How does major depressive disorder with psychotic features differ from a primary psychotic disorder?

• A. In MDD with psychotic features, mood symptoms occur only during mood episodes and mood symptoms are prominent; primary psychosis shows psychotic symptoms independent of mood, with mood symptoms less prominent.
• B. In MDD with psychotic features, there are never mood symptoms.
• C. Primary psychosis always has prominent mood symptoms.
• D. There is no difference.

Answer: (A)

The main idea here is how the timing of mood and psychotic symptoms distinguishes these conditions. In major depressive disorder with psychotic features, the psychotic symptoms occur only during depressive episodes and the mood disturbance is prominent. When the depressive mood lifts, the psychosis tends to resolve or become much less prominent. In a primary psychotic disorder, the psychotic symptoms arise independently of mood, and mood symptoms are not a defining or dominant part of the illness. This difference matters for treatment, since depressive features with psychosis call for approaches targeting mood symptoms in addition to psychosis (often antidepressants plus antipsychotics), whereas primary psychotic disorders are treated mainly with antipsychotics, with mood symptoms playing a far less central role.