Define Major Depression with Psychosis

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A major depressive disorder is one that has multiple depressive episodes over an extended period of time. A psychotic disorder is one that is characterized by delusions or hallucinations. The combination is a type of mental illness that requires professional treatment to resolve.

One way to understand the difference between depression and psychosis is to think of depression as a mood disorder – one where the emotions are primarily affected and the behavior results from this. Psychosis, on the other hand, can be thought of as a disorder in thinking and perception.

Depressive disorder

  • The hallmarks of depression are:
  • Feelings of sadness, emptiness or hopelessness that do not go away
  • Loss of interest in pleasurable activities
  • Sleep disturbances – either insomnia or hypersomnia (sleeping too much)
  • Chronic fatigue
  • Loss of focus; inability to concentrate or make decisions
  • Suicidal thoughts or intentions.
  • Not all of these are present in all cases. How severe the symptoms are and how frequent will determine whether the depression is considered major or mild.

Psychosis

  • For psychosis, the defining characteristics are:
  • Delusions – false beliefs that interfere with someone’s ability to live their lives. For example, believing that people are following you and not being able to go outside because of the resulting fear. Phobias can fall under this category, although the hallmark of a phobia is emotional, rather than just a logical error. Delusions about who you are or other beliefs that dramatically conflict with available evidence are other types.
  • Hallucinations are errors in perceptions, rather than beliefs. Seeing things that aren’t there, or hearing voices would be hallucinations. Other perceptual illusions are possible as well – touch, taste, proprioception (body image), and smell can all be affected. While most of us have had experience with a mistake in perception, a true hallucination is much more difficult to dismiss, may be persistent, and is deemed important and a major distraction.
  • Anxiety and fear is often present as a result.
  • Anger is common and may result from a challenge to the delusional state.
  • Shame or humiliation when the patient is aware of their condition.

Combination

The link between emotion, self esteem and psychosis is still being studied. A paper from 2006 on the subject can be found here. One direct finding was that the content of hallucinations is more negative when someone also has depression.

It makes sense that one condition might flow from the other. For example, someone who understands they are suffering from inappropriate thoughts and beliefs might naturally feel they are defective and trapped. They don’t want the toxic thoughts, but cannot seem to escape them through will power alone. If the psychosis is severe enough to interfere with normal functioning, this too can lead to depression – job loss, failing relationships and an inability to cope are all triggers for depression.

 
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