Major Depression: Category and symptoms

The category of Major Depression represents a superordinate class. Hence, within major depression are a number of sub-classifications.

Cases can be described as:
a. In partial or complete
b. Mild, moderate or severe
c. With melancholia (the American equivalent to endogenous)
d. With psychotic features

Psychotic features may be subdivided into mood congruent psychotic (e.g., delusions of guilt, poverty, disease) and mood incongruent psychotic features (e.g., persecutory, thought insertion).

There is a list of nine possible symptoms of which the patient should have at least five.

1. Depressed mood (or can be irritable mood in children and adolescents) most of the day, nearly every day, as indicated by subjective account or observation by others

2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either account or observation by other of apathy most of the time.)

3. Significant weight loss or weight gain when not dieting (e.g., more than 5% of body weight in a month), or decrease or increase in appetite nearly every day (in children, consider failure to make expected weight gains)

4. Insomnia or hypersomnia nearly every day

5. Psychomotor agitation or retardation nearly very day (observable by other, not merely subjective feelings of restless or being slowed down)

6. Fatigue or loss of energy nearly every day

7. Feelings or worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)

8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)

9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
Major Depression: Category and symptoms

What is psychotic depression?

Psychotic depression is a serious illness during which a person suffers from the dangerous combination of depressed mood and psychosis, with the psychosis commonly manifesting s nihilistic-type delusion.

It is a relatively common psychiatric condition that affects up to 20% of patients with major depression.

Psychotic depression appears distinct from nonpsychotic depression on the basis of noted differences in family psychiatric histories, with an increased risk of schizophrenia, bipolar affective disorder and unipolar depression.

Often the presence of psychotic symptoms can be difficult to establish.  This may be because psychotic depressed patients seem to have more insight into their symptoms than do manic or schizophrenic patients and thus are more likely to hide these symptoms.

Some delusions in psychotically depressed individuals have a paranoid quality, with ideas of reference, suspiciousness and persecutory themes. Others have a guilt-ridden quality of being sinful or a nihilistic component.

Other symptoms in psychotically depressed individuals are severe psychomotor agitation or depression, prolongation of the depression, ruminating qualities, and a failure to respond to treatment all of which carry the risk of an unpredictable and explosive outcome.
What is psychotic depression?

Psychotic depression

Psychotic depression is a relatively common psychiatric condition that affects up to 20% of patients with major depression.

Psychosis in depression is not rare between 10 to 25 percent of patients hospitalized for serious depression, especially elderly patients, develop psychotic symptoms.

It is a serious illness during which a person suffers from the dangerous combination of depression mood and psychosis.

Symptoms of psychosis may include delusions (irrational beliefs that cannot be resolved with rational explanations) and hallucinations (seeing, hearing, feeling, tasting, or tasting or smelling things or people that are not present).

Psychotic depression is more commonly associated with feelings of guilt, worthlessness, and suicidal ideation in addition to and highly correlated with symptoms of psychosis.

Because psychotic individuals cannot distinguish reality from fantasy, their behavior is unpredictable, and cannot accurately assess of their safety.

Michael Shepherd, British psychopharmacology in 1959 pointed out that there were hospital depression and then there were ‘large group of loosely termed ‘neurotic’, ‘reactive’ or ‘exogenous’ depression often admixed with clinical manifestation of anxiety.

Psychotic depression