Depression with psychotic symptoms is the combination of someone in a depressed state, who also experiences symptoms of psychosis, which can vary depending on the person. Depression with psychotic symptoms is one of the most severe and debilitating subtypes of depression. It is not nearly as common as other types of depression and in return, has been harder to diagnose and treat. Understanding the symptoms of psychotic depression can help health care professionals in identifying the causes and proper treatment.
Delusions
Delusional thoughts remain one of the most common features of someone experiencing psychotic depression. A delusional thought consists of an irrational belief about the self or others. When combined with depression, the psychotic delusional beliefs frequently manifest as negative and paranoid. Patients may feel that others are following them, plotting to kill them, talking behind their backs and so forth. A patient with psychotic depression may also feel that he is always sick or at risk for fatal infection from others. This health specific delusion is known as hypochondria. The paranoid delusional beliefs often come in waves and short breaks of clarity may occur. HealthyPlace, a mental health resource, states that patients may be fully aware that these delusional beliefs are not true and will often feel too embarrassed and ashamed to discuss them. This can further complicate a proper diagnosis separating patients from those experiencing non-psychotic depression.
Hallucinations
Hallucinations often occur with patients going through a state of psychotic depression. The hallucinations can manifest as visual or auditory, and frequently prove negative enough to pose a serious threat to the patient. Visual hallucinations may include nonexistent people, images, animals or objects. Sufferers may feel like someone or something is following them or watching them. Auditory hallucinations during psychotic depression often involve voices telling the patient that someone is after them or that they should harm themselves or others. An extreme form of psychotic depression may involve the patient hallucinating and believing themselves to have physically died, known as Cotard's Syndrome. Dr. Oliver Freudenreich, writes in "Psychotic Disorders: A Practical Guide", that patients may attempt to convince their family members that all hope is lost and that his cold dead body provides evidence that they should give up.
Suicide, Distorted Cognition and Mortality
Having suicidal thoughts remains one of the primary required diagnostic criteria for psychotic depression according the revised fourth edition of the "Diagnostic and Statistical Manual of Mental Disorders". The paranoid and nihilistic delusions of psychotic depression significantly impact a patient's chances of self harm or a completed suicide. Suicidal thoughts often go unchecked and may become obsessions due to unique cognitive distortions experienced during psychotic depression. In the June 2007 issue of "Schizophrenia Bulletin," Dr. Jennifer Keller and associates found that patients with psychotic depression proved significantly more likely to experience cognitive distortions compared to patients with non-psychotic depression. Distorted cognition and a low tendency for self-preservation can significantly impact the mortality rates of patients with psychotic depression. In the March 2003 issue of the "American Journal of Psychiatry," Dr. Meena Vythilingam and associates found that patients with psychotic depression had significantly higher rates of mortality compared to patients with non-psychotic depression.
References
- HealthyPlace: Psychotic Depression
- "Psychotic Disorders: A Practical Guide"; Dr. Oliver Freudenreich; 2007
- "Psychotic Depression": Dr. Conrad Swartz; 2007
- Schizophrenia Bulletin: Current Issues in the Classification of Psychotic Major Depression
- American Journal of Psychiatry: Psychotic Depression and Mortality
