I'm new and I've got questions

[HelpingHand]

Hi there. I'm new here. A friend of mine was recently diagnosed with something that I'm trying hard to understand. I'm hoping to get some insight from some members here. I have a university psychology degree. But that didn't really prepare me for the real thing. There's more to life than textbooks, as I'm finding out. Anyways, I hope someone can help, so I in turn can help.
Thanks for reading.

 

[David Baxter PhD]

Welcome, HlpingHand. What is the something you're trying to understand?

 

[HelpingHand]

Thank you.
I was just wondering about delusions and depression. A friend of mine got diagnosed first with schizoaffective clinical depression. But then he later told me it was acute clinical depression.
I was just wondering if paranoid delusions or altered thinking was entwined it this diagnosis. Or not.
I tried to look it up in the DSM-IV, but I kind of got lost in the book!

Edit: I think I may be in the wrong forum. I'm not sure!

 

[David Baxter PhD]

It's an easy book to get lost in. :study: :shock: :read2:

Severe depression can indeed include "mood-congruent" (i.e., consistent with depressed mood) delusional thinking. Previously, this was sometimes called 'psychotic depression.

Criteria for Major Depressive Episode

A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either
? ?(1) depressed mood or
? ?(2) loss of interest or pleasure.
Note: Do not include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.

(1) depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.
(2) markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)
(3) significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.
(4) Insomnia or Hypersomnia nearly every day
(5) psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
(6) fatigue or loss of energy nearly every day
(7) feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
(8.) diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
(9) recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

B. The symptoms do not meet criteria for a Mixed Episode.

C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).

E. The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

 

[HA]

So, is depression with psychosis really just psychotic depression?

What is bipolar with psychosis then?

 

[David Baxter PhD]

So, is depression with psychosis really just psychotic depression?

Not necessarily. I think the operative distinctions are whether or not the delusional thinking is "mood congruent" and whether or not there are other psychotic features such as hallucinations (in which case the diagnosis is probably more likely schizoaffective disorder) and/or mania (in which case the diagnosis is probably going to be bipolar disorder).

Also note Criterion B. above: "B. The symptoms do not meet criteria for a Mixed Episode."

Criteria for Mixed Episode

A. The criteria are met both for a Manic Episode and for a Major Depressive Episode (except for duration) nearly every day during at least a 1-week period.

B. The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

C. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).
Note: Mixed-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar I Disorder.

Criteria for Severity/Psychotic/Remission Specifiers for current (or most recent) Mixed Episode
Note: Code in fifth digit. Can be applied to a Mixed Episode in Bipolar I Disorder only if it is the most recent type of mood episode.

.x1--Mild: No more than minimum symptom criteria are met for both a Manic Episode and a Major Depressive Episode.

.x2--Moderate: Symptoms or functional impairment between "mild" and "severe."

.x3--Severe Without Psychotic Features: Almost continual supervision required to prevent physical harm to self or others.

.x4--Severe With Psychotic Features: Delusions or hallucinations. If possible, specify whether the psychotic features are mood-congruent or mood-incongruent:

Mood-Congruent Psychotic Features: Delusions or hallucinations whose content is entirely consistent with the typical manic or depressive themes.
Mood-Incongruent Psychotic Features: Delusions or hallucinations whose content does not involve typical manic or depressive themes. Included are such symptoms as persecutory delusions (not directly related to grandiose or depressive themes), thought insertion, and delusions of being controlled.

.x5--In Partial Remission: Symptoms of a Mixed Episode are present but full criteria are not met, or there is a period without any significant symptoms of a Mixed Episode lasting less than 2 months following the end of the Mixed Episode.

.x6--In Full Remission: During the past 2 months, no significant signs or symptoms of the disturbance were present.

.x0--Unspecified.

 

[HelpingHand]

Thanks for the info.
Except it's not delusional thinking about guilt. I'm thinking it's more paranoid thinking. But I'm not sure.

Long story short: I met this friend online in a forum/messageboard much like this one about 2 years ago.
In the past month he's said some bizarre things that are completely out of character. It's like for the 2 years I've known him he's declared he's hated cats, but now he's professing how much he adores cats. (This is the best analogy I can think of. Sorry.)
He's accused me of things that have come out of nowhere. Any attempts to clarify are stonewalled. I think I said something that was misunderstood but I've tried to explain myself. What further complicates things is the online nature makes it difficult to clarify.
Accusations still continue to come.
I've pretty much cut myself off. But I don't know where these accusations come from. They're not even clear, but just little comments that dig.
So I'm wondering if this is due to the schizoaffective part of the diagnosis. Or if I really did something that warrants accusations (though I'm not sure what it is). ?

Therein lies my quandary.

 

[David Baxter PhD]

Online diagnosis is probably never a good idea. However, if he is exhibiting paranoid or bizarre thinking as you describe, it is probably closer to schizoaffective disorder or bipolar disorder than major depression.

 

[HelpingHand]

Oh I didn't diagnose him. I'm definitely not qualified for that!
No, he told me he was seeing a therapist and this was the diagnosis he got.
I was just wondering if there was actually merit to his accusations or if it was more paranoia.

 

[HelpingHand]

By the way, this is a GREAT forum. I have a feeling I'll be spending a lot of time here. Lots of great resources. And first-hand information. I'm glad I found this place.

 

[David Baxter PhD]

Oh I didn't diagnose him.

No, sorry - I meant for me to diagnose online is a bad idea.

By the way, this is a GREAT forum. I have a feeling I'll be spending a lot of time here. Lots of great resources. And first-hand information. I'm glad I found this place.

Thanks!

 

[just4U]

Hi, Helping Hand,

Just based on this series of posts it sounds like you're a good friend and like all good friends are concerned about your friend...so much so that you're taking on some guilt for the condition of your friend. You don't need to do that to yourself. It won't help either one of you.

The outbursts and accusations are most likely manifestations of his illness, rather than anything you did or did not do. Until he is stabilized and rational, it is pointless to be anything other than understanding and patient with your friend. Once stabilized, then discuss things with your friend if you really think you may have done something 'wrong'.

I wish you and your friend well.

just4U

 

[HelpingHand]

Hi just4U,

I had to reread my posts to remember what it was I said.

I don't feel any guilt for the condition for my friend. Anger and confusion, yes, But guilt, no. I have always been there for him to talk to, and he knew that. So I don't even have the guilt of "maybe if I was around more..."
Since the nature of our friendship was online, I definitely WAS around more. I always responded to emails or whatever, and he did to mine.

I am patient and understanding. In fact, he used to tease me that I'm TOO patient and understanding.
It doesn't really matter anymore. He hasn't spoken to me for about 8 months. And during one of his last outbursts, he said he never wanted to talk to me anymore. To this day I still don't know what he thinks I did.

Again, since the nature of our friendship was online, I doubt that we'll ever be friends again. This makes me incredibly sad. I considered him to be a good one. As tempted as I am to send off an email to him, I always stop myself. I will respect his wishes and not talk to him anymore. I just really miss him.

Thanks for your post though.

 

[HelpingHand]

Since this thread is supposed to be an intro about myself, besides my dilemma I wrote about up there, um, I like hockey.

Who am I kidding?

I LOVE hockey. I am a die-hard hockey fan.

 

[David Baxter PhD]

So you're saying you hate the Leafs too?

 

[HelpingHand]

Hating the Leafs is a given.