***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: This article reports on the evidence for the validity of psychotic major depression as a distinct subtype based on cross-sectional and 1-year prospect i ve data from the Epidemiologic Catchment Area study . Consistent with findings from previous clinical studies , only about 14 % of major depressions were accompanied by psychotic features . Psychotic as compared with nonpsychotic depression had a more severe course , as reflected in increased risk of relapse , persistence over 1 year , suicide attempts , hospitalization , comorbidity , and financial dependency . These differences could not be explained by differences in demographic characteristics or by symptom severity , as assessed by symptom profile or number of symptoms . The boundary problem with schizophrenia and bipolar affective disorder that is seen in clinical studies was also found in this sample . To our knowledge , this is the first study to examine the validity of psychotic depression in a community sample ; the findings are consistent with those from clinical sample s. They support the clinical significance of psychotic depression and the continuation of its inclusion as a distinct subtype in DSM-IV Objective To compare the relative efficacy of electroconvulsive therapy ( ECT ) in psychotic and nonpsychotic patients with unipolar major depression . Methods The outcome of an acute ECT course in 253 patients with nonpsychotic ( n = 176 ) and psychotic ( n = 77 ) unipolar major depression was assessed in the first phase of an ongoing National Institute of Mental Health-supported four-hospital collaborative study of continuation treatments after successful ECT courses . ECT was administered with bilateral electrode placement at 50 % above the titrated seizure threshold . The remission criteria were rigorous : a score ≤10 on the 24-item Hamilton Rating Scale for Depression ( HRSD ) after 2 consecutive treatments , and a decrease of at least 60 % from baseline . Results The overall remission rate was 87 % for study completers . Among these , patients with psychotic depression had a remission rate of 95 % and those with nonpsychotic depression , 83 % . Improvement in symptomatology , measured by the HRSD , was more robust and appeared sooner in the psychotic patients compared with the nonpsychotic patients . Conclusion Bilateral ECT  is effective in relieving severe major depression . Remission rates are higher and occur earlier in psychotic depressed patients than in nonpsychotic depressed patients . These data support the argument that psychotic depression is a distinguishable nosological entity that warrants separate treatment algorithms The authors report prospect i ve uniform clinical data differentiating 25 patients who committed suicide from 929 patients who did not in a group of 954 patients with major affective disorder followed for an average of 4 years in the Collaborative Program on the Psychobiology of Depression . Eight ( 32 % ) of the suicides occurred within 6 months and 13 ( 52 % ) within 1 year of entry into the study . Hopelessness , loss of pleasure or interest , and mood cycling during the index episode differentiated the suicide group . Diagnostic subcategories , suicidal ideation at entry to the study , suicide attempts during current or past episodes , and medical severity of prior attempts did not differentiate the suicide group OBJECTIVE The present study investigates how consistently DSM-IV major depressive disorder ( MDD ) with psychosis was diagnosed by research consensus across 10 years and the association of clinical characteristics with diagnostic consistency . METHOD The sample included 146 participants , part of a larger first-admission cohort ( N = 628 ) presenting to a psychiatric inpatient facility with psychosis , who were diagnosed with psychotic depression at least once across 4 assessment s spanning 10 years ( after first admission and at 6-month , 24-month , and 10-year follow-ups ) . The primary outcome of this prospect i ve epidemiologic study was retention of the best-estimate consensus diagnosis at each assessment . Diagnoses at each assessment were determined from semistructured interviews , medical records , and informant reports . The participants were recruited from 1989 to 1995 . RESULTS Fifty-five of the 146 participants ( 37.7 % ) were diagnosed with psychotic depression at each available assessment ; 13 ( 8.9 % ) switched from MDD to bipolar disorder , 24 ( 16.4 % ) switched from MDD to schizophrenia or schizoaffective disorder , and the remaining 54 ( 37.0 % ) had other patterns of diagnostic change . Only 47 of 80 participants ( 58.8 % ) diagnosed with MDD at baseline retained a mood disorder diagnosis 10 years later ( 36 [ 45.0 % ] had MDD and 11 [ 13.8 % ] had bipolar disorder ) , while 16 of 52 participants ( 30.8 % ) who ended the study with MDD were initially misdiagnosed . Compared to participants who were consistently diagnosed with MDD , those switching from MDD to bipolar disorder had better premorbid adjustment , more first-degree relatives with MDD , better functioning , and fewer negative symptoms at baseline , whereas those shifting to the schizophrenia spectrum had a more insidious onset , longer initial hospital stays , worse functioning , and more negative symptoms ( all P values < .05 ) . CONCLUSIONS The diagnosis of MDD with psychosis among in patients showed poor long-term consistency . For clinicians , results indicate that the diagnosis of MDD with psychosis based on a single assessment should be considered provisional BACKGROUND Severe unipolar depression is associated with increased risk of suicide , but it remains unknown whether the same risk factors are present in the non-psychotic ( non-PD ) and psychotic ( PD ) subtypes respectively . Therefore , this study aim ed to identify risk factors for suicide in non-PD and PD separately , and to investigate if the presence of psychotic symptoms is an independent risk factor for suicide in severe depression . METHODS This register-based , nationwide , historical prospect i ve cohort study used logistic regression analyses to ascertain risk factors for  suicide  among all adults diagnosed with severe depression at Danish psychiatric hospitals between January 1 , 1994 and December 31 , 2010 . The risk for suicide was expressed as adjusted odds ratios ( AOR ) . RESULTS A total of 34,671 individuals with severe depression ( non-PD : n=26,106 and PD : n=12,101 ) were included in the study . Of these , 755 completed suicide during follow up . PD was not found to be an independent risk factor for suicide in severe depression ( AOR=0.97 [ 0.83 - 1.15 ] ) . Older age ( non-PD AOR=1.05 [ per year ] , PD AOR=1.04 [ per year ] ) , male sex ( non-PD AOR=1.89 , PD AOR=1.98 ) , and a previous incident of self-harm ( non-PD AOR=5.02 , PD AOR=5.17 ) were significant risk factors for both groups . LIMITATIONS As the study population was comprised only of patients with contact to psychiatric hospitals , the results can not be extrapolated to the primary care setting . CONCLUSION The following risk factors for non-PD and PD were identified : older age , male gender and previous incidents of self-harm . In suicide prevention efforts , equal attention should be paid to non-PD and PD patients To evaluate the role of severe depression , i.e. , depression with melancholic and /or psychotic features and alcohol dependence in suicide and undetermined death . The Lundby Study is a prospect i ve , longitudinal study of a population consisting of 3563 subjects . In a long-term follow up 1947–2006 there were 66 suicide cases , including 19 undetermined deaths . Depression and alcoholism were as expected the major contributors to suicide ( 44 % and 23 % respectively ) . Severe depression with psychotic and /or melancholic features was diagnosed in 66 % of all depressions and in 29 % of all suicide cases , as compared to 15 % for major depression only . Alcohol dependence was related to undetermined death . Major depressive disorder with melancholic and /or psychotic features appears to be an important contributor to accomplished suicide in the depression group , and alcohol dependence appears to be related to undetermined death This retrospective study compared the treatment responses of 34 primary , unipolar depressives without psychotic features and 30 with psychotic features . Patients were diagnosed by Research Diagnostic Criteria and received trials of tricyclic antidepressants , antipsychotics , the combination of the two , electroconvulsive therapy , or placebo and psychotherapy . Only three of 18 psychotic patients vs. 17 of 23 nonpsychotic patients responded to antidepressants alone . Electroconvulsive therapy and the combination of antipsychotic and antidepressant medication gave better responses . These data suggest that major depressive disorder with psychotic features is best considered as a distinct subtype rather than a severe variant of major depression BACKGROUND Few studies have examined the extent to which population s of  suicides and attempted suicides  are similar , or different . This paper compares suicides and serious suicide attempts in terms of known risk factors for suicidal behaviour . METHODS Using case-control methodology , risk factors for suicidal behaviour were examined in 202 individuals who died by suicide , 275 individuals who made medically serious suicide attempts and 984 r and omly selected control subjects . Based on data from significant others , measures used spanned  sociodemographic factors , childhood experiences , psychiatric morbidity and psychiatric history , exposure to recent stressful life events and social interaction .  RESULTS Multiple logistic regression identified the following risk factors that were common to suicide and serious suicide attempts : current mood disorder ; previous suicide attempts ; prior outpatient psychiatric treatment ; admission to psychiatric hospital within the previous year ; low income ; a lack of formal educational qualifications ; exposure to recent stressful interpersonal , legal and work-related life events . Suicides and suicide attempts were distinguished in the following ways : suicides were more likely to be male ( OR = 1.9 , 95 % CI 1.1 , 3.2 ) ; older ( OR = 1.03 , 95 % CI 1.02 , 1.04 ) ; and to have a current diagnosis of non-affective psychosis ( OR = 8.5 , 95 % CI 2.0 , 35.9 ) . Suicide attempts were more likely than suicides to have a current diagnosis of anxiety disorder ( OR = 3.5 , 95 % CI 1.6 , 7.8 ) and to be socially isolated ( OR = 2.0 , 95 % CI 1.2 , 3.5 ) . These findings were confirmed by discriminant function analysis , which identified two functions that described the three subject groups : the first function discriminated the two suicide groups from control subjects on a dimension corresponding to risk factors for suicide ; the second function discriminated suicide from suicide attempt subjects on a series of factors including gender , non-affective psychosis and anxiety disorder . CONCLUSIONS Suicides and medically serious suicide attempts are two overlapping population s that share common psychiatric diagnostic and history features , but are distinguished by gender and patterning of psychiatric disorder BACKGROUND Given the therapeutic and prognostic importance of the unipolar-bipolar dichotomy , predicting which patients will become bipolar subsequent to index diagnosis of major depressive disorder ( MDD ) is of paramount clinical significance . We sought to characterize the profile of patients with MDD who would convert to the more subtle bipolar subtype ( known as BPII ) on the basis of clinical and personality variables obtained during MDD episodes . METHODS A total of 559 patients , comprehensively evaluated with the Schedule of Affective Disorders and Schizophrenia and " unipolar " MDD at entry , were administered 17 self-report personality measures .  Hypomanic and manic episodes were systematic ally recorded over a prospect i ve observation period of up to 11 years . We compared 48 converters to BPII ( 8.6 % ) with 22 converters to bipolar I ( BPI ) ( 3.9 % ) and the remaining larger group of unipolar patients . RESULTS Except for greater acuteness , severity , and psychotic symptomatology , BPI converters were essentially similar to MDD nonconverters . By contrast , BPII converters were robustly distinguished from those with MDD who remained unipolar on the basis of self-report measures along the newly derived factors of Mood Lability , Energy-Activity , and Daydreaming . This profile was associated with early age at onset of MDD and pleomorphic psychopathology beyond the usual affective realm , high rates of substance abuse , as well as educational , marital , and occupational disruption and minor antisocial acts prior to discrete hypomanic episodes . Overall , BPII switchers had a more protracted and tempestuous course with shorter well intervals . " Habitual self " descriptions of temperamental instability during MDD episodes provided useful clinical information for predicting which depressed patients will switch to BPII , attaining a sensitivity of 91 % for all three factors combined ( 23 items ) ; Mood Lability alone ( nine items ) was the most specific predictor ( 86 % ) , though of lower sensitivity ( 42 % ) . CONCLUSIONS The BPII subtype is best understood by such lability intruding into , and possibly its accentuation during , depressive episodes , thereby creating an intimate interweaving of trait and state . Clinicians must note that the foregoing temperamental profile appears more fundamental in defining the affective dysregulation of the BPII subtype than hypomanic episodes emphasized in DSM-IV OBJECTIVE The study explored the phenomenology and prognostic significance of delusions in major depressive disorder . METHOD From 452 patients with 
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This elevated risk of suicidal attempt for PMD patients remained stable across all age groups of adult patients .
CONCLUSION Despite data inconsistency and clinical heterogeneity , this systematic review and meta- analysis showed that patients with PMD are at a two-fold higher risk , both during lifetime and in acute phase , of committing a suicidal attempt than patients with non-PMD