- A psychiatrist usually makes the diagnosis of psychotic depression.Stockbyte/Stockbyte/Getty Images
Historically classified as a subtype of depression, psychotic depression occurs when a form of psychosis accompanies a severe depressive episode and the patient has not been diagnosed in the past with a psychotic disorder .Specific criteria regarding symptoms and behavior are required before diagnosing an individual with depressive psychosis, or psychotic depression. Once considered a thought disorder signifying the severity of the state of depression, psychotic depression became a separate diagnosis in the fourth edition of the Diagnostic and Statistical Manual, or DSM-IV. - The psychotic symptoms are usually mood-congruent -- that is, related to the depressive theme -- delusions or hallucinations. Non-mood-congruent psychotic symptoms have a poorer prognosis. Psychotic symptoms of depression are usually temporary.
- In a psychotic depression, hallucinations are usually auditory -- i.e., they involve hearing things or voices -- but can be visual as well. These must be distinguished from hallucinations resulting from other causes, such as alcohol withdrawal.
- Delusions are fixed, false beliefs, and in a psychotic depression they may present as inappropriate feelings of guilt, such as feeling responsible for things that the individual realistically cannot control or unachievable self-expectations leading to feelings of extreme unworthiness.
- Diagnosis of a major depressive episode can be made when a patient exhibits a specific combination of symptoms and consistently displays either a depressed mood or lack of interest in life activities and pleasure for a minimum of two weeks.
- At least three symptoms must accompany the depressed mood or lack of interest. They include weight gain or loss, sleep changes such as insomnia or excessive sleepiness, physical agitation or retardation, fatigue, lack of concentration, and suicidal thoughts or ideation.
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