***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 examine the association between baseline suicidality and outcome of major depression in a r and omized controlled trial of the pharmacotherapy of psychotic depression and to explore the interaction of suicidality , r and omized treatment assignment , and depression outcome . METHODS This study was a secondary analysis of data from 258 persons aged 18 years or older with DSM-IV-defined major depressive disorder with psychotic features who participated in a 12-week r and omized controlled trial ( RCT ) comparing  olanzapine plus sertraline with olanzapine plus placebo ( the Study of the Pharmacotherapy of Psychotic Depression [ STOP-PD ] , which ran from 2002 to 2007 ) . The independent variable was baseline suicidality , defined by 4 groups ( suicide attempt in the current episode , active suicidal ideation , passive suicidal ideation , and no suicidality ) . The outcome variables were change in 16-item Hamilton Depression Rating Scale ( HDRS₁₆ ) total score ( excluding the suicide item ) over time and remission of psychotic depression over time . RESULTS Suicidality groups did not significantly differ on baseline HDRS₁₆ total score . Baseline suicidality group was significantly associated with change in HDRS₁₆ score over time in the sample as a whole ( F₃,₁₃₉₄ = 8.17 ; P < .0001 ) , but was not significantly associated with probability of remission over time . Among participants assigned to olanzapine and placebo , persons with no suicidality had a significantly greater reduction in HDRS₁₆ total score compared to those with passive suicidal ideation ( 7.5-point difference in change scores between the 2 groups ; 95 % CI , 4.3 - 10.7 t₁₃₉₄ = 4.61 , P < .0001 ) , active suicidal ideation ( 4.4 points ; 95 % CI , 1.4 - 7.4 ; t₁₃₉₄ = 2.85 , P = .0176 ) , or suicide attempts ( 6.1 points ; 95 % CI , 2.8 - 9.4 ; t₁₃₉₄ = 3.66 , P = .0015 ) . The 12-week change from baseline in HDRS₁₆ score for patients with no suicidality was not significantly different between the 2 treatment arms . However , the 12-week HDRS₁₆ improvement was significantly greater in the olanzapine plus sertraline arm , compared with the olanzapine plus placebo arm , for patients with suicide attempts ( 8.7-point difference in change scores between the 2 groups ; 95 % CI , 5.1 - 12.4 ; t₁₃₉₄ = 4.75 , P < .0001 ) , active suicidal ideation ( 8.1 points ; 95 % CI , 4.5 - 11.7 ; t₁₃₉₄ = 4.38 , P < .0001 ) , or passive suicidal ideation ( 5.7 points ; 95 % CI , 2.2 - 9.2 ; t₁₃₉₄ = 3.23 , P = .0012 ) , respectively . CONCLUSIONS Baseline suicidality predicted worse acute treatment outcome of psychotic depression . However , participants with suicidality had a better outcome when treated with the combination of olanzapine and sertraline than when treated with olanzapine plus placebo . TRIAL REGISTRATION Clinical Trials.gov identifier : 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 OBJECTIVE Most efforts to describe the prognostic significance of psychotic features in depression have been limited to single assessment s 1 year or less after the initial evaluation . However , the various biological and treatment response differences between patients with psychotic and nonpsychotic depression suggest that prognostic differences may be very long-term . METHOD The 787 patients described here entered the study as they sought treatment at one of five academic medical centers ; they had either RDC major depressive disorder or schizo-affective depression ( other than the mainly schizophrenic subtype ) and completed at least 6 months of follow-up . Of these , 144 ( 18.3 % ) had psychotic depression as defined here . Patients provided follow-up interviews at 6-month intervals for 5 years and annually thereafter ; 98 of those with psychotic depression and 434 of those with non-psychotic depression were followed for 10 years . RESULTS Those who began follow-up with psychotic depression had fewer weeks with minimal symptoms in each of the 10 years of follow-up and reported more psychosocial impairment at both 5 and 10 years . Both the index episode and the first recurrence of psychotic depression lasted longer than nonpsychotic episodes , but nonpsychotic episodes among previously psychotic individuals were relatively brief . Intervals between episodes were significantly shorter for patients who had ever been psychotic . CONCLUSIONS Together with evidence that psychotic features are highly recurrent , these data show 1 ) that psychotic features denote a lifetime illness of greater severity and 2 ) that within individuals , psychotic features may emerge in only the more severe episodes 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 OBJECTIVE The study explored the phenomenology and prognostic significance of delusions in major depressive disorder . METHOD From 452 patients with DSM-III major depression , we selected those with at least one belief fulfilling both DSM-III prerequisites for a delusion ( i.e. , being of " delusional proportions " and being maintained with " delusional intensity " ) . These patients were compared to the others with respect to demographic , historical , and index episode features ; time spent in a depressive episode during a prospect i ve observation period ; and 10-year outcome . The same comparisons were made between patients with mood-incongruent delusions  and those with mood-congruent delusions only . The study covered the period between January 1 , 1978 , and December 31 , 2005 . RESULTS About 20 % of patients had at least one delusion in their index episode . An additional 5.3 % had a belief fulfilling only one of the DSM-III prerequisites for a delusion . In about one quarter of delusional patients , the index episode was not " severe . " Almost 10 % of delusional patients had both mood-congruent and mood-incongruent delusions . In patients with delusions , time to syndromal recovery from index episode was longer and antipsychotic medication was more frequently used ( both p < .0001 ) . The presence of delusions predicted a higher depressive morbidity during the prospect i ve observation period ( p < .05 ) , but not a poorer 10-year outcome . No variable discriminated patients with mood-incongruent delusions from those with mood-congruent delusions only . CONCLUSION The presence of delusions in a major depressive episode has significant therape 
    Output:
    
Our meta- analysis may provide evidence that the presence of psychosis increases the risk of suicide in patients suffering from severe depression .
Conclusions The presence of psychosis in major depression should alert clinicians for the increased risk of completed suicide .