Episode of Major Depression with Psychotic Symptoms in a 17-Year-Old Female: A Case Report

Abstract

Major depressive episodes with psychotic symptoms are a subtype of major depressive disorder characterized by severe affective symptoms accompanied by hallucinations or delusions. This condition is associated with poorer prognosis, higher recurrence rates, and increased suicide risk compared to non-psychotic depression. This case report aims to describe the clinical manifestations, diagnostic process, and management of a 17-year-old female patient with this condition. The patient presented with persistent sadness, loss of interest, social withdrawal, and decreased motivation for one year, which worsened over the last four months following her mother’s death. She also experienced daily auditory hallucinations in the form of commanding voices and had a history of suicidal ideation. Mental status examination revealed depressed mood, congruent affect, and perceptual disturbances without delusions. The Hamilton Depression Rating Scale score was 27, indicating severe depression. Diagnosis was established based on clinical interview, mental status examination, and DSM-5 and PPDGJ-III criteria as major depressive episode with psychotic features. Management included pharmacological therapy with sertraline, aripiprazole, and trihexyphenidyl, along with psychosocial interventions such as counseling and psychoeducation. The patient showed gradual clinical improvement during treatment. This case highlights the importance of early detection, comprehensive evaluation, and appropriate management to reduce complications, improve quality of life, and prevent recurrence in patients with severe depression with psychotic symptoms.