PMD vs Schizophrenia from the layperson's p.o.v

[Ceke2002]

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I'm hoping to start volunteer work with a patient advocacy and public education group in the next couple of months, as a layperson. Basically most volunteers, including myself, are stable/recovered patients who are asked to attend various functions, lectures, focus groups, and so on, to give a more personalised overview of the experience of mental illness. Other medical professionals contribute to the discussion also.

I will (hopefully) be speaking on the issue of Psychotic Major Depression. One thing I expect to be asked is 'What's the difference between PMD and Schizophrenia?' Considering I'm assuming most of our target audience are going to be lay persons, how would the difference best be described in simple terms? All I can think of is 'Patients with PMD have insight, those with Schizophrenia do not', except that seems a little too simplistic. I do expect any of the 'hard' answers would be fielded by one of the medical professionals on hand, but I'd still like to be able to give a more encompassing overview/answer basic questions.

So, in lay terms, how would you explain the difference between PMD and Schizophrenia (or is it not that straightforward, and can't really be explained in a brief sentence or two?).

Thanks in advance for your time. 👍

 

[Encephalopathy]

I'm hoping to start volunteer work with a patient advocacy and public education group in the next couple of months, as a layperson. Basically most volunteers, including myself, are stable/recovered patients who are asked to attend various functions, lectures, focus groups, and so on, to give a more personalised overview of the experience of mental illness. Other medical professionals contribute to the discussion also.

I will (hopefully) be speaking on the issue of Psychotic Major Depression. One thing I expect to be asked is 'What's the difference between PMD and Schizophrenia?' Considering I'm assuming most of our target audience are going to be lay persons, how would the difference best be described in simple terms? All I can think of is 'Patients with PMD have insight, those with Schizophrenia do not', except that seems a little too simplistic. I do expect any of the 'hard' answers would be fielded by one of the medical professionals on hand, but I'd still like to be able to give a more encompassing overview/answer basic questions.

So, in lay terms, how would you explain the difference between PMD and Schizophrenia (or is it not that straightforward, and can't really be explained in a brief sentence or two?).

Thanks in advance for your time. 👍

These are two completely different illnesses that just happen to share the common symptom of psychosis. Depression is a mood disorder and is episodic whereas schizophrenia is a thought disorder and chronic. Maybe the simplest difference is that PMD patients should not be psychotic if they are not depressed while schizophrenic patients can be psychotic anytime.

 

[Bartelby]

I would give a brief description of some salient features of each. Talk about what depression is and how it can lead to a psychotic episode, and contrast that with how schizophrenia is a chronic mental illness that features a lot of "positive" symptoms like hallucinations and delusions as well as "negative" symptoms like emotional blunting. If you take a snapshot in time of each patient the differences could be pretty tough for someone who hasn't worked with either type of patient to grasp, but talking about the overall course of each makes the important differences more obvious.

 

[erg923]

For purposes of your talk (and considering your audience), I think the most fundamental elements to point out are:

1. In PMD, psychotic symptoms are only present during the depressive episode and the psychosis generally remits as the depression remits.

2. Generally, there is a lack of complex, bizarre delusional systems or thought-insertion delusions in PMD.

3. The notion of delusional levels of worthlessness and delusional levels of guilt. These can be subtle, but may be the only symptom(s)
that push an Severe MDE over the threshold to an Severe MDE with psychotic features.

 

[billypilgrim37]

It would help if you let us know what your angle really was? Is part of this to destigmatize psychotic depression? Because, I would imagine for the lay person, the important thing to realize is that people can have very strange symptoms for very different reasons, and that some people recover completely, and some people have a very difficult chronic course. This varies substantially within diagnoses as well, but generally people that have these problems because they became depressed have a better time in the long run than people who have those symptoms and aren't depressed. I don't think the layperson really can understand the difference between a mood disorder (the way psychiatrists speak of mood disorders) and psychotic disorders without some pretty in depth discussion. Most of the other fine points are going to get lost if they don't have the big picture. It might be helpful to include bipolar disorder here as well as sort of a missing link. Or even delusional disorder. It may be helpful to have sort of a 4 sentence case example of each of these things in your mental back pocket to demonstrate the examples.

 

[Ibid]

I'm hoping to start volunteer work with a patient advocacy and public education group in the next couple of months, as a layperson. Basically most volunteers, including myself, are stable/recovered patients who are asked to attend various functions, lectures, focus groups, and so on, to give a more personalised overview of the experience of mental illness. . 👍

It takes all sorts. Peace.

[YOUTUBE]http://www.youtube.com/watch?v=lX0J2pGDSMY[/YOUTUBE]

 

[PETRAN]

As ibid said, don't get stuck on strict a-la DSM categorizations of different "ilnesses". Phenomonelogically you could say (as other posters cleverly said) that psychotic features in depression are more "connected" to the depressed mind-set (voices talking about how worthless you are and stuff like that) and remits when depression remits, whereas psychosis in schizophrenia is...well... it can be whatever but a lot of the times it presents with very extraordinary paranoid ideation (like secret agents, angels, aliens) and sometimes loose associations in thinking.


We could say that attributions in psychotic depression are generally more "internal"-towards one-self (feelings of worthlesness, guilt etc.) whereas attributions in schizophrenia could be more external-towards the world and others/imaginary others (people are conspiring against me, the goverment is controlling me with radio-transmitters etc.). This is as far as phenomenology goes, because brain-wise/neuropsychologically, the would surely share some common mechanisms, a common last pathway or something because they are both treated by the same drugs (the psychiatrists can verify that!).


I view (the proneness to) hallucinations and/or delusions as independent factors/spectrums (maybe from birth) which interact with other features such as arousal, mood, sleep, cognition etc. and appear/become more pronounced when a certain threshold (could be in arousal, mood, cognition etc.) is exceeded. So, the hallucinatory/delusion-induction mechanisms in the brain are (probably) partly the same for all types of conditions and they can be triggered by some kind of extreme event or state (very high stress or euphoria, sleep deprivation, obsessive ruminations, brain liaisons etc.). This is maybe why all anti-psychotic drugs alleviate psychosis, regardless if it is in chronic schizophrenia, mania, psychotic depression, psychotic OCD/body dysmorphic disorder or other more clear-cut organic conditions such as dementia or chronic substance-abuse.


(Well, don't pay attention to my last paragraph, this was just my musings. Look at the previous two 😛)

 

[Ceke2002]

Thank you so much for your responses, I've definitely taken a few notes. Basically the talks that are given are designed to demystify and destigmatise mental illness. I need to double check, but I think we're expected to include things like personal experience of the illness, issues we might have faced, what treatment was like, that sort of thing. I figured because I would most likely be talking about psychotic symptoms as part of PMD, that at least someone would want to know what the difference between that and Schizophrenia was (I would assume most lay people when they think of psychosis, automatically think Schizophrenia). At the moment I'm just waiting until they do their next intake of volunteers, and I get accepted, hopefully, but I wanted to still try and prepare in advance. 🙂

I do find it interesting to read that the psychotic symptoms associated with PMD generally aren't as 'bizarre' as those of Schizophrenia, & don't tend to include things like thought broadcasting, and more external-worldly delusions. My own experience has been very much the opposite. I mean I've experienced the more typical PMD symptoms of irrational guilt, and thinking my body was rotting away from disease, and so on, but I've definitely experienced the whole 'I'm being watched, there are hidden cameras secretly filming me, oh look the TV is sending me messages/insulting me, and the street lights outside are actually loudspeakers that are broadcasting what I think to the world' type vibe at the same time. I've never questioned my diagnosis, but I would assume I was diagnosed with PMD considering I've never experienced psychotic symptoms outside of a depressive episode, and I've always retained awareness that the things I was experiencing weren't real.

But anyway, that's another subject all together, and probably not one a layperson/patient should be discussing with a bunch of medical professionals on a forum. 😎

Thanks again for your input/help, much appreciated. 🙂

 

[PETRAN]

I do find it interesting to read that the psychotic symptoms associated with PMD generally aren't as 'bizarre' as those of Schizophrenia, & don't tend to include things like thought broadcasting, and more external-worldly delusions. My own experience has been very much the opposite. I mean I've experienced the more typical PMD symptoms of irrational guilt, and thinking my body was rotting away from disease, and so on, but I've definitely experienced the whole 'I'm being watched, there are hidden cameras secretly filming me, oh look the TV is sending me messages/insulting me, and the street lights outside are actually loudspeakers that are broadcasting what I think to the world' type vibe at the same time. I've never questioned my diagnosis, but I would assume I was diagnosed with PMD considering I've never experienced psychotic symptoms outside of a depressive episode, and I've always retained awareness that the things I was experiencing weren't real.

Yeah, this is why it is wrong to "construct ilnesses" based on phenomenology/loosely-defined constructs based on subjective experiences and not some kind of objective psychological/neurological mechanism (and why the DSM is destined to fail in the end IMO). The reason that the delusions in psychotic depression are similar to psychotic paranoid schiz. (like in your case) is probably because the delusions in both of these conditions (and probably many others) arise from the same brain mechanism. Its (probably) not like the delusions/hallucinations of paranoid schizophrenia derive from fundamentally different processes than the delusions/hallucinations of psychotic depression, mania or amphetamine psychosis. In a matter of fact, the so-called distinctive feature of schiz.-which is disordered speech - occurs in equal proportions in mania as well. They are probably similar brain mechanisms behind all these. It is better to view mental health complaints as "symptom-clusters" and "spectrums" rather than as qualitatively different "disorders" with rather bad arbitrary symptom groupings.

 

[Ceke2002]

Yeah, this is why it is wrong to "construct ilnesses" based on phenomenology/loosely-defined constructs based on subjective experiences and not some kind of objective psychological/neurological mechanism (and why the DSM is destined to fail in the end IMO). The reason that the delusions in psychotic depression are similar to psychotic paranoid schiz. (like in your case) is probably because the delusions in both of these conditions (and probably many others) arise from the same brain mechanism. Its (probably) not like the delusions/hallucinations of paranoid schizophrenia derive from fundamentally different processes than the delusions/hallucinations of psychotic depression, mania or amphetamine psychosis. In a matter of fact, the so-called distinctive feature of schiz.-which is disordered speech - occurs in equal proportions in mania as well. They are probably similar brain mechanisms behind all these. It is better to view mental health complaints as "symptom-clusters" and "spectrums" rather than as qualitatively different "disorders" with rather bad arbitrary symptom groupings.

Interesting. My, admittedly limited, understanding of the problems with the DSM were more along the lines of it having diagnostic limitations when it as applied as a sort of 'diagnose by numbers' type tool, where the notion of variations, symptom spectrums, and therapist interpretation weren't taken into account as well. Case in point, I was also previously diagnosed with Anorexia Nervosa (restricting subtype). In 24 years of active illness not once did I stop menstruating, despite regularly maintaining a BMI sub 15 (I was actually still ovulating normally at a body mass index of 14.5). Now if you applied the DSM criteria letter by letter to my case, I shouldn't/wouldn't have been diagnosed with A.N, except the majority of Eating Disorder specialists I saw obviously didn't apply the DSM as a series of symptom boxes that needed to all be checked off for a diagnosis to apply. Now Family Doctors/General Practitioners were another thing all together. At least a percentage of them would question/argue with the diagnosis, based on no other criteria apart from 'patient does not have amenorrhoea'. So is the problem with the DSM in the DSM itself, or in the way the DSM is used?

 

[Ceke2002]

It takes all sorts. Peace.

[YOUTUBE]lX0J2pGDSMY[/YOUTUBE]

Thanks for this Ibid, cool video. The Restarts as well, nice choice of music by whoever did this. 🙂

I do agree I want to try to avoid 'pathologising' (is that even a word 😕) a certain spectrum of behaviours. Not quite sure I'd go so far as doing a fist pumping 'Mad Pride' call though.

 

[Ibid]

Thanks for this Ibid, cool video. The Restarts as well, nice choice of music by whoever did this. 🙂

I do agree I want to try to avoid 'pathologising' (is that even a word 😕) a certain spectrum of behaviours. Not quite sure I'd go so far as doing a fist pumping 'Mad Pride' call though.

Glad you enjoyed it. I had it on full blast in my office this morning. Good luck with the speaking engagements, personal accounts delivered by people with authentic lived experience are always the most powerful, memorable and best received in my experience. Watching an” ill” person from the outside never provides the same level of authority as having been through it on the inside. (That’s not to diminish professional perspectives and considerable insights but they are hardly an unheard marginalized group of people)
The anti-capitalist anarchist collective wing of mad pride wear the inverted black triangle and don’t get asked to speak at many conferences I don’t think, God love them.
http://en.wikipedia.org/wiki/Black_triangle_(badge)

Hope you start to get paid for your valuable work in short order.

 

[Ceke2002]

Glad you enjoyed it. I had it on full blast in my office this morning. Good luck with the speaking engagements, personal accounts delivered by people with authentic lived experience are always the most powerful, memorable and best received in my experience. Watching an” ill” person from the outside never provides the same level of authority as having been through it on the inside. (That’s not to diminish professional perspectives and considerable insights but they are hardly an unheard marginalized group of people)
The anti-capitalist anarchist collective wing of mad pride wear the inverted black triangle and don’t get asked to speak at many conferences I don’t think, God love them.
http://en.wikipedia.org/wiki/Black_triangle_(badge)

Hope you start to get paid for your valuable work in short order.

"nutters with attitude" Ha, that's awesome. I think I might adopt that as my new personal motto.

Thanks again for the kind well wishes, and advice. I was involved in a similar program some years back, although I was speaking on the subject of another issue for that one, so I know what a difference they can make in increasing awareness and advocacy of mental health issues. Speaking openly about psychotic illness is of particular importance to me, because of the amount of stigma that gets attached to it. I spent years hiding my symptoms, and avoiding the proper care I needed to function as best I could, because I was scared of being labeled 'that' crazy.

It would be nice to get paid for something like this, although I understand why the funding isn't always available, or is better spent elsewhere, so I'm happy enough to participate on a voluntary basis. Two of my biggest passions, Mental Health Advocacy and raising awareness of Organ Donation, and I don't get paid for either of them. Perhaps I should consider a new career (j/k)