Mood Disorders With Psychotic Features: Diagnostic Considerations and Treatment Challenges

Abstract

Psychotic symptoms can occur in mood disorders, both major depression and bipolar. The most common psychotic symptoms include hallucinations and delusions. A hallmark of psychosis in mood disorders is the presence of mood congruence. For depression, psychosis can consist of delusions of guilt and poverty, nihilism, or hallucinations that denigrate the person, remind them of failures, and encourage them to hurt themselves. Conversely, manic symptoms are often associated with grandiosity and inflated self-esteem of delusional magnitude. Sometimes, psychotic symptoms can be fleeting, trauma-based or due to substance use, all instances that careful interview can uncover. Diagnostic considerations focus on the differentiation of mood disorders from psychotic disorders such as schizophrenia, and anxiety/trauma-related disorders, given the impact on treatment selection and prognosis. Cognitive-behavioral therapy for psychosis has shown efficacy in treatment. From a pharmacological perspective, mono-therapy (antidepressant, antipsychotic, mood stabilizers) can be very effective though many patients end up on composite regimens. [ Psychiatr Ann . 2023;53(4):160–165.]