Mood-congruent and mood-incongruent psychotic symptoms in major depression: The role of severity and personality

Background: Whether psychotic symptoms in major depression (MD) are better explained by a severity model or by a vulnerability model, with personality as a predisposing factor, is still debated. The aim of the present study was to evaluate in MD the relationship between the content of psychotic features (mood congruent (MC) or mood incongruent (MI)) and severity of depression or personality traits. Methods: 62 inpatients affected by MD with psychotic features were divided into three groups on the basis of the content of psychotic symptoms: MC, MI, mixed MC-MI. All subjects completed the SCID-IV, the Structured Clinical Interview for DSM-IV Personality Disorders and the Hamilton Rating Scale for Depression. Personality was assessed after MD remission. Results: MI psychotic symptoms were positively associated with schizotypal traits, whereas MC symptoms were positively related to obsessive-compulsive traits and severity of depression. Patients with both MC and MI psychotic symptoms were characterized by a personality profile and depression severity standing in a middle position between the MC and MI groups. Limitations: The main limitations of the study are represented by the small sample size, the time of assessment of personality and the inclusion of only unipolar depression. Conclusions: Our findings suggest that both depression severity and personality profile, independently from each other, model the content of psychotic symptoms, confirming the validity of subgrouping psychotic depression into two distinct MC and MI types and supporting the inclusion of a third mixed MC-MI type because of its intermediate position in personality profile and severity between the MC or MI group. © 2012 Elsevier B.V.