Meeting abstract

https://doi.org/10.24869/spsih.2026.248

A Psychodynamic Perspective on Psychotic Depression – A Case Report

Matea Galetić Pavlov ; Department of Psychiatry, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia *
Dora Vukorepa ; Department of Psychiatry, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia
Nina Rančić ; Department of Psychiatry, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia
Trpimir Glavina ; Department of Psychiatry, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia; Department of Psychiatry, School of Medicine, University of Split, Šoltanska 2, 21000 Split, Croatia
Tonka Borovina Marasović ; Department of Psychiatry, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia
Tonći Mastelić ; Department of Psychiatry, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia; Department of Psychiatry, School of Medicine, University of Split, Šoltanska 2, 21000 Split, Croatia; Department of Psychological Medicine, School of Medicine, University of Split, Šoltanska 2, 21000 Split, Croatia

* Corresponding author.

Abstract

The aim of this paper is to present the case of
a female patient hospitalized due to depressive
decompensation of psychotic intensity in the
context of pathological mourning following her
father’s death, and to analyze the psychodynamic
mechanisms involved in the development of her
symptoms. The current depressive episode began
as a result of her mother’s frequent visits to the
patient’s brother, who had just had a child. Although
she was happy about this, her mother’s
absences led to feelings of loneliness and abandonment.
Her father had died two years earlier,
and the psychotic elements were characterized
by auditory hallucinations in the form of her late father’s voice. She describes her relationship
with her father as close but ambivalent, marked
simultaneously by love and unresolved anger. She
reports that she never fully accepted her father’s
death and believes that her current difficulties
represent a delayed grief reaction. At the time of
her father’s death, she was faced with numerous
life stressors, which left her without sufficient
space to experience and process the loss of the
object. From a psychodynamic perspective, the
case can be understood as a form of pathological
mourning in which the lost object is not relinquished
psychologically but remains present
through hallucinatory experience. The father’s
voice represents an introjected object that maintains
the connection with the deceased, while
the content of the hallucinations points to internal
conflicts and repressed impulses. Due to the
ambivalent relationship with her father, feelings
of anger and aggression could not be openly expressed
and, after his death, were turned against
the self. The depressive symptomatology can
be understood as an expression of self-directed
aggression, that is, aggressive feelings which,
because they could not be directed toward the
object, were turned inward and manifested as
guilt and self-blame. During treatment, the hallucinations
gradually receded, accompanied by the
emergence of sadness, tearfulness, and anxiety,
as well as improvement in overall functioning.
Such a development can be interpreted as a transition
from psychotic defense toward a healthier
process of mourning and emotional integration
of the loss.

Keywords

psychotic depression; psychodynamics; pathological mourning; hallucinations; object loss

Hrčak ID:

352909

URI

https://hrcak.srce.hr/352909

Publication date:

15.6.2026.

Article data in other languages: croatian

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