This is a very distressing condition where people often describe feeling black and empty, unable to think or feel. Suicidal thinking is related to the profound feeling of despair and feeling of self-punishment.
Symptoms of psychotic depression can be summarised as:
- Observable severe depressed mood
- Severe social impairment
- Severe psychomotor disturbance (agitation, retardation, cognitive processing problems)
- Psychotic features such as delusions and/or hallucinations.
If a patient is very agitated, assume psychosis. Those with psychotic depression usually don’t recover on an antidepressant alone.
Diagnosis of psychotic depression
Psychotic features: consistent with mood (mood congruent) or mood incongruent. Delusions more common than hallucinations (90% vs. 10%).
- Pathological guilt: common in psychotic depression
- Psychomotor disturbance: profound
- Cognitive function: mild cognitive processing problems through to pseudo-dementia
Useful questions
Some additional useful questions which can help to determine if a patient is suffering from psychotic depression include:
- Are you a good person? Do you feel guilty? Do you deserve to feel like this?
- Are you being punished or do you feel you are being punished for something you have done?
- Are you being watched? Are you being poisoned?
- Do you have voices telling you that you are bad … or deserve to be punished… or should kill yourself / someone else?
- Do you have something physically wrong with you? Can you please explain your concerns to me? What evidence do you have?
