Symptoms of Depression & Psychosis

Introduction

Mental illness refers to a wide range of mental health conditions—disorders that affect mood, thought, & behaviour. My diagnosis at present is major depressive disorder with psychotic features, & post-traumatic stress disorder (PTSD).

An episode refers to a certain period of time during which certain symptoms may be experienced. Episodes last anywhere from a couple weeks to six months. During this time, symptoms may fluctuate—some may come while others go; some may be extreme while others are more manageable.

I experience four main types of episodes: depressive episodes, positive symptom psychotic episodes, negative symptom psychotic episodes, & post-traumatic stress disorder episodes. When I refer to “the darkness,” I am speaking of full-blown psychotic depression, a terrible combination of depressive & psychotic symptoms.

I will discuss each type of episode along with their symptoms & warning signs. Symptoms are an indication of an illness. In this case, symptoms indicate when my mental illness is getting the best of me. Warning signs are basically pre-symptoms: an early indication that symptoms are approaching.

Please note that, here, I only list symptoms that I personally experience. This is not a complete list of all the potential symptoms experienced during an episode. Rather, this is a discussion of my personal episodes & what I experience with them. Everyone is different & may encounter different symptoms at different severities. Symptoms & warning signs alike may vary from person to person.

Depressive Episodes

A depressive episode is the simplest place to start because it’s the most common form of mental illness. If you have any questions regarding the subject of depression, please contact me & I will use that as a platform for a new blog post. For now, here are the major symptoms I experience during a depressive episode.

Depressive Episode:

• Anhedonia: inability to experience interest or pleasure

• Avolition: loss of motivation; a lack of interest or engagement in goal-directed behaviour

• Abulia: an absence of willpower or an inability to act decisively; impairment or loss of volition

• Inability to concentrate

• Insomnia: inability to sleep

• Night terrors: symptoms may include sitting up in bed, screaming or shouting, kicking and thrashing, sweating, breathing heavily, or have a racing pulse

• Fatigue & exhaustion

• Emptiness, hopelessness, worthlessness

• Psychomotor agitation: a feeling of restlessness associated with increased motor activity, such as pacing around a room, wringing one’s hands, or pulling off clothing & putting it back on

• Suicidal ideations: thoughts about how to kill oneself; fantasizing about killing oneself

• Changes in appetite or weight

• Apathy

Psychotic Episodes

Psychotic episodes are more complex because there are a variety of types of psychosis one may experience.

Psychotic symptoms are divided into two categories: positive symptoms & negative symptoms. Positive symptoms mean something is being added to the experience, whereas negative symptoms mean something is being taken away. An additional category of psychotic symptoms is that of cognitive symptoms, which involve issues with working memory & executive functioning. Cognitive symptoms can happen at any point with psychosis, not only with positive or only with negative symptoms.

Early psychosis is considered someone’s very first symptoms of psychosis that they ever experience. For me, that happened in the beginning of high school between ages fourteen & fifteen. My first major psychotic break was at age fifteen when I had a major hallucination, which triggered a rapidly developing case of PTSD.

There are three main phases of psychosis. The prodrome phase is the first phase during which there are warning signs & early symptoms preceding the episode. Prodrome means an early symptom indicating the onset of an illness, before the characteristic manifestations of the acute, fully developed illness occurs. I also read somewhere that it means “forerunner of an event,” so this phase is basically the opening act of psychosis. An initial prodrome is defined as the period of time from the first change in a person until development of the first frank psychotic symptoms. My initial prodrome phase occurred at age fourteen when I first began high school.

During the prodrome phase, there are noticeable changes, but those do not yet include full-blown, clear-cut psychotic symptoms. The early signs may be vague & hardly noticeable. There may be changes in the way some people describe their feelings, thoughts, & perceptions, which may become more difficult over time.

The second phase is the acute phase during which psychotic symptoms are evidently experienced & there is a disconnect from reality to some extent. This is also known as the “critical period” because it’s when symptoms are at their peak & the decline of the individual is at its worst.

The third & final phase of psychosis is recovery, when the symptoms begin diminishing & coping becomes easier. Sometimes warning signs, or symptoms from the prodromal phase, may still linger during this time. Recovery involves things like regaining a sense of grounding in reality, control over the psychosis, & stability in one’s self.

As discussed earlier, psychotic symptoms can be divided into two main categories: positive symptoms & negative symptoms.

Positive Symptom Psychotic Episode:

• Hallucination: a sensory impression that has no basis in external stimulation; a false perception of stimuli

• Auditory hallucinations: false perception of sound; this is the most common form of hallucinations, both in general & for me specifically

• Visual hallucinations: false perception of sight

• Hypnagogic hallucination: a vivid, dreamlike hallucination occurring at sleep onset

• Hypnopompic hallucination: a vivid, dreamlike hallucination occurring on awakening

• Kinesthetic hallucination: a hallucination involving the sense of bodily movement

• Somatic hallucination: involves the perception of a physical experience occurring within the body

• Tactile hallucinations: feeling things on the body that aren’t there, such as feeling insects crawling on the body (rare; I have only ever experienced this once at age fifteen)

• Olfactory hallucinations, or phantosmia: smelling things that aren’t actually there (rare; I have only ever experienced this once at age fifteen)

• Gustatory hallucinations: tasting something that isn’t actually there (rare; I have only ever experienced this once at age fifteen)

• Delusion: a fixed false belief or opinion that is resistant to reason & fact

• Paranoia: baseless or excessive suspicion of the motives of others; delusions of persecution; an unreasonable feeling that people are trying to harm you, do not like you, etc.

• Anxiety: a state of uneasiness, distress, or tension caused by apprehension or fear of possible misfortune or danger; symptoms may include increased blood pressure, churning stomach, nausea, headache, heart palpitations, numbness in arms or legs, sweating, restlessness, easily tired, trouble concentrating, irritability, muscle tension, trouble falling or staying asleep, or being easily startled

• Confusion

• Irritability & poor control of temper

• Disorganized behaviour: wearing clothes that don’t fit the weather; displaying inappropriate emotional responses to a situation; difficulty performing daily activities such as cooking or self-care; not responding or reacting to the environment; etc.

• Inappropriate emotional responses (such as laughter in a serious situation)

• Impaired executive functioning (ability to understand information & use it to make decisions)

• Inability to focus or concentrate; poor attention

• Impaired working memory (ability to use information immediately after learning it)

• Suicidal ideations: thoughts about how to kill oneself; fantasizing about killing oneself

Negative Symptoms Psychotic Episode:

• Catatonia: cannot speak, move or respond; dramatic reduction in activity where virtually all movement stops; characterized by muscular rigidity & mental stupor; it’s difficult to engage with anyone, including making eye contact & having a verbal conversation; may include inappropriate posture, mutism, negativism, facial grimaces, & animal-like noises

• Poor personal hygiene

• Apathy

• Flat affect: a severe reduction in emotional expressiveness; emotional unresponsiveness

• Social withdrawal or isolation

• Anhedonia: inability to experience interest or pleasure

• Avolition: loss of motivation; a lack of interest or engagement in goal-directed behaviour

• Abulia: an absence of willpower or an inability to act decisively; impairment or loss of volition

• Suicidal ideations: thoughts about how to kill oneself; fantasizing about killing oneself

• Impaired executive functioning (ability to understand information & use it to make decisions)

• Inability to focus or concentrate; poor attention

• Impaired working memory (ability to use information immediately after learning it)

Warning Signs

Warning signs are basically early symptoms—an indication that symptoms are approaching. They are early symptoms that warn me when an episode is developing. Warning signs are important to know & be able to recognize because, through self-awareness, I can tell when an episode is about to begin by observing warning signs. From here, steps may be taken to minimize potential symptoms, thereby reducing the extremes of my mental illness episodes.

The following list includes a few common warning signs that specifically apply to me. More & more, I am able to identify them, pin-pointing exactly what’s going wrong in my brain. It’s a helpful tool, to say the least.

• Social withdrawal & isolation

• Suspiciousness

• Anxiety

• Impaired concentration

• Decreased motivation

• Tiredness, or feeling energetic after less sleep than usual

• Sleep disturbance

• Depressed mood

• Mood swings

• Irritability; less patience than usual

• Extreme sensitivity to stimuli, such as noise, light, or textures

• Deterioration in functioning, from self-care to employment; growing inability to cope with daily problems & activities

• Suicidal thoughts

• Feeling disoriented

• Irrational statements

• Personality changes

• Memory problems

• Substance abuse

• Difficulties understanding or relating to other people

• Lack of insight (inability to perceive changes in one’s own feelings, behaviour, or personality)