Patients with multiple system atrophy, a neurodegenerative disease entity, have a high incidence of associated mental disturbances such as a mood disorder with or without psychotic features. Treatment of the psychiatric symptoms, without compromising neurological status, is often complicated and unsuccessful. This article describes a patient with olivo-ponto-cerebellar atrophy and treatment-resistant psychotic depression whose psychiatric symptoms were successfully treated with clozapine without aggravating the neurological disabilities.
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