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Psychotic depression (PD) is classified as a sybtype of severe depression in the current diagnostic manuals. Accordingly, it is a common conception that psychotic features in depression arise as a consequence of depressive severity.
To determine whether the severity of depression and psychosis correlate in accordance with the “severity-psychosis” hypothesis and to detect potential differences in clinical features of psychotic and non-psychotic depression (non-PD).
We aimed to answer the following questions:
Does the clinical profile differ between patients with PD and non-PD?
Is the severity of depression and psychosis correlated in patients with depression?
Quantitative analysis of Health of the Nation Outcome Scales (HoNOS) scores from all patients admitted to a Danish general psychiatric hospital between 2000 and 2010 due to a severe depressive episode.
A total of 357 patients with severe depression, of which 125 (35%) were of the psychotic subtype, formed the study sample. Mean HoNOS scores at admission differed significantly between patients with non-PD and PD on the items hallucinations and delusions (non-PD = 0.33 vs. PD = 1.37, p < 0.001), aggression (non-PD = 0.20 vs. PD = 0.36, p = 0.044) and on the total score (non-PD = 10.55 vs. PD = 11.87, p = 0.024). the HoNOS scores on the two items “depression” and “hallucinations and delusions” were very weakly correlated (Spearman coefficient = 0.12).
The results suggest that the severity of depression is unlikely to be the key determinant for the development of psychosis and supports the hypothesis that the psychotic- and non-psychotic subtypes of depression are in fact distinct clinical syndromes.
Landscapes that are rhythmically dissected by natural drainage channels exist in various geologic and climatic settings. Such landscapes are characterized by a length-scale for the lateral spacing between channels. We observe a small-scale version of this process in the form of beach rills and reproduce channelization in a table-top seepage experiment. On the beach as well as in the experiments, channels are spontaneously incised by surface flow, but once initiated, they grow due to water emerging from underground. Field observation and experiment suggest the process can be described in terms of flow through a homogeneous porous medium with a freely shaped water table. According to this theory, small deformations of the underground water table amplify the flux into the channel and lead to further growth, a phenomenon we call ‘Wentworth instability’. Piracy of groundwater can occur over distances much larger than the channel width. Channel spacing coarsens with time, until channels reach their maximum length.
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