Which specifier is used when psychotic features are mood-incongruent?

• A. With mood-incongruent psychotic features
• B. With melancholic features
• C. With peripartum onset
• D. With mood-congruent psychotic features

Answer: (A)

When a mood disorder includes psychotic symptoms, these can either match the mood or not. If the psychotic content does not fit the mood state—such as delusions that are paranoid or bizarre and not tied to depressive guilt or manic grandiosity—the appropriate specifier is “with mood-incongruent psychotic features.” This distinguishes psychosis that is independent of the mood from psychosis that is mood-congruent (which would align with depressive themes like guilt or worthlessness, or manic themes like grandiosity). The other specifiers refer to different aspects of the episode (melancholic features or peripartum onset) or to psychosis that does fit the mood, not to incongruence.