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Major depression with psychotic features

Psychotic depression; Delusional depression

 

Major depression with psychotic features is a mental disorder in which a person has depression along with loss of touch with reality (psychosis).

Causes

 

The cause is unknown. A family or personal history of depression or psychotic illness makes you more likely to develop this condition.

 

Symptoms

 

People with psychotic depression have symptoms of depression  and psychosis .

Psychosis is a loss of contact with reality. It usually includes:

  • Delusions: False beliefs about what is taking place or who one is
  • Hallucinations: Seeing or hearing things that aren't there

The types of delusions and hallucinations are often related to your depressed feelings. For example, some people may hear voices criticizing them, or telling them that they don't deserve to live. The person may develop false beliefs about their body, for example, that they have cancer.

 

Exams and Tests

 

Your health care provider will perform a physical exam and ask questions about your medical history and symptoms. Your answers and certain questionnaires can help your provider diagnose this condition and determine how severe it may be.

Blood and urine tests, and possibly a brain scan may be done to rule out other medical conditions with similar symptoms.

 

Treatment

 

Psychotic depression requires immediate medical care and treatment.

Treatment usually involves antidepressant and antipsychotic medicine. You may only need antipsychotic medicine for a short period of time.

Electroconvulsive therapy can help treat depression with psychotic symptoms. However, medicine is usually tried first.

 

Outlook (Prognosis)

 

This is a serious condition. You will need immediate treatment and close monitoring by a provider.

You may need to take medicine for a long time to prevent the depression from coming back. Depression symptoms are more likely to return than psychotic symptoms.

 

Possible Complications

 

The risk of suicide is much higher in people with depression with psychotic symptoms than in those without psychosis. You may need to stay in the hospital if you have thoughts of suicide. The safety of other people must also be considered.

 

When to Contact a Medical Professional

 

If you have thoughts of suicide or harming yourself or others, immediately call your local emergency number (such as 911) or go to the hospital emergency room right away. DO NOT delay.

You may also call a suicide hotline from anywhere in the United States, 24 hours a day, 7 days a week: 1-800-SUICIDE or 1-800-999-9999.

Call your provider right away if:

  • You hear voices that are not there.
  • You have frequent crying spells with little or no reason.
  • Your depression is disrupting work, school, or family life.
  • You think that your current medicines are not working or are causing side effects. Never change or stop any medicines without first talking to your provider.

 

 

References

American Psychiatric Association. Major depressive disorder. Diagnostic and Statistical Manual of Mental Disorders: DSM-5 . 5th ed. Arlington, VA: American Psychiatric Publishing. 2013;160-168.

Fava M, SD Ostergaard, Cassano P. Mood disorders: depressive disorders (major depressive disorder). In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry . 2nd ed. Philadelphia, PA: Elsevier; 2016:chap 29.

 
  • Forms of depression - illustration

    Depression is defined as a mood disorder, and there are several subtypes. Bipolar disorder, also known as manic-depressive illness, is considered in a separate category.

    Forms of depression

    illustration

    • Forms of depression - illustration

      Depression is defined as a mood disorder, and there are several subtypes. Bipolar disorder, also known as manic-depressive illness, is considered in a separate category.

      Forms of depression

      illustration

    A Closer Look

     

    Self Care

     

      Tests for Major depression with psychotic features

       

         

        Review Date: 12/28/2016

        Reviewed By: Fred K. Berger, MD, addiction and forensic psychiatrist, Scripps Memorial Hospital, La Jolla, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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