Clinical Manual for Diagnosis and Treatment of Psychotic Depression

Examples of psychotic depression are in the media all too often: the mother who inexplicably drowns her children in a bathtub and the quiet graduate student who kills his teacher and classmates, then turns the gun on himself. These are unfortunate examples of psychotic depression—a serious, life-threatening illness that, while treatable, is often overlooked or mismanaged by mental health professionals, with tragic results.

Dr. Rothschild states in his preface that he wrote this book to help clinicians better recognize and treat psychotic depression. He believes that it is frequently missed as a diagnosis, often being mistaken as simple depression or as paranoid schizophrenia. Being incomplete, both diagnoses lead to treatment errors and bad outcomes. He believes that the general lack of clarity about the illness results from too few clinicians' having specialized in its treatment, a misperception that its incidence is rare, and almost no relevant research studies. Dr. Rothschild cites research indicating that from 16% to 54% of patients diagnosed as having major depression may instead have psychotic depression. The author backs up his allegations about psychotic depression's being an "orphaned disorder" with the sobering facts that from 1983 to 2003 the National Institute of Mental Health did not fund one study of medication treatment for the disorder and that no treatments of the disorder have been approved by the Food and Drug Administration. He also points out that the second edition of the American Psychiatric Association's Practice Guidelines for the treatment of patients with major depressive disorder, published in 2000, dedicates only one paragraph to the treatment of psychotic depression.

Dr. Rothschild is the perfect champion for bringing his concerns to the psychiatric community; he has spent 25 years in both the clinical and research settings diagnosing, studying, and treating patients who have psychotic depression. He is a professor of psychiatry at the University of Massachusetts Medical School. His book is an attempt to summarize his vast experience into an evidenced-based, approachable, pragmatic manual. The guide has utility for the clinical psychiatrist in practice as well as for those in training, clinical researchers, general practitioners, neurologists, psychiatric nurses, and others in the mental health professions.

The book is a thorough overview of the disorder and is organized into chapters that cover epidemiology, family studies and genetics, biology, diagnosis, treatment, and special populations. The book also includes a chapter on the nursing care of psychotic depression, written by Judith Shindul Rothschild, Ph.D., R.N., C.S. Of particular interest is a somatic algorithm for the treatment of psychotic depression and a helpful overview of electroconvulsive therapy. Each of the chapters concludes with a bulleted list of clinical pearls as well as cited references and recommended readings for further study. The book is concise, well written, and easily referenced.

In summary, this manual goes a long way toward filling the gaps in our understanding of psychotic depression while giving strong clinical guidelines for improving the treatment of those with the disorder. It is a welcome addition to any mental health professional's library.