Psychiatric specifier

With psychotic features

Delusions or hallucinations occur during a severe mood episode and require explicit risk and diagnostic review.

Episode features

Depressive disordersBipolar disorders

At a glance

Applies to: Depressive disorders · Bipolar disorders
Deciding signal: Psychosis is present, and its relationship to the mood episode determines the diagnostic wording.
Ask this: Do psychotic symptoms occur within the mood episode, and are they mood-congruent, mood-incongruent, or independent?
Wording outcome: Major depressive disorder, current episode, severe with psychotic features

Unusual thoughts retain insight and do not reach delusional intensity.
Psychosis persists outside mood episodes in a way that suggests a different primary diagnosis.

Fit and exclusions

Start with the deciding signal, then test chronology, competing explanations, and the effect on diagnostic wording.

Delusions or hallucinations are clearly present during the mood episode.
The content, conviction, and behavioural impact have been assessed rather than inferred from severe worry or guilt.
The longitudinal relationship between mood and psychosis is documented.

Escalate assessment and treatment intensity; document safety, capacity, and the mood–psychosis timeline.

Focus: Delusions or hallucinations within a mood episode
Time course: Mapped directly against mood-episode onset and remission
Look for: Conviction, perceptual disturbance, behavioural impact, congruence
Avoid: Severe guilt, rumination, or intrusive thoughts are not automatically psychotic

Major depressive disorder, current episode, severe with psychotic features

At a glance

Applies to

Depressive disorders · Bipolar disorders

Deciding signal

Psychosis is present, and its relationship to the mood episode determines the diagnostic wording.

Ask this

Do psychotic symptoms occur within the mood episode, and are they mood-congruent, mood-incongruent, or independent?

Wording outcome

Major depressive disorder, current episode, severe with psychotic features