The Psychotic depression Is a major depressive disorder that is accompanied by delusional ideation (delusions) and sensory-perceptual alterations (hallucinations).
Delusions usually revolve around the depressed state of the patient, since this, apart from delusional ideas, presents all the typical symptoms of the Depression.
Hallucinations on their part are usually less frequent than delusions, but may occur in the most serious cases.
The most typical are auditory hallucinations, whose content is related to the Fallen state of mind : Listen to voices that devalue the patient, Criticize what they do or even incite them to suicide.
Characteristics of psychotic depression
When we talk about psychotic depression, on the one hand there are symptoms related to depression:
Been depressed most of the day, almost every day.
A marked decrease in interest or capacity for pleasure in all or almost all activities.
Significant weight loss without diet or diet.
Insomnia or Hypersomnia habitual.
Stirring or slow motor
Fatigue or loss of energy almost every day.
Excessive or inappropriate feelings of worthlessness or guilt.
Decreased ability to think or concentrate.
Recurrent thoughts of death or suicidal attempts.
And on the other hand the symptoms referring to the psychosis:
Delusions: false and incorrigible belief that is not in harmony with the social and cultural origin of the subject. It is established by one way Pathological and is the main axis of the patient's life dominating his thinking, but also his mood and behavior.
Hallucinations : To perceive in outer space oneself, something that does not really exist.
symptom
The characteristics of psychotic depression resemble those of endogenous depression, with the clear difference that delusions and hallucinations appear.
Thus, the main symptoms of this disease are:
1. Mood swings
The patient presents a decrease in his mood marked by permanent sadness.
Sadness causes a constant and uncontrollable fatigue, which is perceived by the patient as unbearable.
Likewise, the person with psychotic depression loses interest in all activities and is unable to experience pleasure.
2. Anxiety and Irritability
The depressive state can cause symptoms of anxiety, irritability, nervousness or anger in the patient.
These symptoms may be closely linked with delusions and hallucinations, and often aggravate the depressive condition.
3. Impingement of thought
It is common for people with psychotic depression to concentrate and have a very slow course of thinking.
They can be very inhibited, with great difficulties to speak and communicate, and with no capacity to think of things outside their state depressant.
4. Motor alterations
It is also very common for this disease to cause a general slowing of movements.
The patient may be slow or gaunt, orthopedic or shuffling, and show difficulty in performing any action (Eating, showering, dressing, etc.).
However, in some cases the opposite happens, and the movements of the person with psychotic depression are agitated or convulsive.
5. Somatic changes
This type of depression can cause bodily alterations.
The patient may present complete absence of appetite and enormous difficulties in eating, dry mouth, sexual dysfunction, or constant sensation of fatigue.
6. Behavioral disturbances
It is very common to witness extravagant behaviors such as excessive crying, constant shouting or complaining in patients with psychotic depression.
Likewise, in this type of depression, suicide attempts and suicides are especially important.
7. Presence of delusions and hallucinations
Finally, as we have said, in order to be able to speak of psychotic depression we must witness delusional ideas and sometimes hallucinations may appear.
What kind of delusions can be presented?
In fact, in psychotic depressions you can witness any kind of delirium. However, there are 5 types that are seen most often. These are:
1. Delusion of guilt
In the delusion of guilt (or sin), the person has the belief that he has committed a terrible, unforgivable act and is martyred for it.
In psychotic depressions, the content of this delirium can be of any type: from believing that it is undesirable for having suspended a Subject, even believing that he does not deserve to live because he has gotten his parents do not want him.
Usually this delirium is related to the depressed mood and sadness that the patient presents, and constitutes the epicenter of beliefs Of not being happy or not wanting to live.
2. Delirium of ruin
This type of delirium is based on the belief that the future is full of misfortunes and fatalities.
The patient firmly believes that in the future there will only be ruin for him, and based on this idea the desire not to want to live, and the belief of no sense Enjoy something or be happy.
3. Delusion of catastrophe
Something similar happens with catastrophic delirium. In this delirium the psychotic patient believes that both his life and the general world are destined for a cataclysm.
In this way, depression is modulated by the firm belief that the world is going to end or that everything will go wrong.
4. Hypochondriac Delirium
Hypochondriac delirium on its part is a very serious delusion, in which the individual believes to be a passive recipient of bodily sensations that Are imposed by an external agent.
The patient may come to interpret that he suffers incurable diseases that will dictate his premature death.
5. Nihilistic Delirium
Finally, nihilistic delirium, also known as Cotard Syndrome or delirium of denial, is a delusional idea in which the patient believes Suffering the putrefaction of its organs, being dead or directly not existing.
People with this delirium can deny the existence of various parts of their body, believe that they do not need to feed, or even affirm that they no longer Is alive and thinking that it is immortal since it has become a"soul in pity".
This type of delirium only manifests itself in the most severe forms of psychotic depression.
What kind of hallucinations can be witnessed?
The most common hallucinations in psychotic depressions are hearing (hearing things). However, somatic hallucinations may also occur and Visual .
1. Hearing hallucinations
These types of hallucinations are characterized by hearing sounds that do not really exist. They can be in the form of noises,"musics", motors, sounds or Little whispers.
In psychotic depressions, it is common for these types of hallucinations to be in agreement with the sadness or hopelessness that the sick.
In this way, patients with this disease can hear voices or whispers that tell you that it does not make sense to continue living, that everything is disastrous or That should commit suicide.
The patient perceives these hallucinations as external (he does not say those things) and can cause high levels of anxiety and despair.
2. Somatic hallucinations
They appear very infrequently in depressions. These are hallucinations about the sensibility and the corporal sensations (touch, temperature, Pressure, etc.).
In somatic hallucination the patient may feel that his organs are destroyed, that he has very intense pain or that he is losing parts of his body.
This hallucination is usually accompanied by nihilistic delirium (Cotard's syndrome), since the patient believes (delirium) and feels (hallucination) that he is Destroying his body or even that he is dead.
3. Visual hallucinations
They are also not very common in psychotic depressions, although they can occur in severe cases.
Visual hallucinations consist of seeing things that do not really exist. The patient can see figures or images created by his mind. This type of Hallucinations can add stress to the depressed state of the patient.
Consequences
Psychotic symptoms (both delusions and hallucinations) aggravate the depressive mood, make treatment difficult and increase the Suicidal risk .
Of special importance are those delusions and those hallucinations that have a concordance with the state of mind.
In non-psychotic depressions the patients usually suffer Cognitive distortions That prevent them from thinking clearly, taking alternative views And find solutions to their problems.
This way of thinking causes the behaviors that a depressive performs: to remain without doing anything when he thinks that he can not enjoy, not to go to work when Believes he will not be able to, or even attempt suicide when he thinks his life no longer makes sense.
Thus, in non-psychotic depressions, these thoughts are what sustain and aggravate the symptoms of depression.
However, in psychotic depressions, these thoughts go much further, and become delusions.
This makes the thought of the depressive become much more dangerous, becomes more distorted about reality, and has many more difficulties To regain a proper way of thinking and therefore to recover from their depression.
In addition, hallucinations can add more anxiety and agitation in the patient, which makes it difficult to manage their disease, and in many cases, Along with delusions, greatly increase the likelihood of suicidal or self-suicidal behavior.
How is it different from a schizophrenia?
It is often difficult to differentiate a psychotic depression from a schizophrenia .
Schizophrenia is the disease par excellence of delusions and hallucinations. In addition, many symptoms similar to the depression.
The so-called"negative symptoms"of schizophrenia such as inability to enjoy, lack of motivation, inability to express affection or Lack of energy, can make it really differentiate it from a psychotic depression.
The key element in differentiating both diseases is that in psychotic depression, delusions and hallucinations occur only when State of mind is changed.
In schizophrenia, on the other hand, psychotic symptoms are present at any moment of the disease and independently of the symptoms Depressive, which usually appear after having manifested delusions and hallucinations.
Treatment
Psychotic depression usually requires hospitalization as it poses a very high risk of attempted suicide for the patient.
The intervention is usually purely pharmacological, requires the follow-up and supervision of a psychiatrist, and it is of vital importance to return to the Patient to a less delirious and safer state.
The first choice treatment for this type of depression is the combination of Antidepressant drugs (To regulate the mood) and Drugs Antipsychotics (To reduce the intensity and onset of delusions and hallucinations).
Can be combined Tricyclic antidepressants Such as Mirtazapine or Clomipramine, with typical antipsychotics such as Haloperidol or Chlorpromazine.
Also, antidepressants can be combined Serotonin reuptake inhibitors (SSRIs) such as Citalopram or Fluoxetine, with antipsychotics Typical such as Risperidone or Quetiapine.
Both combinations of antidepressants and antipsychotics have been shown to be effective in treating psychotic depression.
Similarly, in severe and resistant cases, in which psychotropic drugs do not improve the depressive state, the use of t therapy is indicated Lectroconvulsive, a treatment that has proven very effective to reverse and control this type of diseases
It is concluded, therefore, that psychotic depression is a life-threatening risk for the person who suffers it, so finding appropriate treatment for Controlling and reducing the intensity of symptoms is vital.
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