Schizophrenia vs. Psychotic Depression

Submitted by, September 22, 2011

I think I have been

I think I have been misdiagnoised for Schizo-affective disorder for many years. My aunt and my older sister committed suicide for depression. My uncle suffers from bipolar. Even he has delusion. His doctor does not think he is schezoprenic.
When I was very ill over 10 years ago. I suffered from vaious mood disorder and delusion. I ended up committing suicided becaue I felt helpless, hopeless and having too much anxiety. The therapist said I had schizo-affective disorder. My psychiatrist never questions that and never provdes his own opinion on what my problem is. I have a stressful and unstable job due to the job nature itself. I am dealing with depression and anxiety now. When the situaion is bad, my obsession come back even with reperdal. I have been on Consta injection for years. If I really have psychotic depression, have I been taking too much anti-psychotic medicion? I had a surgery to remove dermoid cysts on both side of the ovaries. I was wondering if it has something to do with the medicine which triggers irreular period. You answer will made me feel better if I find out I have psychoic depression instead.


Hi Ppt719, I really don't

Hi Ppt719,

I really don't have enough information to make an educated guess regarding an accurate diagnosis for you. But I will try to address the issues you brought up.

It's certainly possible that you have been misdiagnosed with schizoaffective disorder. However, psychotic depression (or rather, "major depressive disorder with psychotic features") is usually not a chronic disorder, whereas schizophrenia and schizoaffective disorder are. Major depression can be chronic in some cases, but the psychosis rarely is. So, for someone whose psychosis is part of a severe depressive episode, treatment with antipsychotic medication would usually be short term, not ongoing.

You say you've been on Consta injection for years. That would be consistent with a diagnosis of schizophrenia or schizoaffective disorder, but not depression with psychotic features.

Now, you mention that your psychiatrist "never questions" your diagnosis. Any ethical psychiatrist would have fully reviewed your history and would not just automatically take a prior diagnosis for granted. And, he should be monitoring your symptoms while treating you.

If you are questioning your diagnosis, have you addressed this with him and asked him, specifically, what evidence there is to support the schizoaffective diagnosis? He should be able and willing to answer that.

There is some overlap between major depression with psychotic features, bipolar disorder with current depressed mood with psychotic features, and schizoaffective disorder. Differentiating between these three does take a thorough history and good diagnostic skills on the part of the clinician.

A bipolar diagnosis (in your case) would only be accurate if there was a history of at least one manic episode (hypmomania doesn't include psychosis), and the psychotic symptoms occurred ONLY during severe mood episodes. The schizoaffective diagnosis would include a history of psychotic symptoms during times when there were NO mood symptoms (depression or mania). With MDD with psychotic features, the psychosis would occur ONLY during a severe depressive episode, and if there is no history of mania or hypomania. (This is a bit oversimplified, but gives you the bare essentials.)

To make it all even more complicated, it is also possible for someone to have a diagnosis of schizophrenia and major depressive disorder, but not meet the criteria for schizoaffective disorder. The differentiation depends a lot on time frames for psychotic episodes and mood episodes, and sorting all that out can be difficult without a thorough and accurate history (which isn't always available).

You also mentioned obsessions, and I'm not sure where those fit in to the clinical picture.

If you have a history of experiencing delusions when you are not in a severe depressive episode, then the schizoaffective diagnosis would likely be accurate (depending on other criteria that must be met).

I strongly suggest you discuss this with your psychiatrist. It may also be worth your while to get a second opinion (i.e. a face to face evaluation with another psychiatrist or a clinical psychologist), and it helps if whoever evaluates you can access your psychiatric history to get the full clinical picture (as much as possible).

I hope this helps!

Dr. Cheryl Lane

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