Psychotic depression and hallucinations

The clinical syndromes of depression have been systematically studied at a number of different levels of conceptualization: genetic,¹ biochemical and physiological,² psychoanalytic,^3,4 epidemiologic,^5-7 and phenomenologic.^8,9 Hallucinations have also been intensively investigated at a number of different levels of organization: neurophysiologically,¹⁰ pharmacologically,¹¹ in sensory deprivation,¹² hypnotically,¹³ and phenomenologically.¹⁴ The reports in the literature about the incidence of hallucinations in depression vary from Beck's finding¹⁵ of 13% to Goodwin's report¹⁶ of 82%. The work of other investigators^17,18 shows incidences falling between those of Beck and Goodwin. A significant problem in investigating the depressive disorders has been the difficulty in categorizing different depressive states. Affective disorders have the lowest overall rate of diagnostic consistency.¹⁹ Because of the difficulty with the specific nosologic categories of depression, as well as the fact that previous studies of the incidence of hallucinations have primarily dealt with manic-depressive psychoses, this study will focus on the incidence of hallucinations in individuals who specifically meet the diagnostic criteria, outlined in DSM I,²⁰ of Psychotic Depressive Reaction.^* * "These patients are severely depressed and manifest evidence of gross misinterpretation of reality, including, at times, delusions and hallucinations. This reaction differs from the manic depressive reaction, depressed type, principally in (1) absence of history of repeated depressions or of marked cyclothymic mood swings, (2) frequent presence of environmental precipitating factors. This diagnostic category will be used when a 'reactive depression' is of such quality as to place it in the group of Psychoses.". Diagnostic and Statistical Manual, American Psychiatric Association, special printing, 1965. Furthermore, the group will be described in terms of sex, age, history of psychiatric care, clinical picture, and follow-up for a 9-year period.