Risks for Insulin Resistance and Metabolic Syndrome Between Major Depressive Disorder (MDD) or MDD With Psychotic Features

• The primary measure is any change in fasting insulin from admission to discharge while subjects are inpatient. [ Time Frame: Measure fasting insulin at two timepoints; to determine change from baseline (admission) and discharge ] [ Designated as safety issue: No ]
  To preserve statistical power, we will measure insulin as a continuous variable rather than dichotomizing participants into insulin sensitive vs insulin resistant.
  
  

• The first secondary measure is a fasting lipid panel, including fasting total cholesterol, fasting LDL, fasting HDL, and fasting triglycerides; we want to measure a change in data from admission to discharge [ Time Frame: Two separate timepoints during inpatient hospitalization; first within 5 days of admission, and second within 72 hours of scheduled discharge ] [ Designated as safety issue: No ]
  
• Fasting glucose will be a separate secondary outcome measure; we want to measure a change in data from admission to discharge [ Time Frame: Two separate timepoints during inpatient hospitalization; first within 5 days of admission, and second within 72 hours of scheduled discharge ] [ Designated as safety issue: No ]
  
• Waist Circumference; we want to measure a change in data from admission to discharge [ Time Frame: Two separate timepoints during inpatient hospitalization; first within 5 days of admission, and second within 72 hours of scheduled discharge ] [ Designated as safety issue: No ]
  Waist circumference will be measured once at admission and once at discharge to determine if any changes have occurred throughout time of inpatient hospitalization
  
  
• Urine microalbumin; we want to measure a change in data from admission to discharge [ Time Frame: Two separate timepoints during inpatient hospitalization; first within 5 days of admission, and second within 72 hours of scheduled discharge ] [ Designated as safety issue: No ]
  
• C-reactive Protein; we want to measure a change in data from admission to discharge [ Time Frame: Two separate timepoints during inpatient hospitalization; first within 5 days of admission, and second within 72 hours of scheduled discharge ] [ Designated as safety issue: No ]
  
• Homocysteine; we want to measure a change in data from admission to discharge [ Time Frame: Two separate timepoints during inpatient hospitalization; first within 5 days of admission, and second within 72 hours of scheduled discharge ] [ Designated as safety issue: No ]
  
• Blood pressure (supine & standing as available) [ Time Frame: We will be measuring this continuously throughout inpatient hospitalization, beginning at time of admission ] [ Designated as safety issue: No ]
  
• Cortisol; we want to measure a change in data from admission to discharge [ Time Frame: Two separate timepoints during inpatient hospitalization; first within 5 days of admission, and second within 72 hours of scheduled discharge ] [ Designated as safety issue: No ]
  Cortisol levels will be measured before and after a dexamethasone suppression test is administered at admission and discharge
  
  

Metabolic syndrome (MS) is a combination of medical problems that can increase the risk of heart disease and diabetes in some people. People with MS can have some or all of the following:

• High blood glucose
• High blood pressure
• Abdominal obesity
• Low levels of high-density lipoprotein (HDL) cholesterol
• High levels of triglycerides

Some studies have shown that people with certain disorders have a greater risk for developing MS. This may be because of a combination of factors, including but not limited to the type of medications used, age, and whether or not someone smokes. This study will also aim to learn more about a naturally-occurring stress hormone called cortisol that is made in the body.

In order to measure these factors, the following things will occur:

• administer a number of questionnaires
• gather information from medical history
• gather information about current psychiatric mood
• draw blood and collect a urine sample

To study the amount of cortisol in the body, a dexamethasone suppression test (DST) will be given. This test involves taking a single 1mg pill of dexamethasone, a steroid, and numerous blood draws. Like any drug, it has some risks, however it is unlikely any side effects will occur because of the low dose administered.