What is Major depressive disorder with psychotic features

Psychotic depression is considered a serious condition, in which immediate treatment and close monitoring by a health-care professional is required.

 

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MAJOR DEPRESSIVE DISORDER

Depressive disorder in itself is a wider term, which includes the following terms, dysthymia, substance-induced depressive disorder, major depressive disorder, premenstrual dysphoric disorder, etc.

The commonality among all these disorders is the prevalence of feelings of emptiness, sadness, accompanied by somatic and cognitive symptoms.

The factor which is considered to be related to grief, i.e. dysphoria, is most likely to lessen in intensity with time and occur in waves, also known as pangs of grief.

 

Major depressive disorder with psychotic features

The factor that distinguishes schizophrenia from the major depressive disorder with psychotic features is the presence of temporal relationship among psychosis and mood disturbance(s). The diagnosis is said to be bipolar or depressive, accompanied by psychotic features, when delusions occur exclusively during an episode of either MDD or depression.

 

DEFINITION

Psychotic depression is considered a serious condition, in which immediate treatment and close monitoring by a health-care professional is required.

A major depressive disorder is a phenomenon that negatively affects an individual’s life. It poses a severe impact on appetite, sleep, mood and behaviour. People often tend to lose interest in the day-to-day and have trouble performing those. Occasionally, the people suffering from MDD with psychotic symptoms may feel worthless.

Nearly 20% of people with MDD symptoms also have psychotic symptoms. This is termed as psychotic depression. In psychiatry, the technical term for this is a major depressive disorder with psychotic features. This condition is accompanied by delusions or hallucinations, i.e. people see, hear, and believe unreal, non-existent things.

Two types of major depressive disorder with psychotic features exist. Delusions and hallucinations are present in both, but the person affected with this disorder may experience either of the two.

MDD with psychotic features can be further explained to be accompanied by,

 

Mood-congruent psychotic features:

The presence of delusions and hallucinations is accompanied by typical depressive themes, i.e. guilt, personal inadequacy, death, or deserved punishment.

Mood-incongruent psychotic features:

The presence of delusions or hallucinations is not accompanied by typical depressive themes, i.e. guilt, personal inadequacy, death, or deserved punishment. Majorly, there is a blend of mood-congruent and mood-incongruent themes.

The symptoms, delusions and hallucinations can be frightening up to the extent of suicide. Prompt diagnosis and treatment can help in such severe cases.

 

PREVALENCE

MDD with psychotic features is frequent in the general population, which averagely affects 0.4% of individuals. The prevalence of psychotic features can also be detected and confirmed somehow with the feelings of worthlessness or guilt.

The prevalence of major depressive symptoms with psychotic features is more among women than in men.

 

SYMPTOMS of MDD

People with major depressive disorder with psychotic features have symptoms contributing to both the aspects, i.e.- major depression and psychosis. The symptoms are as namely,

• Fatigue or tiredness
• feelings of hopelessness
• suicidal thoughts
• feelings of worthlessness
• social isolation
• disturbed sleep patterns
• alterations in appetite
• sudden weight fluctuations

Psychosis, when existing in isolation is characterized by a negligible contact with reality. The symptoms of psychosis consist of delusions, hallucinations, false beliefs and false perceptions.

For the affected, the delusions and hallucinations seem to be real. It can also cause someone to panic to the extent that they end up hurting themselves. This makes it critical for a psychotic depression sufferer to seek help as soon as it is required.

 

DIAGNOSTIC CRITERIA

MDD with psychotic symptoms is a serious condition that may somehow lead the person to prompt the step of self-harm. The person witnessing psychotic episodes should get in touch with a mental health professional, as soon as possible.

While diagnosing, the sufferer is asked questions about medical history, along with the various symptoms that he or she may be experiencing during a session of physical examination. At times, urine and blood tests are done for certain confirmations. Family history of the continuing disorder is checked so that the diagnosis becomes easier.

Certain symptoms pertaining to major depression and psychosis may also help in diagnosing MDD with psychotic features. Not always it’s reported that people are experiencing delusions or hallucinations. We should regularly refer to a psychiatrist in such cases.

In the case of depression, the depressive episode should last for at least two weeks or longer, with a minimum five among the following symptoms:

• agitation
• appetite change(s)
• depressed mood
• difficulty with concentration
• guilt and sadness
• sleep pattern changes
• lack of pleasure in most activities
• low levels of energy
• suicidal thoughts

 

GENDER DIFFERENCES

Psychotic depression affects nearly 20% of adults, with a maximum number of youngsters and elders. The treatment includes medications combining antidepressants with antipsychotics, or ECT (electroconvulsive therapy). Psychotherapy can’t be used as a standalone modality for the treatment of MDD with psychotic features.

Depressive disorders are commonly associated with an increase in various health hazards, accompanied by mortality.

Females are more prone to depression, as compared to males. Also, major depressive episodes, both with and without psychotic features are majorly prevalent in women.

Episodes of depression are commonly seen among divorced or unmarried people.

 

Causes of Psychotic Depression

The most likely cause of psychotic depression is not confirmed. However, a family history of mental disorders is more likely to prompt the occurrence of MDD with psychotic symptoms.

Researchers believe that a blend of genetic factor(s) and stress can contribute to certain alterations in the brain, leading to depression with psychotic features. It may also be triggered by hormonal changes or imbalances.

 

COMPLICATIONS

Psychotic depression is often associated with a high risk of thoughts related to suicidal attempts, that’s why it is also termed as a psychiatric emergency. In such a scenario, we should immediately approach someone known as soon as possible else it’s good to stay with a family member or a friend to avoid such attempts.

 

RISK FACTORS

A person facing major depressive disorders with psychotic episodes should be diagnosed soon as they might develop a weird outlook towards people. This condition is easily treatable and for that, the patient needs to be persistent with all the sessions and medications as prescribed by the mental health professional. Along with this, regular follow-up appointments should be attended for a speedy recovery.

 

CLASSIFICATION/ DIFFERENTIAL DIAGNOSIS

When the MDD is accompanied with psychotic symptoms, along with the occurrence of delusions and hallucinations, certain symptoms such as personal guilt, disease, or weakness, are also observed then it is termed as mood-congruent.

When the basic depressive feelings are absent, instead accompanied by a mixture of the two, then it is termed as mood-incongruent.

 

TREATMENT/ THERAPY

There are no such defined treatments for the cure of major depressive disorders with psychotic episodes. However, there have been certain combinations of antidepressant and antipsychotic medications, along with (ECT) electroconvulsive therapy. These are observed to impact the neurotransmitters in the brain, to bring them back in order, a selective serotonin reuptake inhibitor (SSRI), is used along with one among the mentioned antipsychotics:

• Olanzapine (Zyprexa)
• Quetiapine (Seroquel)
• Risperidone (Risperdal)

The mentioned medications often take weeks or months to act in order.

In case of severe episodes, hospitalization may be the ultimate solution especially in the case of suicidal attempts.

 

IN CASE OF SUICIDAL THOUGHTS

The risk of suicide is proportionately higher in psychotic depression than just the depression alone. If someone has thoughts of killing themselves or harming others, we should either approach a hospital or the National Suicide Prevention Lifeline. There, the trained staff is available to assist us in 24*7.

 

COPING MECHANISMS

The best way to cope with the prevailing situation is, to talk to our doctor regarding the symptoms we might be facing, or suspect something that we might be experiencing.

In case of symptoms of psychosis, along with self-harm tendencies, immediate diagnosis and prognosis should be done and required medications should be provided so that the situation doesn’t get any worse. Regular follow-up with the mental health expert should be kept consistent so as to avoid the chances of relapse.