Hypochondriacal delusion in an elderly man with good response to electroconvulsive therapy but complicated with febrile reaction

Mimi Mei Cheung Wong*, Pui-fai Pang and Michael Gar Chung Yiu

In  this  case  report,  we  present  an  elderly  gentleman  with  prominent  somatic  delusions associated with  depressive  features.  He  was  diagnosed  to  have  severe  depressive  episode  with  mood  congruent psychotic   symptoms   and   was   resistant   to   both pharmacological   and   psychological   intervention.There  was  a  differential  diagnosis  of  delusional  disorder,  somatic  subtype,  resulting  in  a  secondary depressive  episode  in  view  of  his  persistent  somatic  delusions  which  appeared  more  distressing  and more prominent than his mood symptoms. Chronologically, his depressive symptoms had been there first, followed by more and more somatic complaints therefore he was concluded to have treatment resistant depression. Electroconvulsive therapy (ECT) was started with significant improvement especially for his hypochondriacal  delusions.  However,  the  ECT was  complicated  by  recurrent  febrile  reaction  which  had close temporal relationship with each ECT session but was noted to be benign in nature. This patient has reminded us that psychotic depression is common in the elderly and may have atypical presentation. ECT is  an  effective  treatment  option  for  those  resistant  to  pharmacological  and  psychological  intervention. It has resulted in a fast and complete recovery for hypochondriacal delusion. Febrile reactions might be associated with ECT and it is important to rule out other causes.

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Published on: Aug 29, 2017 Pages: 38-41

Full Text PDF Full Text HTML DOI: 10.17352/2455-5460.000021
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