Psychotic Depression and Suicidal Behavior

Abstract

Suicide risk assessments based on verbal reports from individuals with psychotic depression may not always be valid due to potential impulsivity and underreporting of suicidal ideation. It may be important for clinicians to explore the delusional content of such patients' experiences to assess the possibility of suicide as a result of shame, guilt, remorse, or altruistic intentions to save others from harm.

Psychotic (delusional) depression and suicidal attempts: a systematic review and meta‐analysis

“…Our findings have important clinical implications as patients with PMD frequently avoid expressing their psychotic experiences, being unable to deal with their psychotic phenomena and strong feelings of guilt, shame, intense anxiety, fear, etc . Additionally, they are often too psychomotorly retarded to give adequate verbal information about their psychotic experiences; thereby, their psychosis is often overlooked .…”

“…Fifty studies were left for further investigation after exclusion of duplicates and irrelevant to the research question references. Eight studies reported data on completed suicides , nine included bipolar patients , five had no comparison group , five assessed suicidality by means of psychometric scales with no categorical data , two consisted of the same sample with the included studies , and two were excluded because their sample exclusively comprised patients with history of suicidal attempt or adolescent ones with psychotic experiences without fulfilling PMD criteria though .…”

“… study both PMD and non‐PMD groups suffered from depressive episode of equal severity and the PMD group still exhibited higher levels of suicidal attempts. Thus, we speculate that this elevated risk might better be attributed to psychosis per se (e.g., commanding hallucinations, delusional ideas), pronounced guilt feelings, impulsivity , or greater executive dysfunction, the latter closely linked with psychosis, which intercepts successful problem‐solving abilities . Additionally, the PMD's higher levels of psychomotor disturbance, mainly agitation, or more enduring depressive symptoms that expose patients to depression for longer time might play a role in increasing the rate of suicide attempt in PMD.…”

Risk of bias assessments and reporting quality of systematic reviews and randomized controlled trials examining acupuncture for depression: An overview and meta‐epidemiology study

“…Depression, also known as depressive disorder, is characterized by overwhelming and persistent feelings of sadness and worthlessness. Severely depressed patients may have suicidal thoughts and behavior . The 2017 Global Burden of Disease (GBD) study identified depression as the 3rd cause of disability and the 15th contributor to the burden of disease as measured by disability life years (DALYs), with an increase of more than 10% in 2007 .…”

Benzodiazepiner i akuttpsykiatrisk behandling

“…Noen pasientgrupper i psykiatriske avdelinger har høy/økt forekomst av selvmord under innleggelse og rett etter utskrivning (8). Disse pasientene er preget av agitasjon, panikk, desperasjon og av og til psykose (9). De siste 20 årene har vi fått kunnskap om at den primaere suicidforebyggende behandlingen for denne gruppen bør vaere å sikre adekvat behandling av angst og søvn (10).…”