Case report: Depression in an older patient with dysgeusia as the initial symptom.

INTRODUCTION

Depression is the most common mental illness among older adults, with substantial and persistent mood depression as the main clinical feature, which is unfavorable for improvement. The clinical manifestations can range from melancholy to grief or even numbness. Approximately one-third of older adult patients exhibit physical discomfort as the first symptom; dysgeusia as the first symptom, is very rare in clinical practice. Dysgeusia is a clinical symptom with no specific objective indicator; thus, the likelihood of misdiagnosis and missed diagnosis is high.

CASE PRESENTATION

In this study, a 60-year-old female housewife with elementary school as her highest level of education, presented to the outpatient department with dysgeusia, poor sleep, and poor mood persisting for >1 year, which aggravated 2 weeks before hospital visit. Psychiatric examination showed clear consciousness; the patient was cleanly and timely dressed and demonstrated self-care but had a worrisome expression. Using the diagnostic criteria of the International Classification of Diseases (10 edition), a diagnosis of a major depressive episode with psychotic symptoms was made. Following pharmacological and psychological treatment, the patient's condition improved. The patient was compliant to treatment (10 mg/day of escitalopram), had a stable mood, good sleep, and no dysgeusia at >2 years of follow-up as an outpatient. She was able to do housework and take care of her children normally and did not complain about any other issues.

CONCLUSION

Physical discomfort is a very common complaint in older patients with depression. If persistent physical symptoms do not improve after repeated medical treatment, timely assessment of the patient's mental state or psychiatric referral should be considered to diagnose geriatric depression. Timely pharmacological and psychological therapy are the preferred treatment for older adults.