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 conditions mental health, characterized bad mood, decreased activity level and appetite (both in one and the other direction). 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 specific symptoms 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, classical depression, schizo affective disorder and provoked 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 care. 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.
Hello, Doctor! Since July 28, I have been taking amitriptyline at a dose of 1/2 tablet at night, because... the condition did not improve. Now it has become a little easier, but there are still palpitations and anxiety in the first half of the day. Does this mean that treatment has not yet eliminated the problem? It takes a long time to start stopping medications wellness? I'm afraid that I'll have to take pills for the rest of my life...
Hello Maria, what does it mean that you are suffering from psychotic depression? How did psychotic symptoms manifest themselves or are they manifesting themselves?
The problem, from my point of view, is that if you suffer from depression, then you need to treat it with antidepressants; only during the presence of delusional symptoms does it make sense to take an antipsychotic and take it only during a period of psychosis.
Judging by your message, you still focus on respiridone, and the antidepressant itself is outdated and, moreover, has pronounced side effects, take in a tiny dose.
If someone tells you that psychotic or other depression can be cured without medication using psychotherapy alone, do not believe it. Drugs come first and only psychotherapy can be used as a supportive treatment, and not vice versa.
I advise you to ask your psychiatrist directly what you are suffering from. Psychosis? Then, really, you need an antipsychotic, if you still have depression without delusional layers, then only an antidepressant. True, not amitriptyline, but a modern one, preferably from the group of selective serotonin drugs, for example, cipralex, paroxetine, citalopram, sertraline, fluoxetine.
So, first the correct diagnosis, and only then treatment.
I told you in short form everything I could. Now it’s up to your doctors and yourself. Always take a little more personal responsibility for your condition, rather than blindly relying on demigods in white jackets.
In medicine, diagnosis is always made first, followed by treatment. This is an axiom.
Thanks for the answer. I already asked a question about my diagnosis 3 months ago, but did not receive an answer. I will try again. I assume that this is psychosis, because... in January 2008 I was very nervous about work. Then she imagined herself as an energy vampire, bringing nothing but misfortune to people. It seemed that everything bad was happening through my fault, that I had only been causing harm since birth. My husband called an ambulance, I didn’t want to leave, it seemed that the orderlies had come to kill my husband and me. I did not sign any documents at the hospital voluntarily. Only after a week and a half of treatment did I come to my senses. Then, from May 2008 to November 2008, she was treated by a psychotherapist (head of the department of psychiatry, by the way) with hypno-suggestive sessions. He gradually took me off the medications, but at the end of November, at a dose of 1 mg of rispolept and half a tablet. Taking amitriptyline, I lost sleep and began to feel severe pain in my chest. I completely stopped taking medications. There was no delirium. I couldn't sleep. I fell asleep for about an hour or two a night. Thoughts were only about deceased relatives, illnesses and various negative nonsense. (Or is this nonsense?). This went on for 3 weeks. I couldn’t live, I thought all sorts of dirty things. Before the New Year I turned to a private psychiatrist. She immediately prescribed amitriptyline and haloperidol, IVs and injections. After 2 months I switched to Rispolept. I felt good. But now I feel almost satisfactory. In a week I will see a psychiatrist, I will try to clarify the diagnosis again.
And more about psychotherapy. Nobody told me that she more important than drugs. But they said that if you don’t go through it, the disease turns into chronic form and then drugs for life. But I don’t really want to undergo psychotherapy. More precisely, I don’t know what to talk about with a psychotherapist. Can you be cured if you only take medications? Well, so as not to take pills at all?
Based on your good description, it is necessary to differentiate between psychotic depression ( crazy ideas self-accusation, feelings of guilt for the troubles of the world, delusions of persecution - the case with the orderlies, etc.) and pure psychosis (delusional schizophrenia?). The fact that neuroleptics help you well speaks in favor of psychosis and in favor of psychotic depression, especially since at the same time you were taking small doses of amitriptyline.
Head Department of Psychiatry? Something doesn't look the same. Hypnosuggestive therapy for delusional experiences is excluded and contraindicated.
Be sure to ask your doctor what you have, a depressive disorder with delusional ideas or pure psychosis. This is of practical importance; in the first case, an antidepressant must be added to the antipsychotic, in the second, only according to indications. One antipsychotic is enough, and for a long time, at least 1-2 years, in maintenance doses.
Yes, Maria, ask the doctor if you were diagnosed in the hospital with schizoaffective disorder F20 in the form of schizodepressive disorder F25.1?
Hello, Doctor! The diagnosis has not yet been clarified; the psychiatrist is still on vacation. But I know for sure that this is not schizoaffective disorder. My husband was told the diagnosis, he remembers something about psychosis. You say that pure psychosis can only be treated with antipsychotics, but on one rispolept I began to experience insomnia and in general my condition worsened. I assume that this is a depressive disorder with delusional ideas. My psychiatrist sees me not from the very beginning of the disease, but 10 months after an acute 3-week period when I did not take medications. She asked about the diagnosis at the PND, her husband said something about psychosis. She prescribed me haloperidol and amitriptyline. After 3 months I tried to stop haloperidol, but there was a problem bad feeling and she prescribed me rispolept. Then I wanted to stop taking amitriptyline in August, at least for a while. So I reduced my amitriptyline dosage in June. Everything was fine, but in the second week of July, slight anxiety and excitement appeared in the first half of the day. All the time the pulse is 115-120. Since July 28, I independently increased the dose of amitriptyline to 1/2 tablet. in a day. It got better. It was pretty good all last week. On weekends, when my husband is nearby, I always feel great. And since this Monday things have gotten worse again. There was excitement from one to two in the afternoon. In the morning I wake up and feel unimportant. A year ago I took rispolept at a dose of 4 mg and amitriptyline 2 tablets. And I had a strong feeling of unreasonable fear from morning until lunch. On weekends everything was fine. I contacted my local psychiatrist. Triftazine was prescribed intramuscularly for 10 days. This therapy lasted for 3 weeks. The psychotherapist with whom I then went for sessions of hypno-suggestive therapy (in fact, he is the head of the department of psychiatry, the most important psychiatrist in the city) said that all this was part of my illness, normal in general. \\\"What did you want?\\\" - he asked me, -\\\"Your alarm cannot be turned off.\\\" He gave a graph of the wave-like course of the disease. My question is: 1) why didn’t amitriptyline and rispolept cope with this feeling of fear? What is happening to me now, why these worries and how to deal with them? Is it possible to regard the fact that the condition is significantly better compared to last year, as a movement forward, away from the disease. Or, on the contrary, does anxiety indicate that the treatment is not very effective? ; 2) could it be that without psychotherapy my condition will become chronic and I will take medications for life?; 3) there was a break in treatment for 3 weeks and the condition worsened. Newly started treatment is a return to the beginning of therapy, i.e. taking pills for 10 months. wasted in vain?
Maria, schizoaffective disorder is also psychosis. Please specify the diagnosis, but the exact one in the form of an F code
Once I know your diagnosis accurately, I will be able to answer all your questions and give you advice.
In general, you should always take any of your illnesses seriously and always ask your doctor what is wrong with me, why I am prescribed this or that treatment, and how it works.
Otherwise, it turns out that the patient, the main sufferer, does not know anything for sure about his illness.
But situations are different: today you live in this city, tomorrow you move to another. And there will be no one to ask.
Hello, dear doctor! I asked my psychiatrist about the diagnosis. She said it was an anxiety-depressive disorder, not psychosis. I don’t know the diagnosis that I was given in the hospital. But I also assume that this is not psychosis. The doctors there didn’t know everything that I described to you about my condition. I just lay in bed, and they treated me without asking anything, except that they asked whether I heard voices (I didn’t) and whether I wanted to commit suicide (yes, to live at the moment when I first got I didn’t want to go to the hospital). On August 14, I was increased to amitriptyline (1/4-0-1/2) due to complaints of missing my husband while he was at work, and some anxiety in the first half of the day. The melancholy has passed, but the heartbeat remains (pulse is almost all the time 105-120) and slight unrest, which happens in the first half of the day on weekdays in waves. On August 28, I was increased rispolept to 2.5 mg per day, but the worries did not go away. And today they increased my rispolept to 3 mg. As I understand from other posts, in our country antipsychotics are prescribed for depression, which in principle are not needed. So I’m wondering whether I need rispolept or not. What's wrong with me, depression or psychotic depression? In the hospital, I repeat once again, they didn’t know anything about my thoughts, that I thought that I was bringing harm to everyone around me, even if I communicate with them via e-mail(boss at work, whom I email finished work done at home, I broke my leg, and I attributed it to myself). And when I had a 3-week break from taking the pills, I didn’t have any strange thoughts. I simply could not sleep, I only passed out for an hour or two at night. And there was a feeling of losing myself as an individual, not being able to do work and live with my family (I lived with my father-in-law for all these 3 weeks). I don’t know what’s wrong with Rispolept, the doctor asks you to trust her. And my leg is almost constantly in motion (swaying). At a dose of 4 mg, I pumped my leg very hard and constantly moved my tongue in my mouth. There was also fear that tormented me from morning until lunch. The psychotherapist who conducted sessions of hypno-suggestive therapy said that rispolept can give alarming side effects. It even says so in the instructions. And I also read on the Internet about extrapyramidal side effects, they also mention fear and anxiety. Maybe this anxiety is just a side effect for me? But then why only on weekdays? On weekends my husband is home and I feel great. How would you comment on increasing the dose of rispolept? A year ago, to remove fear, I was injected with triphthazine. This helped for 3 weeks. I don’t know the diagnosis made at the hospital. But if it has great importance, I'll try to go to the dispensary and find out. But I haven’t been there for a year, I’m being treated by another psychiatrist. I think they also diagnosed me with anxiety-depressive disorder. My psychiatrist believes that this is exactly what I have and that I do not have psychosis. But he treats with rispolept. Sorry for the annoyingness and inaccuracy of the diagnosis, but I have no one else to consult with.
Still, I think that you suffer from, at a minimum, psychotic depression. The idea that your boss broke her leg because you emailed her the work you did at home is a crazy idea.
It is possible that your doctors are diagnosing you with a psychotic disorder, which is why they are prescribing risperidone, but in order not to upset you, they are not telling you about it.
In general, talk to your doctor, if you have a treatment-resistant form of depression, it would be better to carry out Add-on therapy: to amitriptyline or a more modern antidepressant of the SSRI or SSNRI class, the anti-depressant aripiprazole is added at an initial dose of 5 mg, if necessary, the dose is increased to 10-15 mg per day.
Such combination therapy You can achieve double benefits:
1) if you have psychosis with depressive symptoms, then in any case you need an antipsychotic. Aripiprazole is an atypical antipsychotic with a beneficial profile for patients - no weight gain, no extrapyramidal complications that you already have on risperidone, no sedation, which means inhibition, positive effect on delusional symptoms, neutral effect on prolactin levels, improvement of cognitive function.
True, with the simultaneous use of AD, in the case of a psychotic disorder, you need to be careful because of the possibility of increasing positive symptoms, in your case - delusional ideas. Therefore, doses of AD should be small.
2) if you suffer from a depressive disorder that is resistant to antidepressant therapy, then Add-on therapy with this AAP with one of the antidepressants can lead to a pronounced therapeutic effect.
You just need to remember that in the case of a combination of this AAP with fluoxetine and paroxetine, the dose of aripiprazole should be halved, and if it is used in combination with carbamazepine or St. John's wort, on the contrary, increased by a maximum of 50%.
Hello, Doctor! Your opinion is really needed. I don’t take Ariptprozole because... it is, firstly, very expensive, and, secondly, it is not sold in pharmacies in our city. I take amitriptyline 1/4-0-1/2 tablet. 25 mg and generic rispolept rileptide 1 mg-0-1 mg. I feel pretty good, but it happens on weekdays when my husband is at work (I work from home) in the first half of the day the pulse reaches 120 and there is slight jitters. The psychiatrist increased my dose of rileptide to 3 mg. But it didn’t help, so I take 2 mg. Please tell me, if I just endure this minor discomfort, will I be able to recover? Or is it necessary to achieve ideal health in order to recover? A year ago I felt very bad even on a dose of 4 mg. There was strong fear and anxiety from morning until lunch. The psychotherapist to whom I then went for hypno-suggestive therapy said that it was impossible to turn off anxiety. He explained about the waves, said that the spaces between good condition and the bad ones will increase. (True, I don’t notice the undulation of my condition, but such strong anxiety has not appeared since November). Do I need to increase the dose of rileptide (which I absolutely do not want, because I experience extrapyramidal side effects) or add another drug (last year in the summer I was prescribed triftazine injections). Or you can simply not pay attention to these little things. And when the time comes to stop taking the drugs, if I experience these jitters, will this mean that it is too early to stop taking the pills?
As I already advised you, it is better to switch from amitriptyline to a modern SSRI antidepressant, for example, cipralex, sertraline, paroxetine or citalopram.
Your problem is that a dose of amitriptyline of 6.25 or 12.5 mg is very small to completely relieve the symptoms of depression, and with increasing dose A. there is a high risk of side effects.
It seems to me that the combination of one of the SSRI class ADs with risperidone at a dose of 2 mg per day will bring you more benefit than the combination of amitripityline + risperidone at the doses you indicated.
Hello, Doctor! At the end of October I had an exacerbation and stopped sleeping. The children were tormented by problems with their studies and household problems. The psychiatrist first increased the dose of rispolept to almost 4 mg and amitriptyline to 1/2-1/2-1/2 tablets. And fenozypam to sleep. But it didn't help. I was switched to haloperidol 1/4-0-1/4 tablets and the dose of amitriptyline was not changed. It was still bad, I didn’t want to live. Since November 30th I have been taking haloperidol 1/4-1/4-1/4, ametriptyline 1-1/2-1/2 and releum 0-1/2-1. The condition has improved. I took Pantogam and cinnaresine for 2 months, Panangin for 1 month due to increased heart rate. I was injected with celebroresin and took vitamin B6. Now I feel good and have no anxiety at all. The psychiatrist does not believe that there is a need to change amitriptyline to a modern antidepressant, because I tolerate amitriptyline well. She also believes that you should not consult about the disease on the Internet. I asked her that if I had already had an exacerbation twice in the fall, then I would have to take pills for life. She said it wasn't necessary at all. you have to fight for your recovery. And the psychotherapist who treated me with suggestive therapy said that I need to start 40 interesting things for myself and then my recovery will speed up. But I can’t find a single interesting activity for myself. I used to be fond of floriculture and sewed my own clothes. Now it's not exciting. A year ago I tried cross stitch, but two pictures were enough to make this activity uninteresting. I tried yoga, but it only lasted for 2 months. Nothing interests me now. I work from home 2 hours a day on the computer. I would love to work more, but there is no work. I used to really love doing housework, but now I do only the most important household chores with great reluctance. I'm sitting at home, I don't have any friends at all. Only family. I’m afraid in my old age to find myself completely alone in the apartment. My husband's father has lived alone for 11 years and has been retired for several years. But he finds interesting things to do, plays computer games, plays solitaire, solves crosswords, and goes for walks. And I'm not interested in anything. I sleep until half past 12 so that I have less time to get bored. The children are no joy, my husband is at work from morning to evening. Do you think I have a chance of getting rid of my pill addiction? And is it possible to take haloperidol in small doses for a long time? The psychiatrist plans to return me to rispolept after some time. But it seems to me that haloperidol works better. Could this be possible?
I cannot interfere with the treatment prescribed to you by your attending physician. I have already expressed my thoughts on diagnosis, treatment and prognosis to you more than once, but you depend on your attending physician and therefore must follow his advice if you trust him.
Apathy and loss of interest and joy in life remain, but this is not surprising, because you are not taking therapeutic doses of amitriptyline (50 mg per day), and this is not enough to get rid of depression. In addition, to relieve anxiety, you constantly use antipsychotics and benzodiazepine tranquilizers, which reduce anxiety, but do not affect the symptoms of depression.
The relationship between natural science and religious and moral views on depression has a long history and tradition. Already during the monastic period of the development of psychiatry, experience was accumulated that is valuable for our time. The Byzantine religious ascetic, author of the famous treatise “The Ladder Leading to Heaven” John Climacus (VI century) described “despair” as one of the dangers that await a monk. Speaking about two types of despair, coming from a multitude of sins and from pride, he already at that time distinguished between disorders of spiritual and “natural” origin. In the 19th century religious melancholia (melancholia religiosa) was described by W. Griesinger and included a state of mental depression combined with religious delirium of grave sin, fear of hellish punishments, damnation by God. Another form of melancholy associated with religious experiences, according to W. Griesinger, was “demonomelancholia,” which arose against the background of deepening fear and was accompanied by sensations of the presence of demons in various parts of the body. Subsequently, the terms “religious melancholy” and “religious insanity” were mentioned in the manuals of S.S. Korsakov, V.P. Serbsky. Not only psychiatrists, but also psychologists paid attention to religious experiences of a pessimistic nature. W. James considered the main characteristics of these experiences to be that instead of consolation they bring despair, the hidden meaning in them seems terrible, and the supernatural forces affecting the patient are perceived as hostile.
K. Schneider noted three features of psychotic depression with religious delirium: 1) the transformation of retrospective recall of minimal sins into the experience of grave guilt before God and the inevitable expectation of “deserved” punishment; 2) the appearance of pedantic religious activity, previously unusual for patients, which does not lead to relief from depression and calm; 3) loss of religious faith during mental anesthesia (anaesthesia psychica dolorosa).
Much attention was paid to the relationship between psychopathology and religion in the latest works of D.E. Melekhov. In the course of a pathographic study of N.V. Gogol’s illness, he noted: “In Gogol’s religious experiences there were, especially in the first attacks and even before 1848, elements of the fight against the disease, resistance, prayerful calls for God’s help and requests to loved ones for help in the fight against rebellious thoughts, superstitions, empty signs and cowardly forebodings. In subsequent attacks, and especially in the last one, there was complete dominance of the delirium of sinfulness, self-abasement, loss of faith in the possibility of forgiveness... When refusing food and progressive exhaustion, doctors used therapeutic purpose leeches, bloodletting, flies, emetics instead of restorative treatment, artificial nutrition their d…. The confessor advised him to give up everything and go to the monastery, and during the last attack he horrified Gogol with threats of afterlife punishment, so Gogol interrupted him with the words: “Enough! Leave it! I can't listen anymore! Too scary! Gogol’s illness and death is a typical case when doctors were not yet able to recognize this disease, which had not yet been described in medical literature, and the confessor also did not know the biological laws of this disease, interpreted it one-sidedly, spiritually and mystically, and not in the aspect of “broad horizon" of the human personality, the unity of the biological, mental and spiritual in it, in their complex relationships."
In recent years, much attention has been paid to psychotic depression. The literature notes their inherent delusions and hallucinations, feelings of guilt and agitation, and the risk of the patient committing suicide. However, the structure and features of the development of depression with delusions of religious and mystical content have not been sufficiently studied.
Thus, depression with a religious plot of delusions includes psychotic states that include the main signs of a depressive episode (decreased mood, loss of interests and pleasure, decreased energy) in combination with delusional ideas of religious and mystical content, sinfulness, obsession, witchcraft. Along with the indicated signs, the structure of these depressions may include anxiety, agitation, and hallucinations.
5.1. Clinical variants of depression with a religious plot of delusions
The clinical typology of depression with a religious plot of delirium is based on the traditional domestic psychiatry syndromic principle. By their design, they belonged to depression of the 2nd group according to Y.L. Nuller or complex depression according to A.S. Tiganov and were characterized by a combination of symptoms of depression with symptoms of other psychopathological registers. Often, psychosis began with anxiety-depressive symptoms, and then hallucinatory, delusional, senestopathic, depersonalization-derealization manifestations were added with a gradual weakening of the signs of depression. These features made it possible to consider depression with a religious plot of delusion within the framework of depressive-paranoid, melancholic-paraphrenic, depressive-derealization, anxiety-depressive and depressive-hypochondriacal syndromes.
Depressive-paranoid syndrome. Characterized by depressive-anxious affect with delusional ideas of sinfulness, condemnation, punishment. Against the background of pronounced asthenodepressive manifestations with feelings of somatic ill-being, pronounced manifestations of sensory delirium arise. The environment begins to be perceived as changed, fear and vague ideas about an impending catastrophe arise (delusional perception). In nightmares one sees the dead, people in black (“servants of Satan”), death (“a silhouette in a white robe with a scythe at the ready”), coffins. For example, the patient felt that they wanted to rip her pectoral cross(“I woke up in a cold sweat”). Obsessive ideas about deceased relatives arise. The emerging delusional plot gradually takes on a generalized character: patients consider themselves sinners, fallen, and disgraced the human race. In the church, in the looks of parishioners, priests, and even in the faces of saints on icons, they detect condemning hints (nonsense of special significance). The delusional constructions combine the most modern and archaic ideas: “on instructions from the devil, bugs and video cameras are installed, information is read from the home computer.” False recognitions in the form of a symptom of a negative double have the nature of an immediate threat: “the daughter is the devil in the form of a dragon, she wants to wall her up in the apartment, deprive her of food and drink,” “the husband is the devil, he wants to kill.” Premonitions of an inevitable, terrible ending are reflected in the delirium of the staging (“everything is a set-up: evil spirits have entered into the nurses, orderlies, doctors, they want to kill, strangle, cripple, throw into the abyss”).
Kandinsky-Clerambault syndrome is represented by auditory, visual, olfactory pseudohallucinations, combined with ideas of influence. Patients feel the smell of a grave, hear voices, both condemning and contrasting in content (“some are abusive, others are from God”). Feelings of suggestion, influence, reading thoughts at a distance are interpreted within the framework of the main plot. Condemning themselves for the most insignificant offenses from the point of view of generally accepted norms, patients often and frantically, often at night, pray, refuse meat food, sprinkle their homes with holy water, repent, and confess. The idea of one's own sinfulness is aggravated by the lack of relief.
Observation 9.
Patient Sh., 34 years old. There is no hereditary history of mental illness. The father was active, sociable, and died in 1978 from a myocardial infarction. Mother - sensitive, impressionable, touchy, died in 1973 from cancer. The patient is the second of six children. As a child, she grew and developed without deviations; she did not suffer severe illnesses in childhood. By nature she was shy, indecisive, and touchy. She studied well at school, after 10th grade she tried to enter the agricultural institute, but did not pass the competition, she was accepted into the polytechnic school, from which she graduated. At the age of 22, she married a military man and worked as a foreman in an atelier. At the age of 23 she gave birth to a daughter. In 1993, a friend brought her to church, after which she visited the temple at least once a month, participated in divine services, but did not consider herself an active believer. In 1995, she suffered severe mental trauma caused by the illness and death of her sister. Having returned from Kharkov, where my sister lived, I felt exhausted and depressed. Thoughts appeared that she was to blame for her because she “didn’t look after her well.” Then, along with depression, insomnia appeared. I felt especially bad in the morning. The feeling of guilt was joined by ideas of sin before God. The more I prayed, the more acutely I felt like a sinner. Once I felt that some changes had taken place in the room, the room became alien, unpleasant, scary, fear and anxiety arose: I jumped up at night, saw the outline of a woman with a scythe in a white robe (death had come). I noticed that the neighbors behaved unusually: they looked askance, greeted her dryly and coldly, and tried to avoid her. I perceived their glances, remarks, and smiles as condemning hints, in which I saw confirmation of my own sinfulness. Then I perceived all the neighbors’ conversations in the kitchen as accusatory remarks: “They called me a cow, dirty, fallen.” I remembered how a few years ago a young man looked at her unusually, but she did not look away. Retrospectively, she assessed this as betrayal of her husband, and became even more convinced that she was a sinner and worthy of the most severe punishment. One day I went to the temple to atone for my sins. When I approached the church, I got the feeling that everything around was staged; for some special purpose, people with crosses were walking around the church in a special way. She heard the voice of God that she was desecrating the temple with her presence and had to leave it: “The temple must belong to God.” At home I was anxious and restless: I prayed furiously, I cried, I laughed, I tried to run away somewhere. She was taken by ambulance to a psychiatric hospital.
In the hospital. In the first days in the department she is excited, anxious, excited, makes erratic movements with her hands, mutters something. After the injection of clopixol, she became somewhat calmer. In the conversation she said that everything around was a setup, one of the sisters is a servant of the devil, the other of God. The one who is the servant of the devil bewitched her. She remembers her late sister, says that she is to blame for her, and for this God is punishing her. After treatment with amitriptyline, clopixol, triftazine, the condition improved. I began to sleep better, my anxiety decreased, I became calmer, but for a long time there was a complete absence of criticism of my condition. Later she agreed that she was sick and promised to take medications after discharge. On dates she was friendly with her husband and worried about her daughter. She was discharged under the supervision of a psychiatrist at her place of residence.
This example shows that a patient with asthenic character traits after mental trauma experiences depressive symptoms, which are then joined by acute sensory delirium with its main components: delusional perceptions, painful ideas of special significance, staging. From the very beginning of psychosis, experiences take on a pronounced religious and mystical coloring, the content of which is determined by the ideas of sin before God, delusions of condemnation and punishment.
Melancholic-paraphrenic syndrome. The clinical picture is characterized deep violations integration of mental processes, a disorder of awareness of a person’s own experience, a violation of self-identification.
Melancholic paraphrenia is one of the links in the development of a depressive attack, in which it was preceded by undeveloped asthenic, anxious, depersonalization-derealization, hallucinatory-paranoid syndromes, which were combined and replaced each other. The delusional plot contained ideas of messianism, magical powers, reincarnation, and possession. Along with delusions of the imagination, interpretive and sensory components were included in the mechanisms of delusion formation. The lability of affect and its inconsistency with the delusional plot (delusions of grandeur in depression), noted earlier by B.V. Sokolova, were observed. For example, the painful feeling of individual guilt was transformed into a complex of messianism: the patients realized themselves as the chosen ones of God, saints, called upon to lead humanity to repentance and prevent a worldwide catastrophe.
The nihilistic version of Cotard’s delirium with the denial of the presence of a number of organs and statements about their rotting and decay was complicated by hallucinatory voices congruent with the delirium, “coming from hell” and accusing him of sin.
Delusional depersonalization contained a religious and mystical component with the addition of delusions of possession and delusions of autometamorphosis with experiences of skeletal deformation, the appearance of fur, horns, claws, and a tail. Delusional behavior was characterized by psychomotor agitation, suicidal intentions and actions. At the height of acute endogenous psychosis, individual oneiric-catatonic inclusions were noted in the form of kaleidoscopically alternating fantastic ideas, illusory perceptions, and hallucinations, which were united by the eschatological nature of experiences. The patients imagined that they were in the heavenly spheres, where there was a war of ideas with a predominance dark forces from the army of Satan.
Observation 10.
Patient Ya-va, 53 years old. There is no information about the father. Mother died from a somatic illness, she was kind and calm. The patient was born the youngest of three sisters. The first died in infancy from meningitis, the second was treated in psychiatric hospital in connection with “suicide due to unhappy love.” The daughter is impulsive, unstable in behavior, despite her young age, and was married three times.
The patient grew and developed without deviations and did not suffer any serious illnesses in childhood. Since childhood, her grandmother was introduced to the Orthodox faith; for the last 15 years she has regularly attended church and performed rituals. She was always shy, sociable, and did not notice any causeless mood swings. I studied at school without much interest. After graduating from school, she graduated from the Railway Transport College. For many years she worked at the railway as a labor safety engineer. She earned a lot and often went on business trips. At the age of 25 she got married, from her marriage she has adult daughter. The situation in the house was turbulent. Due to her husband's alcoholic excesses, family scandals often occurred at home. During one of the quarrels, she hit her husband knife wound in the chest. The husband was hospitalized and discharged in satisfactory condition. She received a suspended sentence. To date, the conviction has been expunged.
In September 2001, she was fired from her job due to staff reductions. Is on the labor exchange. She had a hard time experiencing the loss of her job, the financial difficulties that arose, and the change in social status. That same year, after a conflict with my daughter, my mood dropped sharply. Then despair, anxiety, and a feeling of impending disaster appeared. I retrospectively assessed my life and my actions. A conviction arose about her own sinfulness, she decided that God was punishing her for injuring her husband: “I hit her purely intuitively, I don’t know why the memories of what I did do not give me peace.” Then I felt changes in my body: “something was shooting, beating.” The idea arose that her insides were rotting, that her flesh was being replaced by the devil's flesh. I heard “voices from hell” that she would be burned alive in a crematorium for her sins. I decided to commit suicide, but did not find enough strength within myself. The voices ordered to leave the house “so that everyone would have a good time.” In fear, she ran out into the cold dressed at home, wearing slippers. I wandered the streets, somehow ended up on the subway, where I stood for a long time on the platform in a dangerous zone close to the tracks. She was detained by the police. During the picket she cried, screamed, spoke in “biblical language”, and was taken to a psychiatric hospital.
In the hospital. Upon admission, there were signs of frostbite on the upper and lower extremities. Restless, anxious, does not indicate last name, first name, patronymic. She rushes about, screams, tries to run somewhere, says that she has been turned into a devil for her sins. Against the background of relatively small doses of tranquilizers and sedative antipsychotics, by the end of the first week she became more orderly. Gradually, delusional ideas became de-actualized, and partial criticism of one’s condition appeared. She said that all her movements were guided by voices. At first I thought that the voices belonged to the Lord, and then I realized that they belonged to the devil, since “the Lord does Good.” He does not rule out the possibility that the devil is in the body, he prays often and for a long time, saying: “I repent of my sins, but not enough.” Superficial sleep. He eats little.
Diagnosis: F32.3 Severe depressive episode with psychotic symptoms.
After a series of mental traumas, the patient developed severe depression with painful ideas of guilt, sin, and suicidal tendencies. As the depressive attack developed, verbal hallucinations, signs of Cotard’s nihilistic delusion, and delusions of autometamorphosis, congruent with depressive delirium, were added.
Depressive-depersonalization syndrome. Unlike the previous one, given the clinical version, depersonalization experiences do not go beyond the capabilities of a given individual and are limited to the loss of a feeling of love for loved ones in combination with anxiety, a feeling of the illusory nature of the world around [10]. The experience is based on an intense, much more pronounced than in other clinical variants, awareness of guilt for sins committed in the past and present (“she led a dissolute lifestyle, indulged her flesh, had little respect for the word of God, she had to remain a virgin”). The inability to feel and the inability to experience, which form the core of melancholy according to R. Tolle, led to the conviction that God has turned away and does not want to hear either prayers or repentance. The emptiness, the loss of the sense of time, the disappearance of previous feelings for loved ones, especially children (“the son comes, as if made of stone”) were especially hard to bear. Fragmentary ideas of mastery, witchcraft, and damage have the character of delusional interpretations. There was a high suicidal tendency.
Observation 11.
Patient P., 38 years old. There is no hereditary history of mental illness. Mother is kind and gentle. The father is energetic and decisive. The younger sister is healthy. In early childhood, the patient had signs of neuropathy, night terrors, and was afraid strangers, could not stay at home alone, and at times there were mood swings. They did not turn to a psychiatrist for help. She grew and developed keeping up with her peers. At school I studied unevenly, was suspicious and vulnerable, and because of this I had few friends. After graduating from school, I received a specialty as a pharmacist at the college. At the age of 24, she got married and gave birth to a son and daughter. Children get sick often colds. Since the mid-80s, she has become addicted to religion and often attends church. Several years before the onset of the disease, the situation in the family worsened, a protracted family conflict arose, which almost ended in divorce.
IN Last year I felt bad. She underwent surgery for an ovarian cyst. During the examination and postoperative period, alarming concerns arose that the presence of cancer was hidden from her. Then fatigue, weakness, and loss of interest in the environment appeared. In order to get relief, I began to go to church often. However, the condition worsened even more. Once, while in church, I was praying for the health of the children, lit a candle “for good health,” and a painful thought appeared in my mind, “for the peace.” After some time, while saying the same prayer, the bad thought “came again.” Out of fear for the lives of her children, she stopped going to church. She decided that she was in the power of a demon: “God has turned away and is not giving any chance.” I experienced intense fear, anxiety, restlessness, and did not sleep well. Subsequently, the condition worsened even more. She became withdrawn, silent, listened to something, felt empty in her head, complained that she had no thoughts, the world doesn’t care, “there are no feelings, no experiences.” She said that she “goes into the abyss, falls into hell.” She was hospitalized.
In the hospital. According to the doctor on duty, on the day of admission she was agitated, pugnacious, could not stay in place, and periodically screamed loudly. Confused about recent events. It is difficult to enter into conversation. She asks to call a priest, says that she urgently needs to confess, to remove the burden from her soul. During the conversation, her eyes become moist, she says: “I didn’t love children, I didn’t love my husband, I didn’t pay attention to them. I only love God, the devil is trying to move into me, I don’t let him in, it’s so hard. I can't go to church. Just as I light a candle for good health, thoughts come to me that I light it “for the peace of mind.” Immediately she becomes excited again.
During the first 10 days in the department, there was pronounced psychomotor agitation with confusion and impulsive actions. Once she attacked her roommate, shouting: “You’re a witch, you’ve come to kill me,” and tried to throw herself out the window. She told the doctor that she feared an impending global catastrophe. She stated that she urgently needed to go to church and pray, because the forces of darkness wanted to tear her to pieces. I heard from afar some unfamiliar voice scolding and ordering. Massive therapy with neuroleptics was prescribed, the dose of haloperidol reached 30 mg/day. With a sharp psychomotor agitation received chlorpromazine. On the 10th day of treatment, the body temperature increased, and lacunar tonsillitis was diagnosed. After immediate withdrawal of neuroleptics, severe weakness and drowsiness were noted over the next 2 days. The clinical picture has changed. Fear, tension, and anxiety decreased significantly. At the same time, a feeling of my own change arose. She complained that she had lost the sense of time (time flows endlessly), the feeling of sleep disappeared, and the sensation of the taste of food disappeared. It was very difficult for me to experience the inner devastation and lack of feelings for loved ones, especially for children. Treatment with anafranil in combination with clozapine and phenazepam was carried out for several months. The condition has improved significantly. She was discharged under the supervision of a psychiatrist at her place of residence.
Diagnosis: F32.3 Severe depressive episode with psychotic symptoms.
Clinical picture in this observation corresponds to the stereotype of the development of depersonalization depression described by Yu.L. Nuller. Both endogenous predisposition in the form of an asthenic personality type with an anxious and suspicious character, as well as somatogenic and psychogenic influences that were excessive for a given individual, played a role in the occurrence of the disease. The range of disorders is quite wide: against the background of anxiety, depression, phobias with contrasting obsessive thoughts, depersonalization manifestations arise, which at first are fragmentary in nature, and then begin to play a leading role in the clinical picture, apparently, to some extent providing protection from extremely intense anxiety and fear. Clinical picture aggravated by the religious-mystical interpretation of depressive-depersonalization manifestations in the form of painful ideas of sin, mastery, and global catastrophe. Once the intense anxious affect has passed, these ideas are de-actualized.
Anxiety-depressive syndrome. The despair and premonitions of catastrophe characteristic of anxious depression acquire an eschatological connotation. The core of anxious experiences is the fear of death without repentance. In some cases, a feeling of impending danger with the confidence that “retribution for sins is inevitable” is combined with rapid heartbeat, suffocation, and a feeling of discomfort in the chest. The sick wring their hands, fall to their knees, read prayers out loud, grab those around them by the hands, rush about, call on God, call themselves great sinners, say that they have destroyed themselves and all their relatives. At the height of anxiety, voices congruent with affect arise, accusing people of betrayal and lack of faith. There was an intense need to commit suicide.
Depressive-hypochondriacal syndrome. Expressed by a vague, anxious and melancholy affect. The predominant complaints are about general ill health, poor physical well-being, dizziness, and headaches. Along with this, burning, shooting, throbbing pains are noted in the lower back, solar plexus, and genitals. Constant feelings of somatic distress lead to gloomy speculation about the supernatural nature of the disease, not excluding witchcraft and damage. Often these guesses are induced, and the ideas of witchcraft are caused by superstition and are extremely valuable. Patients do not go to medical institutions, preferring the help of “healers”, “psychics”, etc. Some of them go to holy places, look for healing springs, drink holy water.
The dynamics, severity, and comorbidity of depression with the religious plot of delusions were determined by both homonomous and heteronomous (nosology, status, course) factors and were different for mental disorders of the schizophrenic, affective and organic spectrum.
Paranoid schizophrenia with paroxysmal-progressive course. Premorbid personality traits are characterized by the presence of asthenic and schizoid character traits. In the initial period of the disease, erased subdepression, decreased mental activity, and non-psychotic hypochondriacal manifestations were noted. The first attacks were characterized by polymorphism. The attacks, including depression with delusions of religious and mystical content, developed autochthonously, within the framework of acute paranoid and Kandinsky-Clerambault syndrome, 5-10 years after the first manifestation (on average - the fourth attack). Subsequently, psychotic religious experiences became de-actualized, and deficit symptoms with social maladaptation rapidly increased.
Schizoaffective disorder, depressive type. Patients with asthenic and schizoid premorbid personality predominate. The duration of the disease is on average 7.5 years. Depression with religious delusions was more often detected in the second to fifth attacks within the affect-dominant form of schizoaffective psychosis with a predominance of both delusions of perception and visual-figurative delusions of the imagination. In the occurrence of the disease, a certain role was played by previously suffered diseases or other exogenous hazards (chronic diseases of internal organs, neuroinfections, head injuries, cancer), as well as psychogenic disorders associated with family circumstances: divorce of spouses, death of loved ones, etc. . Excessive psychophysical stress associated with religious worship also played a certain role here: long prayers at night, changes in diet, as well as extrasensory influences.
All these harmful effects changed the body’s reactivity and reduced its adaptive capabilities. The pattern of attacks, the structure of which included depression with a religious plot of delirium, was distinguished by its complexity, development, and the sequential inclusion of registers of a disintegrated psyche, starting with asthenoneurotic and affective ones and ending with catatonic-oneiric ones. During the remission stage, the personality of the patients remained intact, and the occasional mild asthenic changes did not interfere with social adaptation.
Acute polymorphic psychotic disorder without symptoms of schizophrenia. It occurred in patients with a predominance of asthenic and hysterical mentality immediately after stressful effects associated with the unexpected loss of a source of livelihood, divorce, or death of loved ones. In search of relief, patients turned to psychics, magicians, esoteric literature, performed meditations with visualization of ideas, and focused on the ideas of karma and transmigration of souls. The transition from non-psychotic negative experiences to psychosis took no more than two weeks. Clinical picture acute period characterized by emotional confusion, anxiety, short-term delusional outbursts of religious content, and deceptions of perception. Depressive affect, reflecting a traumatic situation, did not meet the criteria for depressive episodes (F32.). Recovery occurred after 2-3 months; during a three-year follow-up observation, psychotic symptoms and social adaptation disorders were not noted.
Depressive delusional disorder with affect-congruent delusions. The disease occurred in patients with a predominance of asthenic and cycloid personality traits in the pre-disease period; its duration averaged 7 years, and the duration of the phases was 3-4 months. The picture of the manifest phases was characterized endogenous depressions with the dominance of depersonalization-derealization and anesthetic syndromes. Depression with a religious plot of delusions was more often detected in phases 1-2 (5 observations) within bipolar psychosis with a predominance of depression. Their main clinical expression was a difficult experience of one’s own sin before God, followed by inevitable retribution. As depressive symptoms weakened, pronounced signs of asthenia were noted.
Organic psychotic depressive disorders. Promoted depressive-paranoid states within the framework of vascular lesions of the brain developed against the background of a gradually progressive psychoorganic syndrome. Asthenodepressive and depressive-hypochondriacal symptoms were combined with ideas of damage, adultery, para-religious ideas about witchcraft, induced damage, presence in the apartment evil spirits. Delusional behavior was characterized by seeking protection from clergy and sprinkling the home with “holy water.” Ideas of low value and guilt, as a rule, were not revealed; Instead, a feeling of self-pity and envy of others arose.
In patients with epilepsy, depressive psychoses with a religious plot of delusions developed after a long, at least 7-10 years, absence of epileptic seizures and were characterized by a change in affective disorders with low mood, hallucinatory paraphrenia with the appearance of megalomanic ideas of religious and mystical content.
So, characteristic feature depression with a religious plot of delirium is that general, constant, independent of the influence of the era and the environment signs: depression, low self-esteem, gloomy, pessimistic vision of the future, etc. - are colored by pathological religious experiences. Their extreme nature, in turn, aggravates the course of depressive psychosis. Thus, mental pain, depression, low self-esteem, and guilt are transformed into the idea of personal sin before God, and in advanced cases - into visually figurative “cosmic” experiences of the end of the world, the “decline of the gods,” a grandiose revolution, the culprit of which is the patient himself .
The data obtained allow us to make some general considerations about the closeness of depression with a religious plot of delirium to acute endogenous psychoses. Their structural and dynamic characteristics, such as the paroxysmal type of course, the lability of the structure of attacks, the variety of syndromes, largely determine the intensity and depth of pathological religious experiences, the degree of actualization of the delusional plot on various stages psychosis.
The role of etiological factors in the occurrence of depression with religious delirium is controversial and insufficiently studied. Here, noteworthy is the remark of T.F. Papadopoulos that the shift of depressive delirium towards paraphrenia is due not only and not so much to the depth of depression, but to age, cultural characteristics and personal mediation. We have established that the development of attacks of schizoaffective psychosis and, especially, acute polymorphic psychotic disorders was immediately preceded by psychogenic reactions, personality reactions to somatic diseases, as well as excessive or unconventional cult influences (“cult trauma”). In many manifestations, psychoses directly related to cult trauma were similar to the reactive schizoaffective-like psychoses described by M. Singern R. Ofshe.
Thus, depression with a religious plot of delirium, without pretending to be a specific symptom complex, much less a separate nosological unit, is a psychopathological formation that requires special attention and a therapeutic approach.
Literature
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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 severe symptom very large quantity psychological disorders. The most common of them are:
- schizophrenia;
- schizotypal disorder;
- bipolar disorder;
- panic disorder;
- depression.
Complications of depersonalization
Very rare options, 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:
- Acute feeling of isolation, slow reaction to impressions, loss in space.
- At the same time, a person seems to look at all this from the outside.
- 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 psychological perception 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 ( It's a dull pain from within, mental pain);
- painful mental anesthesia with a clearly presented and insignificant prevalence depressive affect and the complete absence of embodied ideational inhibition.
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- an affective disorder in which, in addition to typical depressive symptoms, psychotic symptoms are observed, such as hallucinations, delusions, etc.
Reasons for development
This pathology is one of the manifestations that is of a hereditary nature and develops as a result of disturbances in biochemical processes in the body.
As a rule, symptoms of the disease appear without a clear relationship with any traumatic factor. In some cases, a psychotraumatic factor can only contribute to the occurrence of the first episode of the disease. Subsequently, a clear relationship is not observed.
The condition of such patients tends to fluctuate seasonally - it worsens in the spring and autumn (then they talk about).
Manifestations
Symptoms of psychotic depression include: depressive symptoms(decreased mood, fatigue, inability to concentrate for a long time, to perform the same work), and psychotic components, due to which this pathology is distinguished.
The latter include:
- hallucinations;
- delusional ideas - hypochondriacal delusions (the patient is sure of the presence serious illness at home, which actually does not exist), nonsense physical disabilities(it seems to him that he is incredibly ugly, he has a terrible shape of his nose, teeth, eyes, etc.),
- stupor - immobility;
- agitation - strong emotional arousal, combined with an unreasonable feeling of fear and anxiety;
- there may also be a dream-like stupefaction (oneiroid), when there is an influx visual hallucinations(usually of fantastic content), and the person himself thinks that he is seeing a dream in reality.
Psychotic depression is characterized by a high intensity of major depressive symptoms. They persist for a long time, their severity does not depend on the influence of external traumatic factors.
Daily mood swings are also common. The peak of severity occurs in the morning, and by the evening the condition may improve.
Between 10 and 15% of patients with depressive disorders commit suicide. The risk of such actions is especially high in patients suffering from psychotic depression.
Psychotic depression and schizophrenia
It is worth distinguishing between psychotic depression and diseases such as schizophrenia. Difficulties in distinguishing between these two mental disorders may appear at the beginning of the disease, when not all signs are clearly expressed and there is no dynamics of the disease.
With psychotic depression, symptoms such as depressed mood, motor retardation come to the fore, no events or actions bring joy or pleasure, and this burdens the patient.
Although psychotic components are present, they are additional. As a rule, there are only individual signs - for example, only delusional ideas or only agitation. Criticism towards one's condition remains. Even if hallucinations appear, the person does not regard them as real events, but understands that something is wrong with him. Characteristic for depressive disorders The theme of delusional ideas is delusions of serious illness, delusions of self-blame.
In most cases, the first signs of schizophrenia are mental disorder people who attract the attention of others are psychotic. There may be delusional ideas, psychomotor agitation. A person’s criticism of his condition, as well as the symptoms that arise, is lost. The characteristic themes of delusional ideas that arise in schizophrenia are persecution (when a person is sure that someone is following him, chasing him), influence (especially mental, through various rays, thoughts, etc.), attitude (someone treats him badly , looks askance, condemns).
Depressed mood is not typical, the motivation for any activity is lost, the person becomes emotionally cold, but this does not bother him at all.
Treatment
If the patient has suicidal intentions, then in order to avoid fatal consequences, treatment in a hospital setting is preferable.
The most effective drugs for treating psychotic depression are antidepressants and antipsychotics. Antidepressants help cope with the main symptoms of depression and normalize changes occurring at the biochemical level in the body.
The choice of antidepressant is based on the presence of certain signs of the disease. If there are pronounced suicidal tendencies, delusional ideas of self-blame, they resort to tricyclic antidepressants (amitriptyline), atypical antidepressants (sertraline, fluoxetine, cipramil).
To eliminate psychotic symptoms, antipsychotics are used (clopixol, thioridazine, chlorprothixene).
The choice of drug and dose is determined by the attending physician individually for each individual patient, depending on the severity of symptoms.
Unfortunately, due to the fact that this disorder refers to endogenous diseases, there is a high risk of relapses in the future. To avoid them, it is necessary to take the drugs for a long time; in no case should treatment be suddenly interrupted.
