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Psychotic depression. Delusions as a thought disorder Treatment of psychotic depression

Psychosis is a serious mental disorder and is characterized by disturbances in thinking and emotions to such a profound extent that the person loses touch with reality.

People who are in a psychotic state experience abnormal thoughts (delusions) and may see or even hear things that are not really there (hallucinations). These are called "positive" symptoms. In contrast to positive symptoms, there are “Negative” ones: asthenia, loss of motivation and social isolation.

All of these painful conditions can be frightening for both the sufferer and his loved ones. Sometimes in psychosis a person is capable of injuring himself or others. It is very important to consult a doctor as soon as you suspect the development of psychosis.

According to statistics, a psychotic state occurs at least once in three out of a hundred people. More often, psychosis occurs in young people, but no one is immune from its occurrence.

At an early stage of psychosis, possible following symptoms:

problems concentrating
depressed or overly happy mood
sleep disorders - people start sleeping too much or not enough
anxiety and anxiety
suspicion to others
attempts to isolate yourself from family and friends
strange, unusual thoughts and beliefs

At a later stage appear:

delusional experiences
visual and auditory
speech disorders
depressive depression
increased anxiety
thoughts and even attempts to commit suicide

What's happened rave And hallucinations with psychosis?

A delusion is a false belief in something that is firmly held in the brain even though it is contradictory to reality. Delusions are more often paranoid, grandiose ideas, and delusions associated with a somatic condition.

People who suffer from paranoid delusions may become convinced that they are being followed, for example through television. They often feel some kind of impact on themselves. Those in psychosis have an exaggerated sense of their importance. Somatic delusion is characterized by the belief in the presence of an incurable disease.

Hallucinations are disorders of sensory perception. They occur in the absence of an external stimulus. A person can “see” objects that do not actually exist, “hear” voices and other sounds when the room is quiet, or smell unpleasant odors of blood, rotting, and feces around. For a person in a state of psychosis, hallucinations seem real and attempts to convince him otherwise end in failure.

Each specific case of psychosis is very individual, and the exact cause of its occurrence is not always clear. There are some diseases that cause psychosis. The influence of drug use, overwork with lack of sleep and other environmental factors is reliably known. In addition, certain life situations contribute to the onset of psychosis.

Some of the diseases causing psychosis:

organic brain diseases, such as Parkinson's disease, Huntington's disease, brain tumors and chromosomal disorders
dementia (especially Alzheimer's disease)
infections affecting the brain: HIV, syphilis and others
severe epilepsy

Exogenous, external reasons:

Psychosis can be caused by the use of alcohol and drugs, as well as stimulants such as methamphetamine or cocaine. The hallucinogenic drugs known as LSD often induce visions of things that don't actually exist, but the effect is temporary. People who do not get enough sleep for long periods of time may also experience symptoms of psychosis. Some strong medications, such as steroids and stimulants, have been associated with psychotic episodes in isolated cases.

Risk factors development of psychosis.

It is currently impossible to accurately determine the likelihood of a person developing a psychotic state. So far, only the genetic predisposition to the occurrence of psychosis is known with certainty.

If one twin develops psychosis, there is a high chance that the other twin will also develop psychosis. Family members with a psychotic person are more susceptible to psychosis.

Children born with a genetic mutation known in the literature as 22q11 syndrome are at risk of developing mental disorders, especially schizophrenia.

Some of types of psychoses.

Reactive psychosis

Extreme stress, such as the death of a family member, can contribute to symptoms of psychosis. Typically, reactive psychosis has a short duration and goes away after a few days.

Psychosis due to alcohol and drug use.

Uncontrolled use of alcohol and drugs can cause symptoms of psychosis. Symptoms of such psychosis may go away immediately when the effects of alcohol or drugs wear off, but irreversible consequences are possible. People dependent on alcohol, drugs, or certain medications are at risk of developing a psychotic disorder if they are withdrawn.

Organic psychoses.

Severe head injuries or illnesses that affect brain function may contribute to symptoms of psychosis.

Mental disorders and psychosis.

A significant number of mental disorders are accompanied by psychosis. They can be triggered by drug or alcohol use, head injuries or serious illnesses. Often mental disorders can appear on their own, for no apparent reason.

Bipolar disorder.

In bipolar disorder, mood changes from very high to very low. Symptoms of psychosis appear at the peak of elevated mood. A person may feel good and not fully realize what is happening to him. And during low mood, when symptoms of depression occur, the psychotic state is accompanied by anger, sadness, or fear. Depressive paranoid thoughts may appear.

Delusional disorder.

A person suffering from delusional disorder tends to believe in things that do not actually exist.

Psychotic depression.

In the classification of diseases, such a disease is called: depression with psychotic symptoms.

Schizophrenia.

is a psychosis that lasts more than six months. Despite the existence of effective treatments for schizophrenia, it is considered a lifelong mental disorder.

Diagnostics psychosis.

Only a psychiatrist can accurately determine the presence of psychosis. The doctor will monitor the person's behavior and ask questions about what he or she is experiencing. Medical and psychological research is widely used, which involves testing mental activity.

Features of the diagnosis of psychosis in children And teenagers.

Some of the typical symptoms of psychosis are normal in childhood. For example, a child may begin to sleep more in response to his body's needs. Young children often communicate with imaginary friends and talk to them. If you are confused by your child's behavior, it is easy to show him to the doctor.

ABOUT treatment psychosis.

Treatment for all types of psychosis involves a combination of medication and psychotherapy. Most people recover with adequate treatment.

Sometimes people with a psychotic disorder may harm themselves or others. In such cases, emergency psychiatric care may be required using strong sedatives. This is called cupping.

Drug treatment.

All symptoms of psychosis can be treated with medications called antipsychotics. These medications eliminate hallucinations and delusions, allowing you to think more clearly. Drugs are selected depending on the symptoms and their severity. In many cases, to relieve psychosis, antipsychotics must be taken for a short time. For long-term and recurring episodes of psychosis, such as schizophrenia, you may need to continue taking medication for many years.

Application of psychotherapy.

The use of cognitive behavioral therapy involves regular meetings with a psychotherapist, the purpose of such conversations is to change thinking and behavior. The use of psychotherapy allows you to cope with your illness more effectively.

Possible complications psychosis:

There are not many medical complications associated with psychosis. However, if left untreated, it can lead to loss of ability to properly care for oneself. This condition is dangerous and contributes to the occurrence of other diseases.

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Depersonalization in depression is one of the most common forms of self-perception, which is a deviation from the norm. With depersonalization, a person practically loses control over his actions, as a feeling of being an observer from the outside appears. But depressive depersonalization is a severe symptom of a very large number of psychological disorders. The most common of them are:

  • schizophrenia;
  • schizotypal disorder;
  • bipolar disorder;
  • panic disorder;
  • depression.

Complications of depersonalization

In very rare cases, if depression with depersonalization has nothing to do with other diseases and does not stop for a long time, they are classified as a separate depersonalization disorder (the so-called depersonalization-derealization syndrome). With prolonged depersonalization, a person can often find himself in a situation that leads to suicide.

Obsessive urges towards perfectionism are very acutely felt, manifesting themselves in impeccable order both in the toilet and in everything around them, requiring serious symmetrical placement of things and even alignment of folds.

Transitions from obsessive to impulsive drives were very often observed. Homicidal and suicidal tendencies are also part of the structure of acute depersonalization (called oscillation in one's existence), which most often lead to aggressive actions towards others or towards oneself in the form of suicide.

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Cyclotomy phases

In the initial stages, there is a noticeable loss of belonging and ordinary feelings, lack of control of movements, thoughts, the feeling of automatic independence suffers and alienation of personalities appears:

  • alienation of cognitive processes, a feeling of one’s own change, a sharp deterioration in intellectual abilities, difficulties in communicating with other people, characterized by a feeling of loss of personality;
  • alienation of any emotions in the form of mental anesthesia.

When new symptoms appear, a feeling of bodily change and a difficult experience of spontaneous volitional activity are increasingly felt, which leads to doing something as if automatically, and subsequently - a poverty of perception of the surrounding world, a loss of connection with the emotions of the external environment. The anesthetic experiences that depression brings with it have every chance of existing only local (with fixation only on the loss of emotions), but they can also be diffuse-partial and total.

During studies in clinics, it was noticed that depressive attacks of schizophrenia very often lead to the progression of a persistent feeling of inferiority, incompleteness, unfinished actions that have been started, and lead to repeated checking of what has been completed.

When studying patients, the structure of allopsychic depersonalization was compiled and divided into subtypes:

  1. Acute feeling of isolation, slow reaction to impressions, loss in space.
  2. At the same time, a person seems to look at all this from the outside.
  3. The world loses its colors, and everything that surrounds such a person becomes gray and dull.

After all the initial phases of cyclotomy, the disorder progresses to total manifestations of the disease:

  • loss of emotions towards loved ones;
  • complete lack of psychological perception of art, nature, the difference in shades of color and contours of an object disappears;
  • loss of a sense of familiarity, of one’s past;
  • complete lack of feeling of completeness of thought;
  • absence of pain, anger, resentment;
  • loss of sense of time;
  • lack of appetite;
  • loss of the feeling of sleep upon awakening;
  • decreased temperature and pain sensitivity;
  • lack of desire to urinate and defecate;
  • the whole world becomes distant and appears very dim.

Even if the patient has a completely adequate reaction to his suffering, his emotional impairment is quite often perceived as a complete limitation in his life. Accompanied by the following feelings:

  • embodied thymic coloring of mental anesthesia (feeling of lack of emotions);
  • increasing anesthesia as depression develops with the possibility of vitalization of anesthesia (aching pain from the inside, mental pain);
  • painful mental anesthesia with a clearly presented depressive affect and a complete absence of embodied ideational inhibition, although its prevalence is insignificant.

This is all very serious and should not be taken lightly. The methods that are used today in psychiatry can help such people, which is why if someone you know has any of the symptoms listed above, you need to talk with his loved ones and decide whether to send him to a psychotherapist or not, although this is extremely recommended.

Psychotic depression is a subtype of major depression. This type of depression is characterized by a combination of severe symptoms of depression with signs of psychosis, such as hallucinations, delusions, disorientation, depersonalization, derealization, etc. The patient may be haunted by auditory hallucinations in the form of individual words or dialogues involving one or more “voices.” It is also possible to experience visual hallucinations in the form of images of animals, people or inanimate objects. With psychotic depression, illogical, strange delusions may occur. Very often a person is haunted by the feeling that what is happening is being staged. Unlike true psychosis, a person who suffers from psychotic depression retains a critical attitude towards what is happening, in particular towards his own actions. A person often experiences shame and tries to hide his experiences and sensations from others. Ignoring and masking symptoms greatly complicates the diagnosis of this type of depression and its differentiation from other disorders, which is extremely important for full recovery.

In most cases, women with psychotic depression have some kind of break with reality, women with psychotic depression can get irritated easily and get angry easily for no apparent reason.

The behavior of women with psychotic depression can also be very specific - they have difficulty speaking, may sleep all day and stay awake all night, or refuse daily hygiene rituals, changing clothes, etc.

Psychotic depression - causes and risk factors

The exact cause of psychotic depression is not yet known, but most scientists note a frequent increase in blood pressure associated with increased levels of cortisol, an adrenal hormone, in people suffering from psychotic depression. It is well known that various types of stress (psychological, physical or emotional) are always accompanied by increased levels of cortisol. This is why some scientists suggest a direct correlation between severe stress and the development of psychotic depression.
It has been noted that the following risk factors may increase the chances of developing psychotic depression:

  • family history of depression or psychosis;
  • Hormonal dysfunctions (often changes in levels of female hormones);
  • Impaired release of neurotransmitters in the brain;
  • Episodes of severe stress;
  • Severe physical injuries;
  • Certain personal characteristics - narcissism, selfishness, suspiciousness, excessive fears, lack of self-esteem, lack of empathy, increased impulsiveness;
  • Drug or alcohol abuse.

All of the above factors increase the likelihood of developing psychosis.

Psychotic depression - symptoms

During psychotic depression, women may experience a variety of symptoms, but the most common and typical symptoms are:

  • Abnormal even strange behavior (passive loneliness, constant pessimism, social isolation, hypochondria, physical immobility);
  • Hallucinations (auditory or visual);
  • Delusions (a constant ongoing feeling of worthlessness, hopelessness, inability to soberly assess events);
  • Phobias (paranoid health concerns, fear of illness);
  • Break with reality;
  • Suicidal thoughts and/or suicide attempts.

Additional symptoms of psychotic depression may include the following:

Bad mood and irritability,
Fatigue,
Apathy,
Insomnia,
Anxiety,
Paranoia,
Constipation,
Decreased intellectual abilities

Psychotic depression - treatment

Treatment for psychotic depression is usually quite effective. In most cases, treatment for psychotic depression should be carried out in a treatment facility. The main treatment includes a combination of medications (depending on severity, age, sensitivity). In most cases, a combination of antidepressants and antipsychotic drugs is recommended.
Electroconvulsive therapy (ECT) is a rapid and effective treatment for psychotic depression. Due to the severity of psychotic symptoms, electroconvulsive therapy is often the treatment of choice.

Untreated psychotic depression can lead to very serious mental disorders, which is why timely, comprehensive treatment is necessary in the case of psychotic depression.

Psychotic depression - prognosis

In most cases, treatment for psychotic depression is effective (if treatment is started promptly and carried out adequately). Recovery from psychotic depression can last on average 6-12 months. Recurrence of depressive symptoms is quite common, while relapse of psychotic symptoms is quite rare.

With psychotic characteristics - this is the name given to the condition of a person who simultaneously faces both psychosis and depression. Let us recall that psychosis is associated with a disconnection from reality, and therefore may include. At the same time, the main symptom of depression is low mood and loss of interest in any activity. Unless, of course, it's not .

Experts say that 15-19% of patients with diagnosed depression deal with psychotic depression. Moreover, they note, its prevalence increases with age. We have collected everything you need to know about this in one material.

What is depression with psychosis?

Classic depression- one of the most common mental health conditions, characterized by poor mood, decreased activity levels, and decreased appetite (both in one direction and the other). Here are a few more symptoms that are characteristic of depression:

  • feeling extreme sadness, anger, or irritability;
  • loss of interest in once enjoyable activities;
  • inability to concentrate;
  • recurring thoughts about death.

Psychosis it means that a person feels disconnected from reality. This occurs when someone regularly experiences things that do not exist - in other words, hallucinations. It is important to remember that psychosis is always a symptom of a condition, but does not exist in itself. Here are the specific symptoms of psychosis:

  • false beliefs or misconceptions;
  • hallucinations (visual or auditory);
  • paranoia.

It is logical to assume that a person with psychotic depression will exhibit symptoms of each condition. Moreover, this can be the entire spectrum of symptoms, or only some of them.

How is psychotic depression diagnosed?

Most diagnostic manuals classify psychotic depression as a subset. However, there is ongoing debate among mental health professionals about whether this definition is accurate.

The International Classification of Diseases (11th edition) considers psychotic depression to be the most severe subtype of depressive disorder. The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), also characterizes psychotic features as a subgroup of depression. However, as we have already said, there is no consensus on the issue yet.

Diagnosis of the condition is also complicated by the fact that depression with psychosis has similar features to some other disorders. Among them, for example, classic depression, schizoaffective disorder and those provoked by external factors. However, if, along with signs of ordinary depression, the doctor records hallucinations and paranoid moods, this is most likely psychotic depression.

What treatment is usually used?

Depression with psychosis is a disease that requires immediate medical attention. Statistics show that depression in depressed patients with psychosis increases significantly compared to patients with non-psychotic depression.

When it comes to treating psychotic depression, the doctor will usually first prescribe a combination of antipsychotic drugs or monotherapy (use of either antidepressants or antipsychotics). Electroconvulsive therapy (ECT) may be used next - especially if prescribed medications have not relieved symptoms - which has been shown to be effective for treating this particular type of depression.

Depression is one of the most common forms of reactive conditions. A characteristic feature of it, perhaps more than any other form of psychogenic reactions, is the absence of any tangible boundary between normality and pathology.

Mild depression is the most common form of normal human experiences: any significant loss in most normal people causes a depressed, melancholy mood, general lethargy and lethargy, lack of sleep, appetite, tears, etc.

In pathological cases we are talking mainly about a quantitative increase in the same phenomena. Depressive syndromes include conditions that include an obligate symptom - decreased mood from mild sadness, sadness to deep depression and optional symptoms - decreased mental activity, movement disorders, various somatic disorders (cardiac arrhythmias, weight loss, constipation, decreased appetite, etc. .)

Depressive triad

1 Mental symptoms:

Emotional symptoms

Sad, melancholy mood (the world becomes bleak and colorless), fear, irritability, hopelessness, a feeling of inadequacy, a feeling of insensitivity, inner emptiness, apathy or inner restlessness, indecision, guilt.

Cognitive symptoms:

Slowing down of thinking (brooding), impaired concentration, thoughts of death, gloomy ideas about the future, meaninglessness of life, decreased self-esteem, negative self-image, anticipation of disasters, ideas of sinfulness, focus on failure, feelings of inadequacy.

Beck (1976) summarized the disorders into a “cognitive triad”: negative images of the self, the world, and the future.

2 Psychomotor symptoms

Psychomotor retardation: hypomia or amymia, limited mobility, stupor.

Psychomotor agitation: constant restlessness, feeling of being trapped, (fussy) thirst for activity.

3 Somatic symptoms

Vital disturbances: fatigue, powerlessness, lack of energy, lethargy, weakness, feeling of pressure or pain in the heart or stomach, loss of appetite, weight loss, headaches, indigestion, decreased libido.

Sleep disorders: difficulty falling asleep, interrupted sleep, early awakening.

Daily mood swings

Autonomic disorders: increased vagotonus, dry mouth, difficulty breathing, dizziness, constipation, cardiac arrhythmia.

About depression as a syndrome one can speak only when there is a more or less constant combination of symptoms in the emotional, cognitive and somatic spheres; as a result of these symptoms, the patient’s lifestyle and quality of life are disrupted, and the depressive syndrome has a protracted course

The term “neurotic depression” was introduced by E. Kraepelin in 1895.

This symptom complex is also described as

      non-psychotic,

      non-endogenous,

      reactive (situational),

      personal depression

    The prevailing mood is characterized by feelings of sorrow or fear.

    Decreased vitality – lack of desires and interests.

    Feeling of one's own inferiority.

    Self-reproaches.

    Thoughts about suicide; suicides.

    Hypochondriacal complaints.

    Sleep and appetite disturbances.

    Strong dependence on evidence of love and affection.

    Lack of independence and demanding position.

    Tendency to cling to someone.

    Reduced tolerance to frustration during failure.

    Explicit or somatized fears.

    It is common for depressed patients

    Underestimation of one's chances and capabilities combined with passivity and restraint, indecision

    Allows others to make excessive demands on him, submission.

    Feels uncomfortable in group situations.

    He cannot make demands himself.

    Lack of initiative.

    Avoids situations of self-affirmation.

    Avoids discussions by withdrawing into oneself.

    Lack of self-confidence and positive sense of self-worth.

    Remains dependent and even seeks it out, fear of independence.

    Seeks the proximity of another person, clings to him. The partner personifies the figure of the “adult”, the mother.

    Seeks security

    Afraid of being abandoned - fear of losing an object, fear of losing the love of an object, separation.

A characteristic feature of the modern neurosis clinic is dominance of emotional disorders, especially with protracted forms of neuroses.

Neurotic depression can become a stage of neurotic development.

The syndrome always occurs psychogenically and in its manifestations reflects a traumatic situation. Main components: reduced background mood, not reaching the level of melancholy. Depressed mood is usually combined with severe emotional lability, often asthenia, mild anxiety, loss of appetite and insomnia.

    Pessimistic attitude not generalized, but is limited to the conflict zone.

    There is a pronounced fight component with illness, the desire to change the traumatic situation.

    No mental and motor retardation, ideas of self-blame, suicidal tendencies.

    Symptoms are not as persistent somatic disorders are less pronounced, are more dynamic and easier to treat than with endogenous depression.

    Expressiveness facial expressions of patients, depressive facial expressions only with mention of psychotrauma.

    The decrease in self-esteem is less pronounced.

    Depressive affect appears in the form of anxiety-depressive, asthenic-depressive, phobic-depressive and hypochondriacal-depressive syndromes.

    « Psychological clarity of experiences", reflection of traumatic pathogenic factors in experiences and statements.

Characteristic:

1) preservation of basic personality qualities,

2) psychogenic, psychologically understandable occurrence and course,

3) nosognosia;

4) ambivalent attitude towards suicidal thoughts;

5) the presence in the dynamics of the development of the clinical picture of phobias, obsessive and sometimes severe hysterical disorders.

Psychotic depression is an acute form of depression in which attacks of psychosis occur. Psychosis refers to hallucinations, disorientation, or any other type of inability to perceive reality. Psychotic depression occurs in every fourth patient hospitalized with a diagnosis of acute depression.

In addition to the symptoms of clinical depression such as feelings of helplessness, worthlessness and hopelessness, psychotic depression also includes psychosis.

Symptoms of psychotic depression include: Nervousness, Increased anxiety, Constipation, Hypochondria, suspiciousness, Insomnia, Mental failure, Physical immobility, Psychosis