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Ask Dr. D. Love Your Own Question
Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 18671
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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My brother has a diagnosis of psychotic depression which I

Customer Question

My brother has a diagnosis of psychotic depression which I have been told is not a proper diagnosis as such, more a term - symptoms of psychosis such as delusions or hallucinations and a depressive stupor? I understand to be suffering a delusion or hallucination, what is a stupor? in this context? Also when my Brother was in hospital he was very cruel saying, I am glad Dad is dead - I hated him causing us distress. He had been smoking an enormous amount of cannabis and refused his medications which invariably led up to a powerful six month psychotic episode. My brother is very manipulative and tells many lies, he appears to present different personality types when he feels it's requires - he shows no emotion other than anger. I wonder if his sensibilities are kind of suspended? if that makes sense.
Submitted: 3 years ago.
Category: Medical
Expert:  Dr. D. Love replied 3 years ago.
Hello from JustAnswer. I will be glad to assist you today.
It will help if you could first provide some further information.
During the 6 months psychotic episode, was he also having depressive symptoms during that 6 months?
Or did he have a period of time with psychotic symptoms without depressive symptoms?
If the latter, how long was the period with psychotic symptoms without depressive symptoms?
Customer: replied 3 years ago.

My Brother fell into the care of the Crisis management team many years ago and was depressed however, he has smoked cannabis since he was around 15 years old and finally stopped at 43 years old - two years ago in actual fact. His first admission to hospital with psychotic depression he was detained under the mental health act and discharged a month later. The clinical lead psychiatrist apparently told my Brother "I would say you have been depressed since being a teenager" He has been dreadfully paranoid when ill and incredibly nasty especially playing mind games and manipulating people in the family in varioius ways although he is intelligent and very articulate. He was also detained on his second hospital admission but this time it was a six month period, however they were also waiting for suitable accommodation with support on site etc. On his first admission he was taken off by the police as he was threatening suicide on the viaduct and in the past he has from time to time self harmed in front of immediate family members and taken an over dose. The last admission there was no mention whatsoever of any kind of suicidal ideation which is confusing because if someone is so severely depressed then wouldn't this be expected? The psychiatrist told him "You are here because of smoking cannabis and behaving badly - my Mum had no choice but to make him homeless as his behaviour was becoming bad to worse and his anger, cruelty and spite new no boundaries. I think, although I am not sure that he may, perhaps have a personality disorder and wondered if the term "psychotic depression" is indeed pointing toward this.

Expert:  Dr. D. Love replied 3 years ago.
Thank you for the additional information.

There are several issues to consider in this situation.

The term, psychotic depression, refers to people that have a complicated episode of depression. These patients satisfy the diagnostic criteria for depression, but also have psychotic symptoms. The criteria for depression does not require depressive stupor, although some people with depression can have stupor, which in a medical context means the same as in any other context - a person that is withdrawn and does not interact with their environment.

I ask about the psychotic episode because there is another condition, called schizoaffective disorder, which also refers to people with symptoms both of a psychosis and depression. This condition refers to people that appear to have a primary psychosis but late also develops depression. At some point in their history, though, they typically have a period of psychosis without depressive symptoms.

So, psychotic depression is generally used to describe a person that appears to primarily have depression that also develops psychotic symptoms, while schizoaffective disorder refers to people that appear to primarily have psychosis that also develops depressive symptoms. In some people, it can be difficult to differentiate between the two, but in someone that has been depressed since a teenager that is now having both depressive and psychotic symptoms, that would be consistent with a psychotic depression.

Neither of these conditions indicate a personality disorder, but neither preclude the possibility of a personality disorder. The presence and diagnosis of a personality disorder is independent of whether psychotic depression or schizoaffective disorder is present.

If I can provide any further information, please let me know.
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Customer: replied 3 years ago.

Thank you so much and sorry so far as I was aware I rated your service as soon as I had read and absorbed the information in your comprehensive and easy to understand reply

excellent 10/10 your answer has taken me into much further understanding and helped me enormously.

Customer: replied 3 years ago.

I am so sorry I can't afford to pay anymore than £24 as I am not employed at this current time.

Expert:  Dr. D. Love replied 3 years ago.
Thank you for the positive rating. The initial payment if excellent; there is no need to apologize for the difficulty in paying more.