Psychotic symptoms

Morten Birket-Smith, psychiatrist

If you are suffering from severe depression, you might get psychotic symptoms. With a psychotic depression you also have negative thoughts. But your thoughts have become unrealistic and difficult for others to understand, as they bear no resemblance to reality.

You might have thoughts about being to blame for serious accidents and catastrophes. You can also be convinced that you are a bad person, and you can feel so sinful that you believe you deserve to die or be punished severely.

Your appetite and thirst can become so reduced that it becomes critical, and in a few cases you might stop eating and drinking altogether. Such a condition can quickly become life threatening and you therefore have to be admitted to a psychiatric ward as quickly as possible.

Can become dangerous

When you are suffering from a psychotic depression, you have an unrealistic perception of reality. You are not fully capable of taking care of yourself - and the situation can become dangerous. With a psychotic depression you always need to be admitted to hospital, in order to be protected and treated. If the situation becomes critical or dangerous, the doctor always needs to be called in. The doctor will arrange the admission. If it is necessary, you might be committed to hospital against your will.

Paranoia

With a psychotic depression you can become paranoid and feel persecuted. You can convince yourself that certain people or secret organisations are out to hurt or punish you. You might believe that you are an innocent victim. But often your depressive thoughts cause you to believe that you have deserved to be persecuted and punished.

Hallucinations

With a psychotic depression you also get hallucinations. You might be hearing voices that speak derogatorily about you or tell you that you must be punished. The voices can also encourage you to punish yourself - perhaps commit suicide. With a severe depression you might also have serious suicidal thoughts without having hallucinations. Severe depression is therefore a very serious disease, which require admission to a psychiatric ward.

An example

One autumn an elderly man was admitted to a psychiatric ward with severe depression. He was anxious, restless and had psychotic symptoms. He was unable to sit still due to the unrest. He told his story rather incoherently and was interrupted by self-criticism and sighing. This is his story:

"During the summer months, we spend most of our time in our allotment. We grow vegetables there for our own use. We have a little house and a shed. We cook food on a little gas hob with a gas cylinder. In the spring, we prepared for the summer. I therefore cleared out the shed as usual.

In the shed I found a gas cylinder. There was still a little gas left in it. I decided that it was dangerous to keep it there. I therefore took a screwdriver and pressed on the valve. The gas was let out this way. Afterwards I put the gas cylinder back. Later I wanted to exchange it for a new one.

The summer was warm and dry. There was a watering ban but we watered secretly. But the soil dried out anyway. It cracked. The leeks and all the other vegetables withered. I know I caused the drought by letting out the gas. I destroyed the ozone layer.

Not only have my vegetables and the harvest failed. I'm also to blame for the drought and hunger catastrophes in the world. I saw a program about the hunger in Africa the other day. Children were dying. It's my fault, and I feel that I no longer have the right to live."

Luckily the man's wife quickly arranged for him to be admitted to hospital and to start his treatment. He was treated with both electroshock and medicine and quickly recovered.