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Psychotic Depression


Presentation

  • “In older people, delusions of poverty or somatic delusions, for example, believing one is suffering from a fatal illness, are more likely to be present.”[psycom.net]
  • When at least one or two of these psychotic symptoms are present during an episode of depression, it constitutes psychotic depression.[betterhelp.com]
  • One of these specific presentations is the presence of symptoms that qualify for a diagnosis of MDD along with displaying hallucinations and/or delusions.[deserthopetreatment.com]
  • Anxiety disorders—such as PTSD or OCD—can be difficult to distinguish from psychotic depression when they present with sensory disturbance.[mdedge.com]
  • This case highlights the importance of baseline tests when assessing patients presenting with mental health symptoms, and the presence of high serum calcium should prompt psychiatrists to consider testing for levels of parathyroid hormone and vitamin[progressnp.com]
Family History of Depression
  • Additionally, those with a family history of depression or psychotic illness are more prone to psychotic depression.[psychcentral.com]
Hearing Impairment
  • You can help people who are either hearing impaired or non native English speaking. By doing this, you are helping others and strengthening our community.[youtube.com]
Fidgeting
  • This means not being able to relax or sit still and constantly fidgeting. If you have psychotic depression you may also have psychomotor retardation. This is when your thoughts and physical movements slow down.[www2.hse.ie]
  • This means not being able to relax or sit still, and constantly fidgeting. At the other extreme, a person with psychotic depression may have "psychomotor retardation", where both their thoughts and physical movements slow down.[nhs.uk]
Neglect
  • A person with psychotic depression may neglect appearance by not bathing or changing clothes. Or that person may be hard to talk to. Perhaps he or she barely talks or else says things that make no sense.[webmd.com]
  • Yet one component of psychotic illness, despite having the potential to be equally (if not more) informative on these challenges, is conspicuous in its neglect: major depressive disorder with psychotic features (MDDP).[academic.oup.com]
  • Because of unsettling experiences not grounded in reality on top of the devastating experience of depression, sufferers of psychotic depression may be at great risk of self-neglect or of harming themselves or others.[brightquest.com]
  • More specifically, a person with psychotic depression may: Have inappropriate emotional outbursts, like yelling at a coworker for a trivial issue Neglect their personal hygiene and appearance Spend an inordinate amount of time sleeping or being by themselves[therecoveryvillage.com]
Motor Disturbances
  • In addition to psychosis, other symptoms more common in this form of depression include increased motor disturbances, either severe agitation or severe slowing up; cognitive impairment; feelings of guilt and hopelessness; hypochondria; anxiety and sleep[bbrfoundation.org]

Workup

  • The history may include negative medical workups or preoccupation with having a serious illness.[mdedge.com]

Treatment

  • Many patients experience short-term memory loss after treatment and may continue to have problems with memory as treatments progress.[betterhelp.com]
  • Treatment of Psychotic Depression Studies are often released exploring different options in medication for the treatment of psychotic depression.[dualdiagnosis.org]
  • By Reuters Staff NEW YORK—Extending olanzapine treatment beyond remission of psychotic-depression symptoms may lower relapse rates, according to findings from the STOP-PD II randomized clinical trial.[psychcongress.com]
  • To assess whether differences in response to treatment in the current episode are related to non-response to prior treatment.[cochrane.org]

Prognosis

  • Fortunately, the prognosis for recovery is good with appropriate treatment. With treatment, you can find relief from symptoms of depression and psychosis and feel more like your regular self.[verywellmind.com]
  • Psychotic Depression Treatment and Prognosis People with psychosis may require emergency hospitalization before entering an inpatient or outpatient treatment program.[bridgestorecovery.com]
  • Outlook (Prognosis) This is a serious condition. You will need immediate treatment and close monitoring by a provider. You may need to take medicine for a long time to prevent the depression from coming back.[mountsinai.org]
  • , [37] [38] and responsiveness to psychopharmacological treatment and ECT. [39] Prognosis [ edit ] The long-term outcome for psychotic depression is generally poorer than for non-psychotic depression. [9] References [ edit ] a b c d e f g h i j k l m[en.wikipedia.org]

Etiology

  • Furthermore, we have struggled to determine whether we can tease out distinct subgroups of etiological significance or, alternatively, whether in reality these reflect manifestations along a continuum of severity. 1 Within this schema, psychotic depression[academic.oup.com]
  • The etiology is multifactorial, including both biological and psychological factors. Reduced levels of neurotransmitters ( serotonin, noradrenaline, dopamine ) are believed to be the pathophysiological basis in most cases.[amboss.com]
  • This article reviews the distinction between depressive and psychotic symptom domains, current knowledge about the etiology and neurobiology of depression and psychosis, and how this knowledge can inform the treatment of patients with features of both[psychiatrictimes.com]
  • Childhood depression: Epidemiology, etiological models, and treatment implications. Integr Psychiatry. 1988. 6:1-8. Lewinsohn PM, Hops H, Roberts RE, Seeley JR, Andrews JA. Adolescent psychopathology: I.[medscape.com]
  • Family Studies According to Robins and Guze [ 22 ], familial transmission of mental disorders is a prerequisite for the definition of a valid psychiatric syndrome: ‘Independent of the question of etiology, therefore, the finding of an increased prevalence[karger.com]

Epidemiology

  • Epidemiological and clinical characterisation following a first psychotic episode in major depressive disorder: comparisons with schizophrenia and bipolar I disorder in the Cavan-Monaghan First Episode Psychosis Study (CAMFEPS). Schizophr Bull.[academic.oup.com]
  • Epidemiological studies have revealed that somewhere between 15 and 19 percent of this group will experience hallucinations and/or delusions in conjunction with their depression, and as many as five percent (approximately three million people) will develop[bridgestorecovery.com]
  • Epidemiology References: [1] [2] [3] Epidemiological data refers to the US, unless otherwise specified. Etiology The consensus today is that depression is influenced by genetic, neurobiological, socio-psychological, and environmental factors.[amboss.com]
  • ., 2003 "Unipolar major depression with psychotic features: Epidemiology, clinical features, assessment, and diagnosis". www.uptodate.com. Retrieved 2016-05-29. American Psychiatric Association (2013).[en.wikipedia.org]
  • Childhood depression: Epidemiology, etiological models, and treatment implications. Integr Psychiatry. 1988. 6:1-8. Lewinsohn PM, Hops H, Roberts RE, Seeley JR, Andrews JA. Adolescent psychopathology: I.[medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • […] abnormal or they attempt to conceal their symptoms from others. [1] On the other hand, psychotic depression may be confused with schizoaffective disorder. [1] Due to overlapping symptoms, differential diagnosis includes also dissociative disorders. [7] Pathophysiology[en.wikipedia.org]
  • Reduced levels of neurotransmitters ( serotonin, noradrenaline, dopamine ) are believed to be the pathophysiological basis in most cases. Additional symptoms of MDD include sleep disturbances, loss of appetite, and suicidal thoughts.[amboss.com]
  • This may suggest a similar pathophysiological mechanism across mental disorders with psychotic symptoms, possibly related to diminished cognitive control and as a result, increased vulnerability to develop psychotic symptoms.[journals.plos.org]
  • In support of the pathophysiological role of the dysregulated hypothalamic-pituitary-adrenal axis in PD, the glucocorticoid antagonist mifepristone has shown promise for the treatment of PD in some studies [ 47, 48, 49 ], but not others [ 50, 51 ].[karger.com]
  • The role of dopamine in the pathophysiology of depression. Arch Gen Psychiatry. 2007 Mar. 64(3):327-37. [Medline]. Alexopoulos GS. Depression in the elderly. Lancet. 2005 Jun 4-10. 365(9475):1961-70. [Medline].[medscape.com]

Prevention

  • If you think someone is considering suicide, get help from a crisis or suicide prevention hotline. Try the National Suicide Prevention Lifeline at 800-273-8255.[healthline.com]
  • Once you have been treated and stabilized, be sure to stick to your doctor's advice and continue taking your medication in order to prevent future relapse.[verywellmind.com]
  • You may need to take medicine for a long time to prevent the depression from coming back. Depression symptoms are more likely to return than psychotic symptoms.[medlineplus.gov]

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