Descriptive Psychopathology: The Signs and Symptoms of ...

378 Section 4: Evidence-based classificationsevere form of melancholia 37 and psychotic depressed patients have melancholicfeatures similar to non-psychotic melancholic patients. 38Like other patients with melancholia, they respond rapidly to ECT. 39Mood-incongruence of psychotic thoughts, i.e. the delusional content, isdeemed “bizarre” (e.g. delusions of passivity not of guilt or worthlessness) andmood-congruence, i.e. the delusion is considered depressive (e.g. low self-worth,self-blame), do not distinguish subgroups of patients with psychotic depression. 40Delusions represent the degree of severity, not unique psychopathology. Otherthan the recognition of psychosis, no measure clearly distinguishes the psychoticand non-psychotic forms of melancholic illness. 41Depression with catatonia or stuporThe close association between mood disorders and catatonia is well established. 42Among newly admitted catatonic patients about 30% are suffering from depressiveillness. 43 Like patients with melancholia without catatonic features, depressedpatients with catatonic features are more likely to exhibit high cortisol levels thatdo not suppress when challenged with dexamethasone. 44 Among newly hospitalizeddepressed patients, about 20% have catatonia. 45 Patients in depressive stuporare indistinguishable from those in stupor with other catatonic features supportingthe idea that depressive stupor is a catatonic sign. 46 Prolonged fixed postures(catalepsy) and other catatonic features occur. Hallucinations and delusions areoften present. 47Perinatal depressionMajor depressive illness occurring during pregnancy or in the postpartum perioddoes not differ substantially from depressive illness occurring at other times, andmost such patients are likely to be melancholic. Serious depressive illness occursin about 5% of women during the several months after delivery. 48 Risk factors aresimilar to those for depressive illness occurring at other times, and include pastpremenstrual dysphoric disorder, undue psychosocial stress, and a personal orfamily history of mood disorder. 49 Because postpartum depression is commonlyassociated with depressive symptoms during pregnancy, pre- and postpartumdepressive illness are best considered a single perinatal process. 50The psychopathology of severe perinatal depression does not differ frommelancholia at other times, 51 although treatment considerations differ. 52 Whenof psychotic severity, perinatal psychotic depressive illness is also indistinguishablefrom psychotic depressive illness occurring at other times. 53Patients with perinatal depressive illness do not have a unique perinatal illness,they have mood disorder. There is an increased risk of depressive illness amongtheir siblings compared to the siblings of women without depressive illness. 54