Śląski Uniwersytet Medyczny w Katowicach, Wydział Nauk Medycznych w Katowicach Klinika Psychiatrii i Psychoterapii, Katedra Psychiatrii Dorosłych.
Psychiatr Pol. 2023 Oct 31;57(5):995-999. doi: 10.12740/PP/OnlineFirst/143044.
We present a case study of a patient who was hospitalized with the initial diagnosis of psychotic depression with predominant delusions of poverty. During his hospital stay despite antidepressant and antipsychotic treatment with 150 mg of sertraline and 20 mg of olanzapine per day, no symptomatic improvement was achieved. Besides, the psychotic features have risen to the fore along with inadequately vaguely expressed affective component. What drew attention was the coherence and permanence of delusional judgements, which, albeit variable in expression, always concerned one theme - the belief of an inevitable bankruptcy. The whole clinical picture, both with the objectifying interview defining the order of emerging symptoms, was suggestive and the verification of diagnosis was made. Persistent delusional disorder with delusions of poverty with subsequent mood disorder was diagnosed. The treatment with 275 mg of clozapine per day was started and we observed a slow gradual withdrawal of psychosis as well as a total normalization of the affective range. The case illustrates the importance of differential diagnosis of mental states in which psychotic features coexist with affective symptoms. It is helpful to determine the sequence of the symptoms development. It should be noted that although the ICD-10 classification distinguishes exclusively 7 subtypes of persistent delusional disorder, in the clinical practice we can encounter other thematic areas of psychosis. It brings substantial therapeutic and prognostic implications.
我们报告了 1 例患者，其最初的诊断为以妄想贫困为主的精神病性抑郁症。在住院期间，尽管给予了每天 150mg 舍曲林和 20mg 奥氮平的抗抑郁和抗精神病治疗，但没有达到症状改善。此外，精神病性特征凸显，情感成分表达不足。引起注意的是妄想判断的连贯性和持久性，尽管表达多变，但始终涉及一个主题——对不可避免破产的信念。整个临床情况，包括客观化访谈确定症状出现的顺序，都具有提示性，并进行了诊断验证。诊断为持续性妄想障碍，伴有妄想贫困，随后出现心境障碍。开始每天给予 275mg 氯氮平治疗，我们观察到精神病逐渐缓慢缓解，以及情感范围完全正常化。该病例说明了在伴有情感症状的精神状态的鉴别诊断中的重要性。它有助于确定症状发展的顺序。应该注意的是，尽管 ICD-10 分类仅区分了 7 种持续性妄想障碍的亚型，但在临床实践中，我们可能会遇到其他主题领域的精神病。这带来了实质性的治疗和预后影响。
