The Historical Aspect of Depressive Delusions Phenomenon Studies

The aim: to provide an overview of domestic and international studies examining various aspects of issue of depressive delusional ideas in endogenous delusional depression disease patternMaterials and method: in order to compile a literature review for the keywords depressive delusions and delusional depressions, data from scientific articles posted in MedLine and PubMed databases as well as other bibliographic sources have been searched and analyzed during the formation of scientific psychiatry to the present.Discussion: based on the analysis of scientific publications, this paper presents data on the psychopathological description of depressive delusions and its relatedness to the depressive affect. The researchers’ viewpoints on primary and secondary characteristics of depressive delusions are being analyzed. We have identified pathogenetic characteristics of the latter that affect the prognostic assessment, such as features of the depressive triad in endogenous depression, severity and type of depressive affect, risk of suicidal behavior, characteristics of premorbid personality traits, genetic background, as well as therapeutic efficacy of treatment methods for depressive delusions in patients with delusional depression. This research reveals the controversial nature of some provisions of scientific publications that gradually divert from clinical diagnostic approaches, which tend to be replaced by psychological and psychoanalytic ones when carrying out prognostic assessment in cases of depressive delirium, which is characteristic of current psychiatric science.Conclusions: scientific publications data analysis testifies to the priority of the clinical and psychopathological method in studying the issues of depressive delusions structure in delusional depression disease pattern as well as in clinical differentiation of depressive delusions, justifies its clinical and prognostic value and enables to choose the treatment effectively.

Delusion and Mood Disorders

After a short introduction, in which definition and epidemiology of delusional ideas in mood disorders are described, the author attempts to develop a psychopathology of these delusions. Next, the author tackles one of the biggest problems delusional depression poses: is it a different nosological entity respecting the non-delusional depression? European psychiatry tends to deny this independence, considering it a severe form of depression. The question should instead be why some depressive patients have delusions and others do not. Following Blankenburg, 1991, the author postulates that some depressive patients have guilt delusions, because in the past they have committed some transgressions which contradict the characteristics of their typus melancholicus personality. Some examples of this link, from the author’s own clinical experience, are presented. In the last section the author develops a phenomenology of delusional depression a propos of a case of nihilistic (Cotard’s) syndrome.

Depressive Mood Disorders

Electroconvulsive therapy is most often used to treat disorders of mood. The internally experienced feeling is the emotional state reflected in the way we present ourselves to others and in the ways we react to them. Mood varies with daily circumstances and is sensitive to the conditions of the body, particularly physical health, fatigue, hunger, and hormonal activity. Moods are experienced internally and fluctuate widely. Two disorders are recognized. Depression, or depressive mood disorder, is dominated by sadness, hopelessness, fear of the future, and the persistent thought that life is not worth living. Mania, or manic mood disorder, is a state of excitement, grandiosity, expansiveness, and feelings of increased power and energy. In the present psychiatric classification, mania is labeled bipolar disorder and the depressed phase is labeled major depression. In a depressive mood disorder, body functions are disrupted. Patients are sleepless, appetite is poor, and weight loss may be pronounced, at times amounting to 20% of the body weight within a few weeks. Work, sexual activity, and family may be disregarded. The future appears hopeless, patients believe they are helpless to affect it, and their thoughts are filled with gloom. Threats of suicide reflect their distress. They are often agitated and restless. Many meet the criteria for the malignant syndrome of melancholia. Overwhelmed by feelings of helplessness, hopelessness, and worthlessness, the depressed patient dwells on thoughts of suicide. He may believe that others are watching or talking about him; voices are heard when no one is present; and concerns that his spouse is unfaithful dominate his thought. At times, the events depicted on the television or movie screen seem to apply directly to him. Such strange thoughts are delusions, and this severe state of depressed mood and disorder in thought is labeled delusional depression or psychotic depression. These disorders require intensive treatment and almost always hospital care. A depressed patient is commonly unaware of the day’s events, registers little of what happens around her, and has a compromised memory. This form of depression can be difficult to distinguish from an Alzheimer-type dementia. When the symptoms of dementia are brought about by depression, however, they can be reversed with treatment.