抑郁症有妄想表现吗？# WaterWorld - 未名水世界
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张纯如精神障碍的正式诊断是抑郁症。根据美国精神病诊断权威标准DSM-5（附件1），
抑郁症是没有妄想表现的。也就是说，如果一个人被诊断为抑郁症，就不应该有妄想表
现。如果一个人有妄想表现，就不应该诊断为抑郁症。
那么确诊为抑郁症的病人是否可以出现妄想呢？回答是肯定的。但是，当一个抑郁症病
人出现妄想症状，原来的“抑郁症”就不再适用于病人。这种情况下就要改变诊断为“
精神病性抑郁症”。这种病人往往同时会出现幻觉症状。相应的治疗和保护措施也要作
出改变。相关学术依据见附件2。
有些人说张纯如有精神病。所谓的日本右翼极端势力对她不断发出暴力威胁其实是她的
妄想。起码从医生给她的正式诊断来看，张纯如没有妄想症状。
附件1 ：Criteria for Major Depressive Episode: DSM-5
A. Five (or more) of the following symptoms have been present during the
same 2-week period and represent a change from previous functioning; at
least one of the symptoms is either (1) depressed mood or (2) loss of
interest or pleasure.
Note: Do not include symptoms that are clearly due to a general medical
condition, or mood-incongruent delusions or hallucinations.
• Depressed mood most of the day, nearly every day, as indicated by
either subjective report (e.g., feels sad or empty) or observation made by
others (e.g., appears tearful). Note: In children and adolescents, can be
irritable mood.
• Markedly diminished interest or pleasure in all, or almost all,
activities most of the day, nearly every day (as indicated by either
subjective account or observation made by others).
• Significant weight loss when not dieting or weight gain (e.g., a
change of more than 5 percent of body weight in a month), or decrease or
increase in appetite nearly every day. Note: In children, consider failure
to make expected weight gains.
• Insomnia or hypersomnia nearly every day.
• Psychomotor agitation or retardation nearly every day (observable by
others, not merely subjective feelings of restlessness or being slowed down
).
• Fatigue or loss of energy nearly every day.
• Feelings of worthlessness or excessive or inappropriate guilt (which
may be delusional) nearly every day (not merely self-reproach or guilt
about being sick).
• Diminished ability to think or concentrate, or indecisiveness,
nearly every day (either by subjective account or as observed by others).
• Recurrent thoughts of death (not just fear of dying), recurrent
suicidal ideation without a specific plan, or a suicide attempt or a
specific plan for committing suicide.
B. The symptoms cause clinically significant distress or impairment in
social, occupational or other important areas of functioning.
C. The symptoms are not due to the direct physiological effects of a
substance (e.g., a
drug of abuse, a medication) or a general medical condition (e.g.,
hypothyroidism).
附件2：精神病性抑郁症。
There’s depression, which if you have depression, most people have. And
then there’s psychotic depression, or more technically known as major
depressive disorder with psychotic features. This is a far less common
disorder than simple depression.
Psychotic depression is characterized by not only depressive symptoms, but
also by hallucinations (seeing or hearing things that aren’t really there)
or delusions (irrational thoughts and fears).
http://psychcentral.com/lib/psychotic-depression/0001291
抑郁症是没有妄想表现的。也就是说，如果一个人被诊断为抑郁症，就不应该有妄想表
现。如果一个人有妄想表现，就不应该诊断为抑郁症。
那么确诊为抑郁症的病人是否可以出现妄想呢？回答是肯定的。但是，当一个抑郁症病
人出现妄想症状，原来的“抑郁症”就不再适用于病人。这种情况下就要改变诊断为“
精神病性抑郁症”。这种病人往往同时会出现幻觉症状。相应的治疗和保护措施也要作
出改变。相关学术依据见附件2。
有些人说张纯如有精神病。所谓的日本右翼极端势力对她不断发出暴力威胁其实是她的
妄想。起码从医生给她的正式诊断来看，张纯如没有妄想症状。
附件1 ：Criteria for Major Depressive Episode: DSM-5
A. Five (or more) of the following symptoms have been present during the
same 2-week period and represent a change from previous functioning; at
least one of the symptoms is either (1) depressed mood or (2) loss of
interest or pleasure.
Note: Do not include symptoms that are clearly due to a general medical
condition, or mood-incongruent delusions or hallucinations.
• Depressed mood most of the day, nearly every day, as indicated by
either subjective report (e.g., feels sad or empty) or observation made by
others (e.g., appears tearful). Note: In children and adolescents, can be
irritable mood.
• Markedly diminished interest or pleasure in all, or almost all,
activities most of the day, nearly every day (as indicated by either
subjective account or observation made by others).
• Significant weight loss when not dieting or weight gain (e.g., a
change of more than 5 percent of body weight in a month), or decrease or
increase in appetite nearly every day. Note: In children, consider failure
to make expected weight gains.
• Insomnia or hypersomnia nearly every day.
• Psychomotor agitation or retardation nearly every day (observable by
others, not merely subjective feelings of restlessness or being slowed down
).
• Fatigue or loss of energy nearly every day.
• Feelings of worthlessness or excessive or inappropriate guilt (which
may be delusional) nearly every day (not merely self-reproach or guilt
about being sick).
• Diminished ability to think or concentrate, or indecisiveness,
nearly every day (either by subjective account or as observed by others).
• Recurrent thoughts of death (not just fear of dying), recurrent
suicidal ideation without a specific plan, or a suicide attempt or a
specific plan for committing suicide.
B. The symptoms cause clinically significant distress or impairment in
social, occupational or other important areas of functioning.
C. The symptoms are not due to the direct physiological effects of a
substance (e.g., a
drug of abuse, a medication) or a general medical condition (e.g.,
hypothyroidism).
附件2：精神病性抑郁症。
There’s depression, which if you have depression, most people have. And
then there’s psychotic depression, or more technically known as major
depressive disorder with psychotic features. This is a far less common
disorder than simple depression.
Psychotic depression is characterized by not only depressive symptoms, but
also by hallucinations (seeing or hearing things that aren’t really there)
or delusions (irrational thoughts and fears).
http://psychcentral.com/lib/psychotic-depression/0001291
