Abstract
Saxby Pridmore and Yvonne Turnier-Shea, Royal Hobart Hospital, Hobart, Australia:
We interviewed a 45-year-old woman the morning after admission. She had taken an overdose of 60 mg of diazepam. She said this followed an altercation with her wealthy, elderly husband. She was keen to go home.
On the recent history, we had no concerns about complying with the patient's request for discharge. However, two mental state features suggested she should remain for further assessment. First, the patient had a mask-like face, which suggested motor retardation of major depressive episode. Second, there was slight slurring of some words, which suggested the patient was still under the influence of benzodiazepines. A complete history revealed that the patient had obtained at least three facial cosmetic surgery operations. As a consequence, her face had been relatively immobile and she experienced minor problems with articulation. On closer examination we were able to accept cosmetic surgery as the cause of these mental state findings and the patient was discharged. The long list of causes of immobile face includes major depressive episode, negative symptoms of schizophrenia, Parkinsonism (idiopathic and drug induced), hypothyroidism and myasthenia gravis [1]. To this list, we suggest can be added, a sequela of cosmetic surgery.