Psychotic depression: symptoms, causes and treatments

Psychological alterations or illnesses tend to alter or alter the way people perceive themselves and their environment. Sometimes this distortion can become so severe that a condition such as depression ends up exhibiting symptoms typical of psychosis.

This is what happens with psychotic depression, A rare subtype of depression that will be discussed throughout this article and which can appear in people who have already had multiple episodes of major depression.

    What is psychotic depression?

    Psychotic depression, also known as depressive psychosis, is a subtype of depression that occurs when severe depression includes a form of psychosis in its symptom box. According to statistical data, this type of psychotic depression typically affects about one in four people admitted to hospital with a diagnosis of depression.

    Psychosis in depression can manifest as hallucinations of any kind, such as voices telling the person they are of no value; delusions in the form of intense feelings of worthlessness and failure or directly cause the patient to completely break with reality.

    As we can see, although these are symptoms of a psychotic illness, their content is strongly related to some of the characteristics of depression, like low self-esteem.

    Although psychotic depression is a diagnostic qualification in itself, it can also appear in the context of bipolar disorder or major depressive disorder. Moreover, due to its similarities, it is very often mistaken for schizoaffective disorder. However, this diagnosis requires the presence of purely psychotic symptoms for at least two weeks. In other words, no depressive or mood symptoms.

    Regarding unipolar psychotic depression, requires psychotic symptomatology to manifest itself only during episodes of major depression. The diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) state that, for the correct diagnosis of psychotic depression, the patient must meet the requirements of a major depressive episode, as well as the criteria of “characteristics”. psychotics ”prescriber.

      How is it different from other psychoses?

      Traditionally, it is understood that a person suffering from some type of psychosis is a person disconnected from reality. These patients may hear voices or present strange and illogical ideas, Among many other symptoms.

      When these symptoms are part of a diagnosis of psychotic depression, they often lead to behaviors such as tantrums and anger for no apparent reason, sleeping during the day to stay awake all night, neglecting your image and personal hygiene. , and even, difficulty communicating with other people.

      On the other hand, people who suffer from other types of mental illnesses, such as schizophrenia, also experience psychotic symptoms. However, in psychotic depression, delusions or hallucinations are consistent with the arguments for depression. While the content of the psychotic symptoms of schizophrenia is generally strange and improbable and unrelated to a mood.

      In addition, in psychotic depression, patients are often ashamed of their thoughts, so they try to hide them. For this reason, this type of depression is a bit difficult to diagnose. however, accurate diagnosis is very importantBecause, in addition to influencing treatment, episodes of psychotic depression are a risk factor for the development of bipolar disorder with recurrent episodes of psychotic depression, mania and even suicide.

      What are the symptoms?

      People with psychotic depression have symptoms of a major depressive episode, including: feeling of hopelessness, worthlessness or guilt, constant fatigue, social withdrawal and restlessness and irritability; accompanied by one or more psychotic symptoms, including delusions and hallucinations. The patient may also have any of the following symptoms:

      • Severe anhedonia.

      • psychomotor retardation.
      • Anxiety.
      • Constipation.
      • Hypochondria.

      • insomnia.
      • Physical immobility.

      What are the causes?

      Although, as of yet, it has not been determined what exact factors cause the development of psychotic depression, it has been observed that psychotic symptoms tend to develop after the person has gone through several episodes of depression without psychosis. Also, once these psychotic symptoms appear, they tend to reappear with each future depressive episode.

      It has also been observed that families in which any of its components have experienced psychotic depression have a higher risk of psychotic depression and schizophrenia. This indicates a possible genetic component of this disease.

      A large number of patients with psychotic depression report having experienced a first episode of depression between the ages of 20 and 40. As with other types of depression, psychotic depression is also usually episodic, with symptoms appearing over a period of time and diminishing over time. Outraged, these people tend to function well both socially and professionally between depressive episodes.

      Finally, while psychotic depression can be considered chronic when it persists for more than two years, most depressive episodes last less than 24 months.

      What is the treatment and prognosis?

      Usually, treatment for psychotic depression is carried out in a hospital setting, so that the patient can be monitored to ensure maximum safety.

      It is usually carried out pharmacological treatment accompanied by psychological therapies which facilitate the patient’s integration into his environment. In pharmacological treatment, combinations of antidepressants and antipsychotic drugs are often used.

      While antidepressants help stabilize mood, antipsychotics allow the brain to perceive and organize information from the environment around the person.

      Appropriate treatment for psychotic depression can become very effective, allowing the patient to recover within several months. However, due to the episodic nature of the disease, continuous medical monitoring is necessary.

      In the most severe cases or those which do not respond to pharmacological treatment, the application of electroconvulsive therapy may be necessary.

      When it comes to the prognosis for this disease, it tends to be much more positive than other psychiatric diagnoses such as schizoaffective disorder. However, people who experience a psychotic depressive episode they are more likely to relapse and kill themselves. Hence the need for close monitoring.

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