Psychotic depressive disorder, more commonly known as major depressive disorder with psychotic features, is the most severe form of depression. It's much less common than other types of depression. It is a serious illness that carries significant risks and must be treated by a psychiatrist, usually in a hospital setting.
Definition
According to the DSM IV-TR, the standard diagnostic text in psychiatry, a diagnosis of major depression with psychotic features requires a combination of severe depression and psychosis. Symptoms of severe depression include depressed mood, loss of energy, difficulty sleeping, fatigue, feeling worthless, guilt, hopelessness and thoughts of suicide. Psychosis means that the patient has delusions, which are fixed ideas with no basis in reality, or hallucinations, in which the patient might hear or see things that do not exist. The delusions in this illness are usually consistent with a depressive theme. The patient feels, for example, that they are responsible for a major natural catastrophe.
Diagnostic Considerations
When evaluating a patient with psychotic depression, the physician must rule out the presence of an underlying medical illness. Examples include medications that can cause these symptoms and neurological illnesses such as a brain tumor.
Psychotic depression can be confused with other psychiatric illnesses such as schizophrenia. Unlike schizophrenia, the psychotic features occur only when the patient is severely depressed.
Prevalence
About 14 percent of major depressive episodes are accompanied by psychotic features. About 0.35 percent of the population will suffer from psychotic depression at some point. It is more common in older people.
Course of Illness
Psychotic depression has a more difficult course than non-psychotic depression. Patients take longer to get better, are more likely to commit suicide and less likely to return to normal functioning.
Treatment
Treatment of depression with psychotic features almost invariably includes hospitalization. The patient is too ill and too detached from reality to function on his own. He may be in danger of hurting himself or someone else. Mothers with newborns or small children require special attention in this matter since there is a serious risk of harm to their children. The treatment of psychotic depression requires a combination of an antidepressant such as sertraline and an antipsychotic such as olanzapine. Alternatively, electroconvulsive therapy can be used.
References
- "Archives of Grneral Psychiatry"; Lifetime Prevalence of Psychotic and Bipolar I Disorders in a General Population; Jonna Perala et al.; Jan 2007
- "Schizophrenia Bulletin: Current Issues in the Classification of Psychotic Major Depression"; Jennifer Keller et al.; 2007 33(4):887-885
- "Diagnostic and Statistical Manual of Mental Disorders DSM IV-TR"; American Psychiatric Association; 2000
