Psychotic Depression - Anatomy of Psych

What is psychotic depression?

Psychotic depression is a subtype of major depressive disorder characterized by psychotic symptoms in addition to mood symptoms.

What does psychotic depression look like?

Signs & Symptoms

Fatigue (exhaustion)
Loss of pleasure in things
Disturbed sleep
Changes in appetite
Feeling worthless and guilty
Being unable to concentrate or being indecisive
Thoughts of death or suicide
Delusions – thoughts or beliefs that are unlikely to be true
Hallucinations – hearing and, in some cases, feeling, smelling, seeing, or tasting things that are not there; hearing voices is a common hallucination

DSM-5 Criteria

The diagnosis of psychotic depression uses the same DSM criteria as major depressive disorder, with the addition of the presence of hallucinations and/or delusions.

With mood-congruent psychotic features:
- The content of all delusions and hallucinations is consistent with the typical depressive themes of personal inadequacy, guilt, disease, death, nihilism, or deserved punishment
With mood-incongruent psychotic features:
- The content of the delusions or hallucinations does not involve typical depressive themes of personal inadequacy, guilt, disease, death, nihilism, or deserved punishment, or the content is a mixture of mood-incongruent and mood-congruent themes

How is psychotic depression treated?

A combination of an antipsychotic alongside an antidepressant is most effective.

References

[1] American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.

[2] Boyd, M. A. (2019). Psychiatric & mental health nursing for Canadian practice. Wolters Kluwer.

[3] Townsend, M. C. (2015). Psychiatric mental health nursing. F.A. Davis.