In clinical practice, patients and parents often ask me, "Why did my child who was diagnosed with depression suddenly start talking nonsense and develop hallucinations, delusions and other psychotic symptoms? Has he changed from depression to schizophrenia ?"
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One of the core characteristics of depression is distorted cognition, extremely distorted cognition, self-attack, self-guilt, feeling that others are treating one unfairly, etc. It is distorted cognition, generalization, black and white.
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1. Do patients with depression have hallucinations and delusions? Do they suffer from schizophrenia?
Before the 1980s, my country's clinical and scientific research on mental disorders was still lagging behind. Most psychiatrists regarded psychotic symptoms as exclusive symptoms of schizophrenia. Once they discovered that patients had delusions and hallucinations, they would reflexively think of them as schizophrenia. This has led to a serious expansion of the diagnosis of schizophrenia, which can even be said to be a misdiagnosis.
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However, in the International Classification of Diseases, 10th edition (ICD-10) , the definition of depression with psychotic symptoms is: meeting the diagnostic criteria for a major depressive episode, and the presence of delusions, hallucinations, or depressive stupor. is defined as "depressive episode with psychotic symptoms", also known as "psychotic depression (PMD)".
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At this time, the patient's hallucinations and delusions may be in harmony with the state of mind, such as self-guilt, death, and nothingness; they may also be inconsistent with the depressed state of mind, such as being victimized, controlled, and thought-inserted.
Among patients with overall depression, the proportion of patients with psychotic symptoms is not low, and can even be said to be common.
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That is to say, when a person's negative cognition reaches a certain level and he self-distorts the world and himself to the extreme, he will have delusions. For example: thinking you are possessed by the devil, or hearing voices that are not there.
People with psychotic depression may neglect their appearance, not bathe or change clothes, may have difficulty conversing, they may speak little, or say things that make no sense.
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However, patients with severe depression like this will experience pessimism, despair, hallucinations, delusions, loss of appetite, functional decline, accompanied by serious suicide attempts and even suicidal behavior.
poses a serious threat to human health, so it must be taken seriously and treated promptly. You must believe that depression is a treatable disease.
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2. How to treat hallucinations and delusions in patients with depression?
With the in-depth research on the disease, the efficacy of drug treatment for depression has indeed made great progress compared with the past. Moreover, in addition to drug treatment, a variety of treatments have emerged.
1. Drug treatment
Antipsychotic drugs are the first choice for treating hallucinations such as auditory and visual hallucinations. Talk to the attending doctor about the hallucinations and let the doctor know your current physical condition and formulate or adjust a treatment plan.
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Antipsychotics, also known as strong tranquilizers or neuroleptics, do not affect the patient's intelligence and consciousness at usual therapeutic doses, but can effectively control the patient's psychomotor excitement, hallucinations, delusions, hostility, thinking disorders, abnormal behaviors and other mental symptoms.
The picture comes from the Internet. It takes a process to use drugs to restore the normal function of the brain. In the process of cooperating with the doctor's medication, you must follow the doctor's advice, take the medication strictly according to the doctor's instructions, and do not increase or decrease the medication or stop the medication without authorization.
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2, Psychotherapy
For patients with depression who have obvious psychosocial factors, they often need to be combined with psychological treatment in addition to drug treatment.
Commonly used psychotherapy methods include supportive psychotherapy, cognitive behavioral therapy, interpersonal therapy, marriage and family therapy, psychodynamic therapy, etc. Among them, cognitive behavioral therapy has been recognized as effective in treating depressive episodes.
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Cognitive behavioral therapy aims to reduce the emotional distress related to auditory hallucinations and develop new coping strategies. It can be used as an auxiliary treatment for auditory hallucinations. Its effectiveness lies in the reduction of catastrophic evaluation, thereby reducing the simultaneous anxiety and painful feelings.
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3, physical therapy
Patients with serious passive suicide attempts and patients who are ineffective in treatment with antidepressants can be treated with modified electroconvulsive therapy (MECT). After electroconvulsive treatment, maintenance medication is still required.
Typically, psychotic depression initially requires hospitalization, and medications often include a combination of antidepressants and antipsychotics.
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In recent years, a new physical therapy method has emerged—repetitive transcranial magnetic stimulation (rTMS) therapy, which is mainly suitable for mild to moderate depressive episodes.
Transcranial magnetic stimulation treatment can reduce the frequency and severity of hallucinations such as auditory hallucinations. Compared with placebo, low-frequency repetitive transcranial magnetic stimulation treatment significantly reduces symptoms, so it has also become a promising method for treating auditory hallucinations and other hallucinations.
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Long-term depression not only affects the patient's mental health, but may also endanger the patient's life safety. Therefore, if you suffer from depression, you must treat it as early as possible to avoid serious consequences.
I am Director Xia of the Department of Psychiatry. If you have mental and psychological problems, such as insomnia, depression, anxiety, etc., you can leave a message in the comment area and I will help you! #Pay attention to mental health# #Health decryption# #Health science contest# #Depression# #媯 Zero Zero Plan#
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