Academic journal article General Psychiatry

Senile Depression with Somatzation Symptoms and Insomnia Is Diagnosed as Multiple System Atrophy: A Case Report

Academic journal article General Psychiatry

Senile Depression with Somatzation Symptoms and Insomnia Is Diagnosed as Multiple System Atrophy: A Case Report

Article excerpt

1. Case history

The patient was a 66 year old divorced female, native of Shanghai, who had been admitted to the geriatric ward of Shanghai Mental Health Center 3 times with complaints of physical discomfort. This discomfort had been present for 2 years and was accompanied mainly with weakness of both lower limbs, and negative cognitions.

A review of the medical history revealed that the patient had no evidence of weakness as of July 2013, especially in the lower extremities. These symptoms worsened and the patient was no longer able to do housework. The patient had undergone multiple examinations in multiple departments of a local general hospital, but no physiological abnormal was discovered. However, the patent still believed she was seriously ill, and had a variety of physical discomforts, manifested as palpitations, stomach pain, shortness of breath, etc. These symptoms continued to get worse and the patient became reluctant to go out. By this time she had a depressive mood with loss of appetite, insomnia, and weight loss. The patient came to our outpatient department for the first time in January 2014 and was considered as having "neurasthenia". The patient was treated with sertraline 50mg qd and zolpidem tartrate 10mg qn, but these were not efficacious. One morning in February 2014, the patient attempted suicide by cutting her wrist with a kitchen knife in her own room. After surgery and blood transfusion treatment, the patient was admitted to our hospital in April 2014 for the first time and diagnosed with "depression". The patent was treated with sertraline 75mg/d, mirtazapine 30mg/d, lorazepam 0.5mg bid and Modified Electroconvulsive Therapy (MECT), and was discharged a month later after it she had achieved a certain level of recovery. The patient was in good mood and her physical discomfort disappeared. She felt like she did in the past, full of energy.

The patient's mirtazapine was reduced to 15 mg/d in August 2014, and soon the weakness in both feet became worse. Starting in February 2015, her discomfort in the waist and abdomen occurred again, felt like a stione pressing on those areas, with general weakness, and she could not lift her feet. The outpatent doctor she saw increased mirtazapine to 30 mg/d, but there was still no obvious effect. So in February 2015, the patient was admitted again with a provisional diagnosis of "recurrent depression". The patient was treated with duloxetine 60mg/d, mirtazapine 30 mg/d and MECT, and discharged from the hospital about 2 months later when symptoms relieved.

The patient complained of a far weaker curative effect from her second hospitalization compared with her first hospitalization. Weakness in both lower limbs was not completely relieved, and later these symptoms became worse. Six months later, the patient became depressed again, lacked confidence and was not willing to communicate with others. At this point, taking into account that the patient had complained of lower limb weakness, it was recommended that she seek consultation in a neurology department. Outpatient physical examination record noted the following: increased muscular tension in both lower extremities, which was considered as a potental sign of Parkinson's disease. The patient was prescribed Madopar 0.5# tid for treatment. The symptoms did not relieve a month later, so the patent was again admited to our hospital in November 2015 with "recurrent depression".

The patient had a 5-year history of hypertension, with blood pressure that was under control, but she denied presence of other illnesses. The patent said she was usually cheerful before this illness began to occur. Although divorced, she had a harmonious relationship with her children and ex-husband. She denied a family history of psychiatric abnormalities and other genetic illnesses.

Physical examination revealed a slow gait, increased muscular tension in both lower limbs, and normal muscular strength in the limbs without static tremor. …

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