A 60 year male is brought by his wife. He thinks that he had committed sins all throughout his life. He is very much depressed and has considered committing suicide but has not thought how to do it. He has also had sessions with a spiritual guru. He is not convinced by his wife that he has lead a pious life. He does not want to hear anything on the contrary. How will you treat him?
The patient in question is presenting with features of depression and delusional guilt suggesting a diagnosis of depressive disorder with psychotic features. Treatment of such patients initially includes a combination of anti psychotic and antidepressant medication. In these patients, psychotic features of depression such as hallucinations or delusions (delusional hypochondria, feelings of guilt, nihilistic thoughts) are predominantly mood congruent. These patients return to normal functioning after resolution of acute mood and psychotic symptoms. Psychotic symptoms are indicators of the severity of depression, including suicide risk. Ref: Lippincott's Primary Care Psychiatry By Robe M. McCarron, page 100; Fundamentals of Psychiatry By Allan Tasman, page 126-8.
Anti depressant alone
Anti psychotic + Anti depressant
Antidepressant with cognitive behavioural therapy
Guidance & re counselling with guru + Anti depressant