Psychotic epression is one of the most severe forms of the general depressive diseases in which the person experiences moments of delusional or paranoid being. During such an episode, synesthesia may occur, including audio-visual hallucinations and erratic behavior. Psychotic depression is a chronic, cyclic condition. In general, the patient may have unremarkable general depressive episodes marked by moments of extreme psychosis. Suicide is most prevalent in patients affected by psychotic episodes. Increased stress and substance abuse can initiate a psychotic episode. The nature of this condition is like the depressive phase of bipolar disorder.