PMD misdiagnosis
Research type
Research Study
Full title
Diagnosis in psychotic major depression
IRAS ID
287774
Contact name
Margaret Heslin
Contact email
Sponsor organisation
Kings College London and South London Maudsley NHS Foundation Trust
Duration of Study in the UK
0 years, 8 months, 1 days
Research summary
Research Summary
Psychotic Major Depression (PMD) is a mental health disorder in which people experience low mood and hallucinations of delusions. It is often misdiagnosed as non-psychotic depression but it is unclear why. Hypotheses from the literature for why this is the case includes hallucinations/delusions not being asked about, patients not recognising their symptoms so do not disclose them even when asked, or patients recognising their experiences as symptoms but not being comfortable disclosing them to clinicians.
We will address the current evidence gap by examining the experiences and views of people with PMD in the process of them gaining the diagnosis of PMD. There are three study objectives:
1. To explore the timeline and context of how people received a diagnosis of PMD;
2. To explore what factors led to or was a barrier to getting a diagnosis of PMD;
3. To explore what factors might have led to an earlier diagnosis of PMD.We will recruit 15-20 people with a diagnosis of PMD through the ‘consent for contact’ register held by the NIHR Maudsley Biomedical Research Centre. Additional recruitment will occur through clinicians working with people with mood disorders.
We will use individual semi-structured in-depth interviews to ask people about their views and experiences. Open-ended questions will be based on a list of prompts used to target the following topics:
1. Pre-diagnosis.
2. Initial contact with mental health services.
3. Journey to diagnosis, including misdiagnosis and late diagnosis.
4. What could have happened earlier.
5. Clinician approaches.Summary of Results
Psychotic Major Depression (PMD) is a mental health disorder in which people experience depression (low mood) and hallucinations (seeing or hearing things that others cannot) and/or delusions (false beliefs about the world or self). It is often misdiagnosed as regular depression but there are no actual studies investigating why this is. Some researchers think that reasons for this could include hallucinations/delusions not being asked about, patients not recognising their symptoms so do not disclose them even when asked, or patients recognising their experiences as symptoms but not being comfortable disclosing them.
We aimed to investigate this by talking to people with a diagnosis of PMD about their experiences and views of their diagnosis and the process of getting their diagnosis. The research team talked to 10 people with a diagnosis of PMD. Interviews were recorded and then written out word for word. We then used this data to create a thorough overview of what people told us.
From the interviews, four key topics were identified: difficulty retelling the story, barriers to symptom identification, experiences following disclosure, and responses to diagnosis. The key topic of barriers to symptom identification highlighted that hallucinations and delusions can be overlooked by health professionals. People with PMD reported that health professionals do not always check for these symptoms. People with PMD also reported having difficulty verbalising their symptoms, or find it difficult to disclose due to stigma, fear or shame. Short/rushed appointments, lack of consistency with health professionals, being moved between services and medicalising language made disclosure of symptoms less likely.
We concluded that psychotic major depression should be considered as a possible diagnosis by healthcare professionals when assessing a person who has come in with depression. Healthcare professionals should be mindful of the specific barriers to disclosure of psychotic symptoms, and building rapport with the patient should be prioritised to facilitate disclosure.
REC name
South Central - Oxford C Research Ethics Committee
REC reference
20/SC/0381
Date of REC Opinion
4 Dec 2020
REC opinion
Further Information Favourable Opinion