Depression with psychotic features

A person may hear or see things others do not, hold a fixed belief that conflicts with evidence, or become convinced of intense guilt, punishment, danger, or bodily illness. Severe depression may also bring slowed thinking, withdrawal, sleep disruption, fatigue, and difficulty concentrating. The experience can feel real and frightening; arguing about it may increase distress. Psychotic symptoms can occur in several medical or mental-health conditions, so a clinician needs to assess mood, thinking, medicines, substances, physical health, and immediate safety.

Arrange urgent assessment through a GP, psychiatrist, or emergency service, especially if this is new or worsening. Stay with the person when possible, speak calmly, reduce noise and confrontation, and help them avoid driving or making risky decisions. Share a current medicine list and describe the exact words, visions, beliefs, sleep changes, and behaviour you have noticed. Do not stop prescribed treatment suddenly; the treating clinician can explain the plan and monitoring.

Call local emergency services or go to an emergency department now if there is a command voice, a suicide or violence risk, severe confusion, inability to care for basic needs, extreme agitation, or danger from a frightening belief. Do not leave the person alone if immediate safety is uncertain. Even without obvious danger, new hallucinations or delusions alongside depression warrant prompt professional review.

What could be causing these experiences? How will you assess safety and physical contributors? What treatment and monitoring are needed? What warning signs mean we should return to emergency care?