A 17-year-old girl presented to you in the outpatient department with restlessness, lack of interest in activities, and poor sleep. These symptoms started after the death of her father one month back. Her mother had similar problems. According to the family, she is demanding and hoarding in nature. On examination she is anxious, her mood is depressed, has intrusive blasphemous thoughts, and believes that she will be punished.
Delusions
Severe depression with psychotic symptoms
Delusions in Psychotic Depression
The following are the common delusions that occur in patients with psychotic depression (severe depression with psychosis)
- Delusions of Guilt
- Delusions of Impoverishment (can also be considered as a type of nihilistic delusion.
- Nihilistic delusions, including collard syndrome
- Persecutory delusions*
- Hypochondriacal delusions
Mnemonic: GINPH
When these delusions occur against a background of depressed mood, they are mood-congruent and favor the diagnosis of psychotic depression. When patients with depression have delusions of grandeur or even neutral delusions e.g. delusions of reference, they are mood-incongruent delusions."
* These patients consider them well-deserved unlike in schizophrenia where patients feel remorse towards them and mania where patients consider them a response to the great position they have earned).
Reference
- Harrison P, Cowen P, Burns T, Fazel M. Shorter Oxford Textbook of Psychiatry. 7th ed. Oxford University Press; 2017:896-896.
Clinical Exercise
What prognostic factors can you identify in this case?