You know what needs to be talked more about? Psychotic Depression.
So, I have seen numerous posts here on all the types of disorders that exist on the schizophrenia spectrum - from schizophrenia itself to schizoid personality disorder - and what I have noticed is that this website is sorely lacking in raising awareness about a very common psychotic disorder - namely, Psychotic Major Depressive Disorder.
Approximately 1 in 4 patients admitted in a mental hospital who are in for depression are psychotically depressed. That’s damn 25% of patients, which is a huge amount, considering that approximately 15% of the world population suffers from depression at some point in their lives.
So, what is psychotic depression?
Psychotic Depression is a kind of severe form of clinical depression because in addition to usual depressive symptoms, sufferers also experience hallucinations (visual or auditory) that are directly related to their (very) low mood. These hallucinations are often negative and increase self-critical beliefs. There are often delusions and paranoia, very much similar to as seen in other schizophrenia spectrum disorders.
How is psychotic depression different from schizoaffective disorder?
Psychotic depression is primarily a mood disorder, while Schizioaffective disorder is a thought disorder. Yes, it is difficult to differentiate between the two, as a diagnosis of the latter requires presence of psychotic symptoms for two or more weeks without mood symptoms. Conversely, psychotic depression requires that the psychotic features occur only during episodes of major depression.
What are the symptoms of psychotic depression?
1. Severe anhedonia
2. Psychomotor retardation/agitation
3. Indecision
4. Hallucinations (visual or auditory but gustatory or tactile ones might be experienced too) and/or delusions (Delusions can be mood congruent or mood incongruent.)
5. Loss of interest in previously enjoyed activities
6. Pronounced sleep disturbances (severe insomnia) 7. Suicide ideation/Suicidal thoughts
8. Self-harm
What are the causes of Psychotic Depression?
Psychotic symptoms tend to develop after an individual has already had several episodes of depression without psychosis. However, once psychotic symptoms have emerged, they tend to reappear with each future depressive episode. The prognosis for psychotic depression is not considered to be as poor as for schizoaffective disorders or primary psychotic disorders. Still, those who have experienced a depressive episode with psychotic features have an increased risk of relapse and suicide compared to those without psychotic features, and they tend to have more pronounced sleep abnormalities.
The families of those who have experienced psychotic depression are at increased risk for both psychotic depression and schizophrenia.
Most patients with psychotic depression report having an initial episode between the ages of 20 and 40. Over a lifetime, it appears that patients with psychotic depression experience an average of 4 to 9 episodes. As with other depressive episodes, psychotic depression tends to be episodic, with symptoms lasting for a certain amount of time and then subsiding. While psychotic depression can be chronic (lasting more than 2 years), most depressive episodes last less than 24 months. Unlike psychotic disorders such as schizophrenia and schizoaffective disorder, patients with psychotic depression generally function well between episodes, both socially and professionally.
[Information sources: Wikipedia and DSM-V]
