The Phenomenology of Obsessions in Depressive Psychosis

¹ Consultant Psychiatrist, Middlewood Hospital, Sheffield, 6

The case notes of 398 cases of depressive psychosis admitted to the Professorial Unit of the Maudsley Hospital were studied.

Fifty-two cases exhibited frank obsessions before the onset of the depression and in 4 per cent. the content was homicidal. 124 cases exhibited obsessions during the depression and in 51 per cent. the content was suicidal, homicidal or both. 21 cases showed transition of obsessions into delusions during the depression, and in 38 per cent. the content was homicidal.

Forty-eight per cent. of the obsessions occurring during the depression showed diurnal variation in intensity. This was similar to the 55 per cent. incidence of diurnal variation of the depressive symptoms in general.

Combining all obsessions in depression, and ignoring whether they persist as such or become delusions in the course of the depression, the suicidal attempt rates are found to be similar whether the content is "killing" (homicidal or suicidal) or "non-killing".

It is concluded that obsessions in depression are twelve times more likely to have as content ideas of killing the self or others than have pre-depressive obsessions. Obsessions in depression are just as likely to show diurnal variation in intensity as the associated depressive symptoms. The suicidal attempt rate is unrelated to whether or not ideas of killing the self or others form the content of the obsession or obsession-delusion transition.

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