Psychotic depression is a subtype of major depression that occurs when a severe depressive illness includes some form of psychosis. The psychosis could be hallucinations (such as hearing a voice telling you that you are no good or worthless), delusions (such as, intense feelings of worthlessness, failure, or having committed a sin) or some other break with reality. Psychotic depression affects roughly one out of every four people admitted to the hospital for depression [1].
Causes
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. Family members of those who have experienced psychotic depression are at increased risk for both psychotic depression and schizophrenia [2].
Symptoms
Psychosis involves a break or disconnect from reality, so people experiencing it aren’t necessarily aware of their symptoms, which can include:
hallucinations, or seeing, hearing, and feeling things that aren’t real
delusions, or believing things that aren’t true
psychomotor impairment, or slowed thoughts, movements, and feelings
a state of stupor, where you’re unable to move, speak, or respond to your environment
Psychotic hallucinations and delusions might involve:
believing you have a serious health concern, despite multiple tests showing otherwise
believing you have unique or special powers
believing you’re a famous person or historical figure
hearing voices criticizing or mocking you
seeing a frightening or threatening animal following you
paranoia, or an irrational or extreme suspicion of other people
Delusions, with or without hallucinations, happen more often than hallucinations alone in people experiencing psychotic depression.
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