Question:medium
A 60 year old male is brought by his wife. He thinks that he has committed sins all through his life. He is very depressed and has considered suicide but has not thought about how to go about it. He has also attended sessions with a spiritual guru. He is not convinced by his wife that he has led a pious life. He does not want to hear anything to the contrary. How will you treat him?
A 60 year old male is brought by his wife. He thinks that he has committed sins all through his life. He is very depressed and has considered suicide but has not thought about how to go about it. He has also attended sessions with a spiritual guru. He is not convinced by his wife that he has led a pious life. He does not want to hear anything to the contrary. How will you treat him?
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Depression plus a fixed delusion of sin means psychotic depression, so treat both the mood and the psychosis.
Updated On: Jun 24, 2026
- Antipsychotic plus antidepressant
- Antidepressant alone
- Antipsychotic alone
- Electroconvulsive therapy alone
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The Correct Option is A
Solution and Explanation
Name the syndrome first. Persistent depressed mood, pervasive guilt, suicidal ideation, and an unshakeable delusion of having sinned together describe major depression with psychotic features. The man cannot be talked out of his belief, which marks it as a true delusion rather than ordinary guilt, and the delusion is in keeping with the low mood, so it is mood congruent psychotic depression.
Treatment must cover both halves of the illness, the mood disturbance and the psychosis. An antidepressant given on its own will not dissolve the delusion, and an antipsychotic given on its own will not lift the depression or the suicidal drive. The accepted pharmacological answer is to combine the two, an antidepressant together with an antipsychotic, so that both the mood and the delusional thinking are addressed.
Among the listed options, an antidepressant alone or an antipsychotic alone each leaves one core problem untreated. Electroconvulsive therapy is in fact very effective for psychotic depression and is preferred when the illness is severe, drug resistant, or carries high suicide risk, but as a starting treatment for this presentation the combination of an antidepressant and an antipsychotic is the chosen answer.
\[\boxed{\text{Antipsychotic plus antidepressant}}\]
Treatment must cover both halves of the illness, the mood disturbance and the psychosis. An antidepressant given on its own will not dissolve the delusion, and an antipsychotic given on its own will not lift the depression or the suicidal drive. The accepted pharmacological answer is to combine the two, an antidepressant together with an antipsychotic, so that both the mood and the delusional thinking are addressed.
Among the listed options, an antidepressant alone or an antipsychotic alone each leaves one core problem untreated. Electroconvulsive therapy is in fact very effective for psychotic depression and is preferred when the illness is severe, drug resistant, or carries high suicide risk, but as a starting treatment for this presentation the combination of an antidepressant and an antipsychotic is the chosen answer.
\[\boxed{\text{Antipsychotic plus antidepressant}}\]
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