Hypoxia and Medicine

Question about diagnostic criteria for Major Depressive Episode- mood-incongruent delusions or hallucinations?

In the diagnostic criteria, for a Major Depressive Episode, under A., before the list of symptoms. Note: Do not include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations. Does that mean that the symptoms cannot be due to mood-incongruent hallucinations, or does it mean that it cannot be due to hallucinations, at all? ex.What if a patient begins thinking that he is such a bad person that when he is trying to decide if he wants to do something together, with one of his friends, he hears a "no" in his mind (hallucination-though he thinks that it is God). He avoids that friend and feels very guilty. It seems to be a mood-congruent delusion, though it was caused by a hallucination. He begins to worry that he is "hurting" other people, therefore begins to sleep in more often, causing hypersomnia, another symptom of Major Depression. Could these things count as symptoms toward a diagnosis of a Major Depressive Episode, w/psychotic features? The diagnostic criteria from behavenet.com say that symptoms cannot be due to mood-incongruent delusions or hallucinations, but at another website, it says that symptoms cannot be due to mood-incongruent psychosis. http://www.mentalhealth.com/dis1/p21-md01.html

Public Comments

1. Hallucinations and delusions can accompany severe depression (when it has psychotic features). These features, however, would be decidedly negative in nature (e.g., believing your brain is rotting, seeing demons, becoming convinced that there is a conspiracy against you). A mood-incongruent hallucination or delusion, in the case of major depression, would be one which is "positive" (e.g., I am the strongest person in the world, everyone is on my side, having visions of beautiful butterflies singing happy songs). The hallucination of the hypothetical patient you described would be mood-congruent (consistent with depression). It involves guilt/self-persecution, social isolation, etc. ~M~ [edit] In answer to your added question: yes - the symptoms you described would count toward the diagnosis of MDD with psychotic features. The symptom you described is MOOD-CONGRUENT (i.e., consistent with depressed mood).