Which clinical feature best distinguishes Major Depressive Disorder (MDD) with psychotic features from MDD without psychotic features?

Question

Accepted Answer

A. Presence of mood-congruent delusions or hallucinations. ## Distinguishing Feature: Psychotic Symptoms

**Key Point:** The hallmark discriminator between MDD with psychotic features and MDD without psychotic features is the presence of delusions or hallucinations that occur exclusively during the depressive episode.

### Defining Characteristics of MDD with Psychotic Features

**High-Yield:** In MDD with psychotic features, the psychotic symptoms are **mood-congruent** — they align thematically with the depressive mood state. Common examples include:
- Delusions of guilt, worthlessness, or poverty
- Delusions of deserved punishment
- Nihilistic delusions (e.g., body rotting, being dead)
- Hallucinations with depressive content (voices accusing or condemning)

**Clinical Pearl:** Mood-congruent psychosis in depression carries a worse prognosis and typically requires combination treatment (antidepressant + antipsychotic), whereas non-psychotic MDD may respond to antidepressant monotherapy.

### Comparison Table: MDD vs. MDD with Psychotic Features

| Feature | MDD without Psychosis | MDD with Psychotic Features |
| --- | --- | --- |
| **Delusions/Hallucinations** | Absent | Present (mood-congruent) |
| **Mood Severity** | Mild to severe | Usually severe |
| **Vegetative Symptoms** | Present | Present |
| **Duration Criterion** | ≥2 weeks | ≥2 weeks |
| **Treatment** | Antidepressant monotherapy often sufficient | Antidepressant + antipsychotic required |

**Warning:** Do not confuse mood-congruent psychosis in depression with mood-incongruent psychosis (seen in schizophrenia or bipolar disorder), where delusions are unrelated to mood themes.

**Mnemonic:** **MCP** = **Mood-Congruent Psychosis** is the defining feature that separates MDD with psychotic features from non-psychotic MDD.

Answer

B. Duration of depressive episode exceeding 2 weeks

Answer

C. Severity of depressed mood and anhedonia

Answer

D. Presence of vegetative symptoms such as sleep and appetite disturbance

Which clinical feature best distinguishes Major Depressive Disorder (MDD) with psychotic features from MDD without psychotic features?

Explanation

Distinguishing Feature: Psychotic Symptoms

Defining Characteristics of MDD with Psychotic Features

Comparison Table: MDD vs. MDD with Psychotic Features

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Feature	MDD without Psychosis	MDD with Psychotic Features
Delusions/Hallucinations	Absent	Present (mood-congruent)
Mood Severity	Mild to severe	Usually severe
Vegetative Symptoms	Present	Present
Duration Criterion	≥2 weeks	≥2 weeks
Treatment	Antidepressant monotherapy often sufficient	Antidepressant + antipsychotic required