User:Justyss Chi/Psychotic depression

Introduction

Psychotic depression, also known as depressive psychosis, is a major depressive episode that is accompanied by psychotic symptoms.[2] It can occur in the context of bipolar disorder or major depressive disorder.[2] It can be difficult to distinguish from schizoaffective disorder, a diagnosis that requires the presence of psychotic symptoms for at least two weeks without any mood symptoms present.[2] Unipolar psychotic depression requires that the psychotic features occur only during episodes of major depression.[3] Diagnosis using the DSM-5 involves meeting the criteria for a major depressive episode, along with the criteria for "mood-congruent or mood-incongruent psychotic features" specifier.[4]

signs and symptoms

Individuals with psychotic depression experience the symptoms of a major depressive episode, along with one or more psychotic symptoms, including delusions and/or hallucinations.[2] Delusions can be classified as mood congruent or incongruent, depending on whether or not the nature of the delusions is in keeping with the individual's mood state.[2] Common themes of mood-congruent delusions include guilt, persecution, punishment, personal inadequacy, or disease.[5] Half of patients experience more than one kind of delusion.[2] Delusions occur without hallucinations in about one-half to two-thirds of patients with psychotic depression.[2] Hallucinations can also occur, being auditory, visual, olfactory (smell), or haptic (touch), and are congruent with mood delusions . Other symptoms include Severe anhedonia, loss of interest, and psychomotor retardation are typically present.[6]. Patients also experience hyperactivity of the hypothalamic-pituitary-adrenal axis. ''They have increased risk of self-harm, and have higher symptom burden over the long term. Cause Psychotic symptoms tend to develop after an individual has already had several episodes of depression without psychosis.[2] However, once psychotic symptoms have emerged, they tend to reappear with each future depressive episode.[2] The prognosis for psychotic depression is not considered to be as poor as for schizoaffective disorders or primary psychotic disorders.[2] 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.[2][5]. Psychotic depression disorder also places its victims at 5.3 times higher risk for suicide then those with non-psychotic depression. When psychotic depression is coupled with an major depressive episode the risk for a suicide attempt in a lifetime and in a phase is much higher.

Family members of those who have experienced psychotic depression are at increased risk for both psychotic depression and schizophrenia.[2] Prevalence of psychotic depression is 4 per 1000 in the general population. Most patients with psychotic depression report having an initial episode between the ages of 20 and 40. As with other depressive episodes, psychotic depression tends to be episodic, with symptoms lasting for a certain amount of time and then subsiding. While psychotic depression can be chronic (lasting more than 2 years), most depressive episodes last less than 24 months. A study conducted by Kathleen S. Bingham found that patients receiving appropriate treatment for psychotic depression went into "remission". They reported a quality of life similar to that of people without PD[7].

Pathophysiology

There are a number of biological features that may distinguish psychotic depression from non-psychotic depression. The most significant difference may be the presence of an abnormality in the hypothalamic pituitary adrenal axis (HPA). In a study that tested hormonal differences between those who experience (Spelling) psychotic depression and non-psychotic depression showed that the most significant hormonal differences is the presence of Hypothalamic pituitary areal (HPA) axis. This meant the development of psychotic symptoms in depression show high levels of cortisol and increase of blood pressure. The HPA axis appears to be dysregulated in psychotic depression, with dexamethasone suppression tests demonstrating higher levels of cortisol following dexamethasone administration (i.e. lower cortisol suppression).[2] Those with psychotic depression also have higher ventricular-brain ratios than those with non-psychotic depression.[2]

Diagnosis

Differential diagnosis See also: Depression (differential diagnoses) Psychotic symptoms are often missed in psychotic depression, either because patients do not think their symptoms are abnormal or they attempt to conceal their symptoms from others.[2] On the other hand, psychotic depression may be confused with schizoaffective disorder.[2] Due to overlapping symptoms, the differential diagnosis includes also dissociative disorders.[8]. Although, decreases in the frontal cortex grey matter volumes differentiate from psychotic depression and depression.

Diagnosis is traditionally determined through acquiring patients history, a physical exam, along with laboratory work. Neurological assessments are also conducted using tomographic or magnetic resonance imaging. Italic text treatment Electroconvulsive therapy is effective in combination with antipsychotics and antidepressants treatment. However, antipsychotic medications can have adverse effects. Effects can include weight gain, dyslipidemia, increase the risk for developing type 2 diabetes.</ref>