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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by Diane E. on July 20, 2000, at 15:24:05
Hi,
I have just gotten off the phone with my husband's therapist. He suffers from depression and I had called her
yesterday to let her know that he was doing particularly poorly. She works closely with his psychiatrist. She told
me that his diagnosis is "depression with psychotic features." I had not heard this before (I always thought his
diagnosis was major depression). I asked her to give me some examples of his psychotic thinking. Her examples
were the fact that when he is really doing poorly he is convinced that he will never get better and that
he believes he has a character flaw rather than a mental illness (on better days, he understands that this is an
illness). I always thought that this type of thinking was sympotmatic of depression and not a delusion (i.e., low
self-esteem, tons of self-blame, feelings of hopelessness). She said that it is a tricky distinction, but that she and
the psychiatrist believe these are delusions. Can some one help me to explain this better? When does
depressed thinking become delusional? How can the two be distinguished?Thanks,
-Diane
Posted by noa on July 20, 2000, at 18:24:49
In reply to depression with psychotic features, posted by Diane E. on July 20, 2000, at 15:24:05
I guess I would look for whether he can acknowledge that it is POSSIBLE that he may be wrong about his prognosis, even though he FEELs that way, ie, to be able to acknowledge that others see it differently and that there is a possibility, no matter how small, that they could be right, even though he cannot imagine their perspective.
However, I, like you, have always thought of psychotic features in depression as being more blatant than that, such as believing that one is inherently evil, or the devil, or the bearer of badness in some way that affects others, like actually believing one causes bad things to happen to others just by being present, because one is so inherently bad.
But perhaps it is just the rigidity of the thoughts that they are focusing on. Thinking of his illness in these terms may help in choosing the right meds.
Posted by shellie on July 20, 2000, at 18:56:46
In reply to depression with psychotic features, posted by Diane E. on July 20, 2000, at 15:24:05
" Her examples were the fact that when he is really doing poorly he is convinced that he will never get better and that he believes he has a character flaw rather than a mental illness (on better days, he understands that this is an illness). I always thought that this type of thinking was sympotmatic of depression and not a delusion (i.e., low self-esteem, tons of self-blame, feelings of hopelessness). She said that it is a tricky distinction, but that she and the psychiatrist believe these are delusions. Can some one help me to explain this better? When does depressed thinking become delusional? How can the two be distinguished?"Hi Diane. It must be a "tricky" distinction, because everything you've written seems like major depression to me. The only thing I can think of is the "tons of blame" part. Like if he not only thinks he is bad because he is depressed (common for depressives), but also believes he is depressed because he is bad, that would be delusional to me.
Maybe Noa's correct in it helps his doc chose his medications. Unless it is used in his treatment strategy (either for therapy, or meds), the diagnosis doesn't really change anything. And his therapist is saying it's a tricky (or perhaps a subtle) distinction. I do hope she's not writing that on the insurance forms though: my therapist's belief is that you always give the least harmful diagnosis on any forms. Like for me, both my therapist and pdoc write "major depresson"; not "major depression with dissociative disorder" Shellie
Posted by stjames on July 21, 2000, at 2:36:09
In reply to depression with psychotic features, posted by Diane E. on July 20, 2000, at 15:24:05
> Hi,
>
> I have just gotten off the phone with my husband's therapist. He suffers from depression and I had called her
> yesterday to let her know that he was doing particularly poorly.James here....
From the Merck, http://www.merck.com/pubs/mmanual/section15/chapter189/189b.htm
Some experts consider psychotic manifestations, which occur in 15% of melancholic patients, the hallmark of a delusional or psychotic depressive subtype. Patients have delusions of having committed unpardonable sins or crimes; hallucinatory voices accuse them of various misdeeds or condemn them to death. Visual hallucinations (eg, of coffins or deceased relatives) occur but are uncommon. Feelings of insecurity and worthlessness may lead some patients to believe that they are being observed or persecuted. Others think that they harbor incurable or shameful disorders (eg, cancer, sexually transmitted disease) and that they are contaminating other persons. Very rarely, a person with psychotic depression kills family members--including infants--to "save" them from future misfortune and then commits suicide.
Dexamethasone suppression test results are consistently positive in patients with psychotic depression.
In atypical depression, reverse vegetative features
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