Table I.

Diagnostic features and treatment considerations in elderly patients with psychosis and depressive symptoms

Major depression with psychosis	Schizophrenia with major depressive episodes	Schizoaffective disorder	Schizophrenia with subsyndromal depression
Diagnostic features
Major depression in which psychosis occurs only with mood disturbance	Schizophrenia with episodes of major depression	Schizophrenia with episodes of mania and/or major depression	Schizophrenia without major depressive and/or manic episodes
Predominantly a mood disorder	Predominantly a thought disorder	Predominantly a thought disorder	Predominantly a thought disorder
Can have cognitive deficits	Includes post-psychotic depression	Requires 2-week psychosis without mania and/or major depression	Can have cognitive deficits
	Does not meet criteria for schizoaffective disorder	Mood symptoms are present for substantial portions of the total duration of the active or residual periods of the illness
		Can present with subsyndromal depressive symptoms
		Includes post-psychotic depression Can have cognitive deficits
Somatic treatment
ECT or antidepressant + atypical antipsychotic	First optimize dose of atypical antipsychotic; if needed, add antidepressant, preferably an SSRI	First optimize dose of atypical antipsychotic; if needed, add antidepressant, preferably an SSRI	First optimize atypical antipsychotic monotherapy; if needed, add antidepressant, preferably an SSRI

ECT = electroconvulsive therapy; SSRI = selective serotonin reuptake inhibitor.