摘要目的：探讨伴有与不伴精神病性症状抑郁症的临床特征差异及其影响因素。方法根据是否存在精神病性症状，将374例重度抑郁发作患者分成伴精神病性症状抑郁症组（ PMD）和不伴精神病性症状抑郁症组（ NMD），两组患者均完成社会人口学调查表（包括性别、年龄、婚姻状况、文化程度、家族史、疾病初发年龄、发作次数、住院次数等）及汉密尔顿抑郁量表（ HAMD）的评定。结果PMD组总阳性家族史（ PMD组47／79，NMD组104／268， P＜0．01）、精神病性障碍阳性家族史（ PMD组19／79，NMD组26／268， P＜0．01）、住院次数[PMD 组（2．52±1．29）次，NMD 组（1．39±1．31）次， P＜0．01]、HAMD总分[PMD总分（47．85±8．69）分，NMD总分（43．44±8．51）分， P＜0．01]及焦虑／躯体化[PMD组（11．40±3．28）分，NMD组（9．19±3．54）分， P＜0．01]、认知障碍因子[PMD组（12．24±3．77）分， NMD组（9．45±3．68）分， P＜0．01]显著高于 NMD组；发病年龄[PMD 组（30．09±5．17）岁，NMD 组（35．95±9．06）岁， P＜0．01]、本次病程[PMD组（1．58±0．76）月，NMD组（3．02±2．87）月， P＜0．01]、日夜变化因子分[PMD组（0．76±0．46）分，NMD组（1．01±0．51）分， P＜0．01]显著小于NMD组。 Logistic回归分析结果显示，具有精神障碍阳性家族史（β＝3．278）、发病年龄早（β＝－2．524）、认知障碍（β＝3．836）的重度抑郁症患者，伴发精神病性症状的风险性大（均P＜0．05）。结论 PMD与NMD相比，具有较多的精神疾病阳性家族史、精神病性障碍阳性家族史、临床症状重、发病年龄早、住院次数多等特点；具有精神障碍阳性家族史、发病年龄早、认知障碍严重的重度抑郁症患者，伴发精神病性症状的可能性大。

abstractsObjective To analyze the clinical features and its influencing factors of depression pa?tients with and without psychotic symptoms. Methods According to the presence of psychotic symptoms, 374 patients with major depression were divided into psychotic major depression ( PMD group,79 case) and nonpsychotic major depression ( NMD group,268 case) . All patients completed social demographic question?naire ( including gender,age,marital status,educational level,family history,positive family history of psychi?atric disorder,disease onset age,frequency of attack,times of hospitalization,etc.) and Hamilton's depression scale (HAMD?24). Results Positive family history(PMD group 47/79,NMD group 104/268, P<0.01), psychiatric disorder positive family history(PMD group 19/79,NMD group 26/268, P<0.01) and times of hospitalization(PMD group(2.52±1.29),NMD group(1.39±1.31), P<0.01) in the PMD group were signifi?cantly higher than the NMD group.HAMD total scores(PMD total score(47.85±8.69),NMD total score (43.44±8.51), P<0.01),the factor score of anxiety/somatization(PMD group(11.40±3.28),NMD group (9.19±3.54), P<0.01) and cognitive impairment(PMD group(12.24±3.77),NMD group(9.45±3.68), P<0.01) in the PMD group were significantly higher than the NMD group.Disease onset age(PMD group(30.09 ±5.17),NMD group(35.95±9.06), P<0.01),the course of the disease(PMD group(1.58±0.76),NMD group(3.02±2.87), P<0.01),the factor score of day and night change(PMD group(0.76±0.46),NMD group(1.01±0.51), P<0.01) in PMD group were significantly lower than the NMD. Logistic regression anal?ysis showed the major depression with positive family history of mental disorders( β=3.278) ,attack in early age( β=-2.524),seriously cognitive dysfunction in patients( β=3.836) may indicate the psychotic symp? toms( P<0.05).Conclusion PMD patients more positive family history,psychiatric disorder positive family history,likely to be hospitalization,severe symptoms and attack in early age compared with NMD. With posi?tive family history of mental disorders,attack in early age,seriously cognitive dysfunction in patients with ma?jor depression may indicate the psychotic symptoms.