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Episode depresif berat dengan gejala psikotik merupakan bentuk dari depresi berat yang disertai gejala psikotik yang khas seperti waham atau delusi non-bizarre nihilistik, somatik, kemiskinan, ketidakberhargaan, atau adanya keyakinan-keyakinan delusional tentang perasaan bersalah dan sedang dihukum, serta kadang-kadang muncul halusinasi. Keyakinan-keyakinan delusional pada penderita episode depresif dengan gejala psikotik merupakan suatu distorsi kognitif, sebuah pola berpikir yang rancu dan menimbulkan kesalahan secara negatif yang meningkatkan kerentanan terhadap depresi. Studi kasus ini mengkaji klien yang didiagnosis episode depresif berat dengan gejala psikotik dari sudut pandang psikologi dengan pendekatan Teori Kognitif Beck. Seorang laki-laki bernama G, berusia 45 tahun mengurung diri dan tidak mau bertemu dengan saudara-saudaranya. Klien tidak mau mandi serta tidak shalat. Klien merasa ia tidak bisa melakukan apa-apa lagi. Menurut kakak, adik ipar, dan istri klien, klien pernah mengalami kecelakaan ketika bekerja di pabrik dan saat mengendarai sepeda motor sehingga kondisi fisiknya menurun. Klien lalu mendapatkan pemutusan hubungan kerja. Kondisi kejiwaannya terganggu. Hasil integrasi tes psikologi menunjukkan bahwa klien memiliki depresi dan kecemasan berlebihan. Teori kognitif Beck mengenai depresi mencantumkan tiga aktivitas kognitif yang mendasari munculnya sebuah gangguan, yaitu: a) negative triad (pandangan pesimistik terhadap diri sendiri, dunia, dan masa depan); b) skema atau keyakinan negatif yang dipicu oleh peristiwa/ situasi kehidupan negatif; dan c) distorsi kognitif. Negative triad berupa pandangan klien bahwa ia telah gagal, sedang dihukum, dan tidak bisa melakukan apa-apa di masa depan. Skema atau keyakinan negatif klien, yaitu meyakini bahwa karena sakitnya yang dialaminya tersebut membuatnya tidak berdaya. Distorsi Kognitif dalam bentuk overgeneralisasi, yaitu“Saya tidak bisa melakukan apa-apa lagi”.
Kata Kunci: depresi, gejala psikotik, keyakinan delusional, Teori Kognitif Beck, negative triad
Severe depressive episodes with psychotic symptoms are a form of major depression accompanied by typical psychotic symptoms such as delusions or nihilistic, non-bizarre delusions, somatic, poverty, worthlessness, or delusional beliefs about guilt and being punished, and sometimes appear hallucination. Delusional beliefs in people with depressive episodes with psychotic symptoms are a cognitive distortion, a pattern of thinking that is ambiguous and negatively causes errors that increase susceptibility to depression. This case study discusses clients diagnosed with severe depressive episodes with psychotic symptoms from a psychological perspective with Beck’s Cognitive Theory approach. A 45-year-old man named G locked himself in and didn’t want to see his brothers and sisters. Clients did not want to shower and did not pray. The client feels he could not do anything else. According to the brother, sister-in-law, and client’s wife, the client had an accident while working in a factory and while riding a motorcycle so that his physical condition declined. The client then gets terminated in work. His mental condition is disturbed. The results of the integration of psychological tests show that the client has depression and excessive anxiety. Beck’s cognitive theory of depression lists three cognitive activities that underlie the emergence of a disorder, namely: a) negative triads (pessimistic views of yourself, the world, and the future); b) negative schemes or beliefs triggered by negative life events/ situations; and c) cognitive distortion. Negative triad is the client’s view that he has failed, is being punished, and cannot do anything in the future. The client’s negative schema or belief, which is to believe that because of the pain he is experiencing makes him helpless. Cognitive Distortion in the form of overgeneralization, which is “I can’t do anything else”.
Keywords: depression, psychotic symptoms, delusional beliefs, Beck’s Cognitive Theory, negative triads
Summary
Psychotic disorders are severe mental disorders that cause abnormal thinking and perceptions. People with psychoses lose touch with reality. Two of the main symptoms are delusions and hallucinations. Delusions are false beliefs, such as thinking that someone is plotting against you or that the TV is sending you secret messages. Hallucinations are false perceptions, such as hearing, seeing, or feeling something that is not there.
Schizophrenia is one type of psychotic disorder. People with bipolar disorder may also have psychotic symptoms. Other problems that can cause psychosis include alcohol and some drugs, brain tumors, brain infections, and stroke.
Treatment depends on the cause of the psychosis. It might involve drugs to control symptoms and talk therapy. Hospitalization is an option for serious cases where a person might be dangerous to himself or others.
Overview
What is schizophreniform disorder?
Schizophreniform disorder is a short-term type of psychotic disorder, a serious mental condition that can distort the way you:
- Think.
- Act.
- Expresses emotions.
- Perceive reality.
- Relate to others.
Like schizophrenia and other psychotic disorders, schizophreniform disorder is a type of mental illness — called a “psychosis” — in which you cannot tell what is real from what is imagined. Although schizophrenia is a lifelong illness, schizophreniform disorder lasts between one and six months.
How common is schizophreniform disorder?
About one person in 1,000 develops schizophreniform disorder during his or her lifetime.
Who is more likely to get schizophreniform disorder?
The disorder occurs equally in men and women between the ages of 18 and 24. However, it often strikes men at a younger age. In women, it most often occurs between the ages of 24 and 35.
Symptoms and Causes
What causes schizophreniform disorder?
Although the exact cause of schizophreniform disorder is not known, researchers believe that genetic, biochemical and environmental factors may be involved.
- Genetics (heredity): A tendency to develop schizophreniform disorder might be passed on from parents to their children. This increases your risk of developing the disorder compared to the general population. However, this does not guarantee that the disorder will be passed on.
- Brain chemistry: If you have schizophrenia or schizophreniform disorder, you might have an imbalance of certain chemicals in the brain. These chemicals, called neurotransmitters, are substances that help nerve cells in the brain send messages to each other. An imbalance in these chemicals can interfere with the transmission of messages, leading to symptoms.
- Environmental factors: Evidence suggests that certain factors in the environment might trigger schizophreniform disorder in people who have inherited a tendency to develop the disorder. These factors can be poor social interactions or a highly stressful event.
What are the symptoms of schizophreniform disorder?
Symptoms of schizophreniform disorder are similar to those of schizophrenia and might include the following:
- Delusions (false beliefs that are not based in reality and that you refuse to give up, even when presented with factual information showing they are inaccurate).
- Hallucinations (seeing, smelling, hearing, or feeling things that are not really there).
- Disorganized speech, such as: your statements not making sense, using nonsense words and skipping quickly from one topic to another.
- Odd or strange behavior such as: pacing, walking in circles and writing constantly.
- Other symptoms, including: limited emotional expression, lack of energy, poor hygiene and grooming habits, loss of interest or pleasure in life and withdrawal from family, friends and social activities.
What are the complications of schizophreniform disorder?
About two-thirds of people with schizophreniform disorder develop schizophrenia. In some cases, people with schizophreniform disorder also have symptoms of depression, which increases the risk of suicide.
Diagnosis and Tests
How is schizophreniform disorder diagnosed?
If symptoms are present, your healthcare provider will perform a complete medical history and physical examination. Although there are no laboratory tests to specifically diagnose schizophreniform disorder, your healthcare provider might use various diagnostic tests to rule out physical illness as the cause of your symptoms. These tests may be blood tests or imaging studies of the brain.
If your healthcare provider finds no physical reason for the symptoms, he or she might refer you to a psychiatrist or psychologist. These are health care professionals who are specially trained to diagnose and treat mental illnesses.
Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate you for a psychotic disorder. The healthcare provider or therapist bases his or her diagnosis on your symptoms and his or her observation of your attitude and behavior.
Your healthcare provider or therapist then determines if your symptoms point to a specific disorder as outlined in the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5), which is published by the American Psychiatric Association and is the standard reference book for recognized mental illnesses. According to the DSM-5, a diagnosis of schizophreniform disorder is made if you have characteristic symptoms that last between one and six months.
Management and Treatment
How is schizophreniform disorder treated?
The goal of treatment for schizophreniform disorder is to protect and stabilize you and relieve your symptoms. Treatment generally consists of medication and psychotherapy (a type of counseling). People with severe symptoms or who are at risk of hurting themselves or others might need to be in the hospital until their condition is stabilized.
Medication — The primary medications used to treat the psychotic symptoms of schizophreniform disorder — such as delusions, hallucinations and disordered thinking — are called anti-psychotics. A group of newer medicines, called atypical antipsychotics, are most commonly used. These include:
- Risperidone (Risperdal®).
- Clozapine (Clozaril®).
- Quetiapine (Seroquel®).
- Ziprasidone (Geodon®).
- Olanzapine (Zyprexa®).
- Iloperidone (Fanapt®).
- Paliperidone (Invega®).
- Asenapine (Saphris®).
- Lurasidone (Latuda®).
Psychotherapy — The goal of therapy is to help your learn about the illness, establish goals and manage everyday problems related to the disorder. It also can help you manage the feelings of distress associated with the symptoms and challenge thoughts that might not be based in reality. Family therapy can help families deal more effectively with a loved one who has schizophreniform disorder, enabling them to contribute to a better outcome.
After your symptoms improve, you should continue treatment for 12 months. This includes gradually reducing the dosage of medication and carefully monitoring for signs of relapse (return of symptoms). Also, it’s important to educate yourself and your family to help them cope with your illness and detect early signs of relapse.
Prevention
Can schizophreniform disorder be prevented?
There is no known way to prevent or reduce your risk of schizophreniform disorder. However, early diagnosis and treatment can help decrease the disruption to your life, family and friendships.
Outlook / Prognosis
What is the outlook for people with schizophreniform disorder?
People with schizophreniform disorder recover within six months. If the symptoms continue beyond six months, you most likely have schizophrenia, which is a lifelong illness.
Living With
Can I live a normal life with schizophreniform disorder?
Schizophreniform disorder can be extremely disruptive. It messes up how you think, act, express emotions, perceive reality and relate to others. This causes problems with relationships, employment and other aspects of “normal life.”
Some individuals with schizophreniform who have worked in the past find it easier to return to employment. If you’ve never worked, it might be helpful to do some volunteering for charity to see if a certain job appeals to you. To help make your choice consider questions like the following: Are you good with a hammer? Would you rather sit behind a desk inside or work in a park outside? Do you prefer to work independently or in a group? Figure out what you can and can’t do with your disorder. Do your best to preserve the life you had before, while learning to accept the challenges you face now.
Some patients may need to be hospitalized. It may be necessary for your safety and the safety of others.
Many schizophreniform disorder patients engage in substance abuse. Such a decision will not help treat the symptoms of this disorder and can worsen your quality of life even more, making it harder to recover.
If I have schizophreniform disorder, do I qualify for Social Security Disability?
No. To qualify for SSD, you have to have symptoms for at least one to two years, depending on a number of factors. Schizophreniform lasts six months or less. If you have schizophrenia, then you might qualify.
How can my family and friends help?
You may need to rely on your family and friends to help you cope with the symptoms of schizophreniform disorder. Try to trust them when they tell you that you’re perceiving reality incorrectly. If possible, bring them with you to your psychiatric and therapy appointments. They may be able to help you better understand what’s going on and how to improve your condition.
When should I see my healthcare provider?
See your healthcare provider right away if you experience the symptoms of schizophreniform disorder. Listen to your friends and family when they tell you that they’ve observed you acting abnormal.
What questions should I ask my healthcare provider about schizophreniform disorder?
- Do I have schizophreniform disorder or schizophrenia?
- How long do you estimate my symptoms will last?
- What specialist should I see?
- Can I attend work/school?
- Do I need to be hospitalized?
- Do I have another mental health disorder such as depression?
- What medications do you recommend?
A note from Cleveland Clinic
Schizophreniform disorder can be devastating. It can make you act in odd ways, think inconsistent thoughts, change topics too quickly when you speak, express emotions inconsistently, change your relationships with others and damage how you see and interact with reality. It can be scary to experience, but fortunately, some specialists and treatments may help.
Remember to trust your friends and family and any healthcare provider you’re working with. What you perceive as reality may not be true, so try to listen when they correct you. Take your medications exactly as ordered. See your healthcare providers frequently to ensure the best care. Manage depression symptoms that may occur and avoid substance abuse to improve your overall quality of life.
