A psychological disorder called major depressive disorder with psychotic features characterizes people who experience both symptoms of depression and psychosis, including delusions and hallucinations. A study published in the November 2002 issue of "The American Journal of Psychiatry," finds that depressive episodes with psychotic features are relatively common in the general population, affecting roughly 1 in 1,000 people. Characteristic symptoms of Major Depression with Psychotic Features are listed below.
Symptoms of Depression
Individuals with major depression typically experience feelings of persistent sadness or loss of interest in activities for most of the day, every day over an extended period. They experience changes in mood, such as irritability, tearfulness, emptiness, and hopelessness. They may have feelings of excessive guilt or worry, and may become so hopeless that they contemplate suicide, make suicidal gestures or attempt suicide. Physically, depression causes symptoms like gastrointestinal and digestive upset, fatigue, chronic aches and pains, and weight loss or gain. Memory deficits, difficulties with attention, trouble making decisions, and problems organizing thoughts are also common. Many depressed persons will also experience sleep disturbances.
According to A Healthy Place, symptoms of anxiety, insomnia, constipation, physical immobility, impaired thinking, and hypochondria are particularly common among depressed persons with psychotic symptoms.
Delusions and Hallucinations
Confused and disturbed thoughts are a hallmark symptom of a psychotic episode, and these may take the form of delusions and hallucinations. Hallucinations (perceiving things that are not truly there) and delusions (false beliefs) are two types of psychotic symptoms that may be present among those who are depressed. According to the study in the 2002 issue of "The American Journal of Psychiatry", feelings of worthlessness or guilt are good predictors of experiencing hallucinations and delusions.
Hallucinations may occur in all five senses. A depressed person may see people, animals, or other things that aren't truly there, may hear noises or voices that do not really exist, may erroneously believe things are touching or crawling on them (e.g., insects), may claim to smell scents that are not really in the air, and may report having unpleasant and inexplicable tastes in their mouth.
Delusions are unshakable false beliefs that are clearly untrue and seem bizarre to others. Delusions of grandeur are particularly common and are characterized by thoughts of immense power, wealth, or religious authority. Some may believe, for example, that they are the leader of a certain country. Others may engage in dangerous stunts, believing that they are invincible. Delusions may sometimes be paranoid in nature. For example, persecutory delusions, in which a depressed person believes people are out to punish or kill them, may occur. Hypochondriacal paranoia, involving a belief that certain physical symptoms (real or imagined) are signs of serious illness, is also common.
Confusion of Thought
Depressed persons experiencing psychotic symptoms may exhibit confused and disturbing thoughts that are sometimes expressed aloud. They may demonstrate rapid speech, chatter constantly about unconnected topics, or display an odd rhythm or pattern to their speech in which they switch from topic to topic and then abruptly lose their train of thought and stop.
Usually people experiencing paranoid or confused thoughts, delusions, and hallucinations demonstrate a lack of insight about these thoughts, appearing out of touch with reality. However, according to The Healthy Place, those with psychotic depression may often know their disturbing thoughts are untrue, and they may try to hide them from others.
References
- National Institute of Health: Major Depression with Psychotic Features
- Healthy Place: Psychotic Depression
- "The American Journal of Psychiatry;" Prevalence of Depressive Episodes With Psychotic Features in the General Population; Maurice M. Ohayon et al.; November 2002
