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Delusional Depression: A Disorder of the Drive

Author(s): M. Bürgy

The distinction between melancholic and non-melancholic depression is an important way of classifying depressive disorders. Phenotypically and geneotypically, melancholia seems to be an entity of its own, which finds its extreme exacerbation in depressive delusion. The delusional depression is clinically easily overlooked and difficult to treat. This paper aims to contribute to the understanding of delusional depression by developing the symptomatology from a disorder of the drive. It is shown how the predisposed personality, primarily the typus melancholicus about increasing loss of energy and drive gets into inhibition, emotional numbness and fear and how fear turns the life-historically understandable worries about poverty, illness, guilt and hopelessness into delusional convictions. From the understanding of disease development, more effective therapeutic strategies, in particular on pharmacotherapy and psychoeducation, can be derived. A clinical case illustrates the investigation of depressive delusions.

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