This paper reports on a grand round presentation of a psychiatric case history of a young woman who showed frequently changing symptoms compatible with a major depressive disorder. She also presented with auditory hallucinations and grand mal seizures. All her symptoms were refractory to a wide range of pharmacotherapy and ECT.
In the paper, senior clinicians in neurology, psychopharmacology, psychiatry and social work discuss the phenomenology and possible treatment of this clinical picture. They emphasize the dangers associated with single minded psychopharmacological treatment of an atypical depression and delineate the importance of “organic” symptoms in mental disorders. A twelve month follow-up of the case is provided.
References
1.
WestE.D., DallyP.J.Effect of iproniazid in depressive symptoms.Br Med J1959; 1: 1491–1494.
2.
AkiskalH.S.Factors associated with incomplete recovery in primary depressive illness.J Clin Psychiatry1982; 43: 266–271.
3.
LehmannH.F.Clinical evaluation and natural course of depression.J Clin Psychiatry1983; 44: 5–10.
4.
QuitkinF.M.The importance of dosage in prescribing antidepressants.Br J Psychiatry1985; 147: 593–597.
5.
AkiskalH.Approach to chronic and treatment resistant depressions. In: KemaliD., RacagniG., eds, Chronic treatment in neuropsychiatry, New York: Raven Press, 1985.
6.
SpitzerR.H., EndicottJ., RobinsE.Research diagnostic criteria: rationale and reliability.Arch Gen Psychiatry1978; 35: 773–779.
7.
StancerH., PersadE.Treatment of intractable rapid cycling manic-depressive disorder with levothyroxine.Arch Gen Psychiatry1982; 39: 311–312.
