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Published online by Cambridge University Press: 16 April 2020
Thirteen years ago the clinical symptoms of the patient has begun as depression. Main symptoms was the psychomotor retardation, fatigue, markedly diminished interest in all and mutizmus. At this time the diagnosis was Major Depressive Disorder, the therapy were changed antidepressant drugs (fluvoxamine, fluoxetine after paroxetine), and the patient's symptoms resolved -, but the recovery was slow. Later – years after – her depressive symptoms were resumed again, but joined psychotic symptoms. So the therapy consisted of antidepressant and – temporary - antipsychotic medication (haloperidol). The remission was total too, but brief : just the main symptoms were the alogia, affective flattening, lack of emotional rezonance, severe insomnia, depressed mood and delusion symptoms. Longitudinal the diagnose became Schizoafffective Disorder. We must changed the antidepressant drugs four times (sertraline, venlafaxine, bupropion and after duloxetine), and the antipsychotics three times (risperidone, amisulpride and finally olanzapine) by the time the symptoms disappeared. We saw, that a psychotic disorder might start with mild affective symptoms as a differential diagnostic problem, and the psychozis fulfill for many years.
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