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Psychotic Depression — MRCPsych Paper B MCQ

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ModerateMood DisordersPsychotic DepressionMRCPsych Paper B

A 48-year-old man is admitted with a severe depressive episode with psychotic symptoms. He believes that his internal organs have rotted away and no longer exist. He is eating and drinking, there is no immediate requirement for a rapid treatment response, and he is willing to take medication. Which pairing best identifies the syndrome and the NICE-supported pharmacological approach?

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Correct answer: E — Cotard syndrome; consider an antidepressant combined with an antipsychotic

The belief that the body or its organs are dead, absent or decomposing is a nihilistic delusion characteristic of Cotard syndrome. Cotard syndrome is a psychopathological syndrome rather than a stand-alone diagnosis and commonly occurs in severe depression with psychotic symptoms. NICE recommends considering an antidepressant combined with an antipsychotic for psychotic depression. Capgras and Fregoli syndromes are delusional misidentification syndromes; De Clérambault syndrome involves the belief that another person is in love with the patient; and Othello syndrome involves delusional jealousy. ECT may be considered when a rapid response is required, such as life-threatening refusal of food or fluids, when preferred because of previous benefit, or after other treatments have failed—not merely because psychotic features are present.

Reference: NICE, Depression in adults: treatment and management (NG222), sections 1.12 Psychotic depression and 1.13 Electroconvulsive therapy, 2022, reviewed 2026, https://www.nice.org.uk/guidance/ng222/chapter/Recommendations; Debruyne H et al., Cotard's syndrome: a review, 2009, https://pubmed.ncbi.nlm.nih.gov/19470281/