Psychotic depression , also known as depressive psychosis , is the episode of major depression accompanied by psychotic symptoms. May occur in the context of bipolar disorder or major depressive disorder. This can be difficult to distinguish from a schizoaffective disorder, a diagnosis that requires the presence of psychotic symptoms for at least two weeks without any mood symptoms. Unipolar psychotic depression requires that psychotic images occur only during severe episodes of depression. Diagnosis using DSM-IV involves meeting the criteria for major depressive episodes, along with criteria for the "psychotic feature" specifier.
Video Psychotic depression
Symptoms
Individuals with psychotic depression experience symptoms of major depressive episodes, along with one or more psychotic symptoms, including delusions and/or hallucinations. Delusions may be classified as congruent or out of sync mood, depending on whether their delusional properties match the individual mood. Common themes of congruent mood delusions include guilt, torture, punishment, personal disability, or illness. Half of patients experience more than one type of delusion. Delusions occur without hallucinations in about one-half to two-thirds of patients with psychotic depression. Hallucinations may be hearing, sight, smell (smell), or haptic (touch), and congruent with delusional material. Affect it is sad, not flat. Severe anhedonia, loss of interest, and psychomotor retardation are usually present.
Maps Psychotic depression
Cause
Psychotic symptoms tend to develop after an individual already has several episodes of depression without psychosis. However, once psychotic symptoms appear, they tend to reappear with every depressive episode in the future. The prognosis for psychotic depression is not considered as severe as a schizoaffective disorder or a primary psychotic disorder. However, those who have experienced episodes of depression with psychotic features have a higher risk of recurrence and suicide than those who lack psychotic features, and they tend to have more severe sleep disorders.
Families of those with psychotic depression have a higher risk for psychotic depression and schizophrenia.
Most patients with psychotic depression reports have an early episode between the ages of 20 and 40. Like other depressive episodes, psychotic depression tends to become episodic, with symptoms that last for some time and then subside. While psychotic depression can be chronic (lasting more than 2 years), most depressive episodes last less than 24 months. Unlike psychotic disorders such as schizophrenia and schizoaffective disorder, patients with psychotic depression generally function well between episodes, both socially and professionally.
Differential diagnosis
Psychotic symptoms are often overlooked in psychotic depression, either because patients do not think their symptoms are abnormal or they try to hide their symptoms from others. On the other hand, psychotic depression may be confused with schizoaffective disorder. Due to overlapping symptoms, differential diagnosis also includes dissociative disorders.
Pathophysiology
There are a number of biological features that can distinguish psychotic depression from non-psychotic depression. The most significant difference may be the presence of abnormalities in the pituitary adrenal axis pituitary (HPA). The HPA axis appears to be dysregulated in psychotic depression, with the dexamethasone suppression test showing higher cortisol levels after dexamethasone (ie lower cortisol suppression). Those who suffer from psychotic depression also have higher ventricular-brain ratios than those with non-psychotic depression.
Treatment
Some treatment guidelines recommend a combination of antipsychotic antidepressants and antipsychotic antipsychotic or tricyclic antidepressant monotherapy or second generation electroconvulsive (ECT) therapy as first-line treatment for unipolar psychotic depression.
Pharmaceutical treatments may include tricyclic antidepressants, atypical antipsychotics, or a combination of antidepressants from newer, more tolerable SSRI or category SNIs and atypical antipsychotics. Olanzapine may be an effective monotherapy in psychotic depression, although there is evidence that it is ineffective for symptoms of depression as monotherapy; and olanzapine/fluoxetine are more effective. Quetiapine monotherapy may be helpful in psychotic depression because it has antidepressant and antipsychotic effects and a reasonable tolerability profile compared to other atypical antipsychotics. Treatment of drug-based psychotic depression is currently quite effective but can cause side effects, such as nausea, headache, dizziness, and weight gain. Tricyclic antidepressants can be very dangerous, since overdoses potentially lead to fatal cardiac arrhythmias.
In the context of psychotic depression, the following is the most well studied combination of antidepressants/antipsychotics
Generasi pertama
- Amitriptyline/perphenazine
- Amitriptyline/haloperidol
Generasi Kedua
- Venlafaxine/quetiapine?
- Olanzapine/fluoxetine
- Olanzapine/sertraline
In modern ECT practice, therapeutic clonic seizures are induced by electrical currents through electrodes placed in anesthetized and unconscious patients. Despite much research, the mechanism of action of ECT is still unknown. ECT carries the risk of temporary cognitive deficits (eg, confusion, memory problems), in addition to the burden of repeated exposure to general anesthesia.
Research
Efforts were made to find treatments that targeted the specific pathophysiology proposed from psychotic depression. The promising candidate is mifepristone, which by competently blocking certain neuro receptors, makes cortisol less able to act directly on the brain and is thought to repair the overactive HPA axis. However, Phase III clinical trials, which investigated the use of mifepristone in PMD, were discontinued earlier due to lack of efficacy.
Transcranial magnetic stimulation (TMS) is being investigated as an alternative to ECT in the treatment of depression. TMS involves the administration of focused electromagnetic fields to the cortex to stimulate certain neural pathways.
Studies have shown that psychotic depression differs from non-psychotic depression in several ways: potential triggering factors, underlying biology, symptomatology beyond psychotic symptoms, long-term prognosis, and response to psychopharmacology and ECT treatment.
Prognosis
Long-term outcomes for psychotic depression are generally worse than non-psychotic depression.
References
Source of the article : Wikipedia
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