40 Quinlan et al. © 1997 WILEY-LISS, INC. DEPRESSION AND ANXIETY 6:40–42 (1997) PSYCHOTIC VERSUS NONPSYCHOTIC DEPRESSION IN HOSPITALIZED ADOLESCENTS Paul E. Quinlan, D.O.,* Cheryl A. King, Ph.D., Gregory L. Hanna, M.D., and Neera Ghaziuddin, M.D. One hundred fifty adolescent inpatients with major depression were systemati- cally assessed for demographic and clinical differences between psychotic and non- psychotic depression. Delusions and/or hallucinations were present in 10% of the subjects. The psychotic group had significantly more frequent and severe suicidal ideation. Posttraumatic stress disorder was also more frequent in the psychotic group. Depression and Anxiety 6:40–42, 1997. © 1997 Wiley-Liss, Inc. Key words: depression; psychosis; suicidality; posttraumatic stress disorder; adolescence Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of Michigan Medical Center, Ann Ar- bor, MI *Correspondence to: Paul E. Quinlan, D.O., Department of Psy- chiatry, Child and Adolescent Psychiatric Hospital, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0390. Received for publication 20 December 1996; Revised 29 May 1997; Accepted 30 June 1997 INTRODUCTION The prevalence of psychotic symptoms in studies of adolescents with major depression has ranged from 18% in a predominately outpatient sample (Ryan et al., 1987) to 45% in a sample of hospitalized adoles- cents (Haley et al., 1988). Psychotic depression in clinical samples of adolescents has been associated with sexual abuse and alcohol/drug use (Ryan et al., 1987; Haley et al., 1988). In one study of homeless adolescents, psychotic symptoms were associated with depression severity, suicidal ideation, physical/sexual abuse, and drug use (Mundy et al., 1990). However, the previous studies described a minimal number of psychotically depressed adolescents, and none of them used a structured interview to assess comorbid condi- tions such as posttraumatic stress disorder (PTSD). Because of the limited information on psychotic mood disorders in youth, the present study systematically as- sessed 150 adolescent inpatients with major depres- sion for demographic and clinical differences between psychotic and nonpsychotic depression. The present results provide evidence for increased rates of suicide and PTSD in psychotically depressed adolescents. METHODS The subjects were 150 adolescents with major de- pression from a total of 265 adolescents consecutively admitted to the adolescent psychiatry inpatient pro- gram of a university medical center during a 2-year period. Subjects were 12–18 years of age. Psychotic symptoms sufficient for a diagnosis of major depres- sion with psychotic features were present in 15 (10%) of the subjects. Exclusion criteria were mental retarda- tion, pervasive developmental disorder, organic mental disorder, bipolar disorder, schizophrenia, delu- sional disorder, and psychotic disorders not classified elsewhere. Informed consent to participate in research was obtained from each adolescent and parent or guardian. The computerized version of the Diagnostic Inter- view Schedule for Children (C-DISC) was completed independently by the adolescent, parent/guardian, or both (Fisher et al., 1993). The C-DISC was supple- mented with the PTSD section of the Diagnostic In- terview for Children and Adolescents (Welner et al., 1987), clinical admission interviews, and behavioral observations. Consensus diagnoses were made using all sources of information according to DSM-III-R criteria (American Psychiatric Association, 1987). A demographic/medical history form was completed for each subject by the parent/guardian. In addition to a routine admission medical evaluation, all psychotic pa- tients received the following studies to rule out medical illnesses associated with psychosis: antinuclear antibody, B 12 , folate, ceruloplasmin, copper, lysosomal enzymes, serum lactate and pyruvate, urine amino acids, urine por- phyrin screen, computed tomographic head scan with contrast, and sleep-deprived electroencephalogram. De- pression severity was assessed with the Children’s De- pression Rating Scale-Revised (CDRS-R; Poznanski et al., 1984) and the Reynolds Adolescent Depression Scale (RADS; Reynolds, 1987). Presence and severity of sui- cidal ideation were assessed with the Suicidal Ideation Questionnaire-JR (SIQ-JR; Reynolds, 1988).