a prospective study, the authors compared 22 delusional and 36 non-delusional depressive patients with respect to demographic and clinical variables, personality, and response to treatment. Delusional depressives had a higher total score than non-delusional depressives on Hamilton's Rating Scale for Depression, as well as a higher score for depressed mood and psychomotor retardation. The type of treatment failed to differentiate the two groups as to outcome at discharge. However, six of the seven delusional depressives who did not respond to tricyclic antidepressants had a full recovery with ECT. The results indicate that delusional depression represents a more severe type of major depression.

Delusional depression: phenomenology and response to treatment.

In this retrospective study demographic and clinical characteristics, personality traits, family psychiatric history and response to treatment were compared in 55 delusional and 40 nondelusional hospitalized patients who met DSM-III criteria for major depression. Male delusional depressives had a greater frequency of delusional ideas at the index episode than female delusionals. Delusional depressives had a greater frequency of family history for alcoholism, a smaller frequency of previous depressive episodes and tended to respond more favorably to treatment with electroconvulsive therapy or tricyclic antidepressants combined with neuroleptics than to antidepressants alone. The findings and the implications arising from them are discussed.

Type and content of delusions in unipolar psychotic depression.

In a prospective study the authors compared unipolar psychotic and non-psychotic patients for the presence of delusional ideation in previous episodes. Psychotic patients had a significantly higher frequency of delusions in previous episodes. The type and content of delusional ideas were similar from episode to episode. The results and their implications are discussed.

Disturbances of perception in depressive patients.

In a sample of 121 depressive patients hospitalized at Eginition Hospital from 1976 to 1980, 22 (18.2%) patients manifested disturbances of perception and, with 1 exception, all patients had hallucinations. Auditory and visual hallucinations were the most frequent. The group of patients with disturbances of perception had a positive family history for affective illness (p less than 0.025), a smaller number of previous depressive episodes (p less than 0.05), a greater frequency of delusional thinking (p less than 0.001) and psychomotor agitation (p less than 0.05).

Sleep deprivation psychoprophylaxis in recurrent affective disorders.

Administration of prophylactic 36 h total sleep deprivation to 9 manic-depressive patients (5 bipolar and 4 unipolar depressives) reduced the frequency of relapses and increased the duration of normothymia in 5 patients, left the course of illness unchanged in 3 patients whilst in 1 patient the effect could not be evaluated. Sleep deprivation appeared to be more effective in women, 'rapid cyclers', patients with a positive family history of mental illness and patients with recurrent depression. These observations confirm previous impressions and suggest a possible prophylactic effect of sleep deprivation.

Plasma cyclic AMP in manic-depressive illness.

The postulated disturbance of cyclic AMP (cAMP) in manic-depressive illness was investigated by using plasma as the biological material. Cyclic AMP was measured by a protein-binding assay, which was found very satisfactory for the purpose of this study. In the drug-free state, depressed patients (n = 28) had significantly lower and manic patients (n = 9) significantly higher plasma concentrations of cAMP than controls. Unmedicated manic-depressive subjects had normal cAMP levels during normothymic phases (n = 7). Cyclic AMP was reduced by neuroleptics in mania and elevated by tricyclics in depression. Lithium exerted a normalizing effect on cAMP in both phases of the illness. It is concluded that manic-depressive illness is associated with a disturbance in the cAMP system. The use of plasma rather than urine for the investigation of the state of cAMP in psychiatric disorders is advocated.