Dysglycemia prevalence and risk factors differ in middle-aged first-episode drug-naïve patients with psychotic versus non-psychotic depression

Psychotic major depression (PMD) is a severe subtype of major depressive disorder (MDD). This study explored the relationship between dysglycemia and psychotic symptoms in middle-aged patients with first-episode, drug-naïve (FEDN) PMD. In this cross-sectional study, 1718 patients aged 18–60 were assessed, including 601 middle-aged FEDN MDD outpatients, 12.6% of whom had psychotic symptoms. To evaluate patient anxiety, depression, and psychotic symptoms, the study utilized the 17-item Hamilton Depression Rating Scale (HAMD), the 14-item Hamilton Anxiety Rating Scale (HAMA), and the positive subscales of the Positive and Negative Syndrome Scale (PANSS). Fasting blood samples were collected. Patients with psychotic symptoms were older, had later depression onset, higher suicide attempt rates, and more severe anxiety. Middle-aged patients with FEDN PMD showed a significantly higher prevalence of dysglycemia compared to those without psychotic symptoms. Notably, dysglycemia was associated with thyroid dysfunction. Additionally, logistic regression analysis revealed that anti-thyroid peroxidase (A-TPO) antibodies and TSH levels served as significant risk factors for dysglycemia, with area under the curve (AUC) values of 0.889 and 0.794, respectively. Middle-aged FEDN MDD patients with psychotic symptoms exhibit a higher prevalence of dysglycemia relative to their non-psychotic counterparts, highlighting the need for integrated psychiatric and metabolic management. A-TPO and TSH may serve as predictors. Future studies should explore long-term outcomes and targeted interventions.