Psychotic depression is a severe mental disorder, which is characterized by the occurrence of typical depressive signs and symptoms of psychosis. Those are hallucinations, delusions, disorientation, depersonalization, derealization, and others.
According to data, a person who suffers from psychotic depression loses the opportunity to perceive the real world full way. The patient may experience verbal hallucinations in the form of particular words or speech of one person or different “voices” of many people. He may experience visual hallucinations in the form of images of animals, people, or inanimate objects. The person with psychotic depression has rather strange and illogical, delirious ideas. In this case delirium is usually judgments about everything happening around the patient. The person suffering from this disorder spends most of his time alone. It is difficult to maintain a conversation with such a person because his thoughts and speech are illogical, inconsistent and inexpressive.
However, unlike other psychosis, the patient has a critical attitude towards his actions – a person realizes that his feelings are unnatural and illogical, thoughts are unreal. This individual often feels humiliated and ashamed, he tries to hide or disguise his feelings and delusional thoughts from others. It is rather complicated to diagnose this disease because the person hides symptoms. Keep in mind that even a single episode of psychotic depression increases the risk of the development of bipolar disorder and may trigger suicide attempts.
It is necessary to distinguish this disease from schizophrenia. The dynamics of development of psychotic depression consist of depressive components: low mood, slow movements, an inferiority complex. Although clinical cases have psychotic components but they are considered as additional components. Generally, while only certain characteristics take place not all the range of pathologies appears: for example, only hallucinations or only delusions. Since hallucinations appear the individual does not consider visions as real-life facts, he realizes that unhealthy processes occur in his psyche.
Psychotic depression causes
Genetic (hereditary) predisposition is one of leading causes of this disease. According to studies, among 80% of patients with psychotic depression their family members had various types of depression or other psychopathological disorders.
According to the biological version of the disease development, another cause is violations in the activity of the brain due to lack of chemicals responsible for the emotional background.
The nature of this disease can be a predominance of certain individual traits. People of psychasthenic type, in addition to features of irritable weakness, vulnerability and feelings of inferiority, possess self-doubt, indecision, constant inclination to doubt. Such persons are timid, shy, inactive, awkward, ill-adapted to the circumstances. Another significant trait is a tendency to morbid philosophizing, insufficient sense of reality, there is no liveliness and brightness to perceive positive events, no pursuit of self-awareness. They have an abstract, detached from the real facts, way of thinking. They always doubt the correctness of their actions plus they are rarely happy with themselves, tend to conduct useless mental process. They are easy to obey and characterized by lack of will.
It is important to mention that the condition of a person who suffers from psychotic depression during a year has a tendency to change: as a rule, depressive episodes occur during the spring or autumn.
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Psychotic depression symptoms
The symptoms of psychotic depression can be divided into two groups: the purely depressive symptoms and psychotic components.
Depressive components include:
- Low mood;
- Feelings of helplessness and hopelessness;
- The feeling of fatigue, weakness, lack of vital energy;
- Problems with concentration, inability to perform usual activities;
- Violations in regimes “sleep-wake”, sleeping problems;
- Disorders of the digestive system, weight loss or gain.
Psychotic components include:
- The visual and/or verbal hallucinations – they see something that ordinary people can’t see;
- A variety of delusions – judgments are not corresponding to reality, such judgments master the whole consciousness of the individual, they can’t be explained;
- Stupor is the state of motor and mental retardation;
- Agitation is intense excitement and restlessness, combined with irrational phobic anxiety;
- Oneiroid syndrome is dream-like disorientation with the presence of the fantastic experiences and pseudo-hallucinations, intertwined with the events of reality;
- Depersonalization is the alienation of some individual’s mental processes and distorted perception of “self”;
- Derealization is painful feeling of unreality, alienation, obscurity of the world;
- Anosognosia may occur, lack of a critical assessment of the disease.
People with psychotic depression have suicidal thoughts. Most of the patients are full of absurd ideas of their own inferiority and guilt. When psychotic depression takes place, family history of affective disorders play a certain role. This disease is characterized by high intensity of symptoms. The feature of psychotic depression is frequent fluctuations in the emotional background during the day. Typically, most depressive symptoms occur in the first half of the day and the patient’s condition gets better at night.
Psychotic depression treatment
The most effective treatment of this disorder is a combination of antidepressants, antipsychotics and other groups of antipsychotic drugs.
Continuous use of antidepressants decreases the main manifestations of the disease, regulates the biochemical processes in the body, normalizes neurotransmitter levels, and prevents the occurrence of relapses. When choosing medications, it is necessary to consider characteristics of the disease, the presence, and severity of particular symptoms. If a person has delusions and suicidal thoughts it usually used selective serotonin reuptake inhibitor (SSRI). To deal with psychotic manifestations, a group of neuroleptics is used. Antipsychotic medications influence on the functioning of neurotransmitters which function is to ensure interaction between groups of nerve cells. If there are no changes, then electroconvulsive therapy is used as an alternative method to medication.
Since this psychotic disorder is a rather complicated and dangerous disease, psychotherapeutic techniques can not be the leading methods of treatment, but are used in combination.
Since psychotic depression refers to diseases of endogenous nature, there is a high risk of secondary depressive episodes in the future. In order to avoid relapse, it is necessary to carry out preventive measures, to take medications, and not to interrupt the course of treatment.