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CASE REPORT
Year : 2017  |  Volume : 22  |  Issue : 1  |  Page : 69-71

Diagnostic and therapeutic hardships with mixed affective state presenting as catatonia in a patient with intellectual disability


1 Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
2 Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India

Correspondence Address:
Karthick Subramanian
Department of Psychiatry, Jawaharlal Institute of Post Graduate Medical Education and Research, Dhanvantri Nagar, Puducherry - 605 006
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmhhb.jmhhb_22_16

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Mixed affective episodes can be misdiagnosed, especially in patients with intellectual disability (ID). We describe the case of an 18-year-old girl with mild ID, who presented with features of catatonia during the first mixed episode. These symptoms responded well to electroconvulsive therapy, following which clear affective symptoms emerged. Her affective episode did not respond adequately to olanzapine but improved significantly after the addition of sodium valproate. The difficulties of diagnosing affective episodes in persons with intellectual disabilities are discussed. This case suggests that mixed affective episodes should be considered in the differential diagnosis when poorly elaborated affective and psychotic symptoms are present in a patient with ID.


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