Psychiatry & Psychotherapy Podcast

Psychotic Depression with Dr. Cummings

Dec 22, 2023

In this podcast, the underreporting of psychotic symptoms in depression is discussed, along with the higher suicide rate in individuals with psychotic depression. The use of acceptance and commitment therapy (ACT) and antipsychotics for treatment is explored. The differences between nightmares in PTSD and malingering are examined. The complexities of treating psychotic depression and alternative approaches, such as ECT and ketamine, are discussed. The mechanisms and diagnosis of depression and delirium are explained. The importance of identifying and treating UTIs in elderly patients to prevent delirium is emphasized. The speaker's approach to assessing patients for medical issues is outlined. The potential differential diagnoses for psychotic depression, including substance use disorder and borderline personality disorder, are explored. The Bush-Francis-Catatonia Scale and treatment with lorazepam are discussed. The process of administering intramuscular medication for psychotic depression is explained.

01:23:00

Creator website

AI Summary

Highlights

AI Chapters

Episode notes

Podcast summary created with Snipd AI

Quick takeaways

The underreporting of psychotic symptoms in individuals with depression is a significant concern, driven by fear of consequences and stigma.

Psychotic depression has a higher suicide rate compared to non-psychotic depression, with most suicides occurring within the first two years following diagnosis.

Psychotic depression requires a combination of antidepressant and antipsychotic medications for effective treatment, with electroconvulsive therapy (ECT) considered for severe cases.

Deep dives

History and differential diagnosis of psychotic depression

Psychotic depression has a complex history, with the definition and understanding evolving over time. Previously, psychotic depression referred to severe cases where individuals were unable to carry out daily activities. However, the current understanding recognizes that psychosis can occur in mild, moderate, or severe depression. Differential diagnosis is crucial to differentiate psychotic depression from conditions like borderline personality disorder, delirium, bipolar disorder, and substance-induced psychosis.

Depression: A Complex Impact on the Brain

01:46

Complexity and Treatment Challenges in Psychotic Depression

01:49

Responding to Untrue Realities

01:22

Evolution of Definition of Psychotic Depression

01:40

Introduction

4min

Acceptance and Commitment Therapy for Psychotic Depression

13min

Nightmares in PTSD vs. Malingering

13min

Treating Psychotic Depression: Complexities and Alternative Approaches

20min

Depression and Delirium: Mechanisms and Diagnosis

6min

UTI and Delirium: Importance of Clearing Infection Before ECT

2min

Assessing Patients for Medical Issues

2min

Differential Diagnoses for Psychotic Depression

19min

Understanding the Bush-Francis-Catatonia Scale and Treatment with Lorazepam

2min

10.

Administering Medication for Psychotic Depression

2min

The underreporting of psychotic symptoms by patients in depression is a significant concern, frequently driven by the fear of consequences like hospitalization or the stigma of embarrassment.

We'll discuss the history, the differential to consider when thinking of psychotic depression, mechanisms, and treatment. Notably, individuals with psychotic depression face a suicide rate double that of their non-psychotic counterparts. A recent cohort study by Paljärvi in 2023 revealed a stark contrast: deaths due to suicide were 2.6% in the psychotic depression cohort, compared to 1% in the non-psychotic group. Alarmingly, most suicides occurred within the first two years following diagnosis. People who suffer from psychotic depression often do not report their psychotic symptoms, leading to inadequate response to normal depression treatments. With 6-25% of individuals with major depressive disorder (MDD) exhibiting psychotic features, it is imperative to understand and address these unique challenges. Join us as we unravel the complexities of this underrecognized aspect of mental health.

By listening to this episode, you can earn 1.25 Psychiatry CME Credits.

Link to blog.

Link to YouTube video.