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Showing posts with label psychotic depression. Show all posts
Showing posts with label psychotic depression. Show all posts
Monday, 11 January 2021
Treatment of Psychotic Depression
Cochrane Review 2015(Wijkstra J 2015)
Psychotic depression is heavily understudied, limiting confidence in the conclusions drawn. Evidence suggests that combination therapy with an antidepressant plus an antipsychotic is more effective than either treatment alone or a placebo. Evidence for treatment with an antidepressant alone or for an antipsychotic alone is lacking.
Maudsley Prescribing Guidelines 2018(Taylor 2018)
Tricyclic augmented by olanzapine or quetiapine as the first line
If tricyclic is not well tolerated, use SSRI or SNRI instead
NICE
For people who have depression with psychotic symptoms, consider augmenting the current treatment plan with antipsychotic medication (although the optimum dose and duration of treatment are unknown).
CANMAT 2016
Use antipsychotic and antidepressant cotreatment (Level 1 evidence)
APA Practice Guidelines for Major Depressive Disorder, 2010
For patients who exhibit psychotic symptoms during an episode of major depressive disorder, treatment should include a combination of antipsychotic and antidepressant medications or ECT.
BAP (Cleare et al., 2015)
In psychotic depression combine an antidepressant with an antipsychotic initially in preference to treating with an antidepressant alone or an antipsychotic alone.
Saturday, 9 January 2021
Treatment of Guidelines for Psychotic Depression
Treatment of Guidelines for Psychotic Depression
First-line
Tricyclic with olanzapine or quetiapine
Second choice
SSRI/SNRI
Consider
Electroconvulsive therapy
Thursday, 9 January 2020
Delusions in Psychotic Depression
(Mnemonic: GINPH)
● Delusions of Guilt
● Delusions of Impoverishment (can also be considered as a type of nihilistic delusion.
● Nihilistic delusions, including Cotard syndrome
● Persecutory delusions*
● Hypochondriacal delusions
Patients with Psychotic depression consider these thoughts well-deserved unlike in schizophrenia where patients feel remorse towards them and mania where patients consider them a response to the great position they have earned.
When these delusions occur against a background of depressed mood, they are mood-congruent and favor the diagnosis of psychotic depression. When patients with depression have delusions of grandeur or even neutral delusions e.g. delusions of reference, they are mood-incongruent delusions" and favor the diagnosis of schizophrenia (ICD-10).
When these delusions occur against a background of depressed mood, they are mood-congruent and favor the diagnosis of psychotic depression. When patients with depression have delusions of grandeur or even neutral delusions e.g. delusions of reference, they are mood-incongruent delusions" and favor the diagnosis of schizophrenia (ICD-10).
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