title: Intractable depression or psychosis.
abstract: OBJECTIVE
  Some patients with treatment resistant depression may have a difficult to recognize and therefore untreated thought disorder. Even a subtle disorder may significantly impact patients' lives. This case illustrates a mechanism for identifying and treating this subgroup of patients.
  
  
  METHODS
  The treatment of a 67-year-old female with intractable depression is described.
  
  
  RESULTS
  The Rorschach Exner Comprehensive System identified the presence of a thought disorder with four out of five conditions positive on the Schizophrenia Index and five out of seven conditions positive on the Depression Index. Low-dose risperidone was added to the patient's medications with excellent results. Post-testing indicated that the Schizophrenia and Depression Indices were no longer positive.
  
  
  CONCLUSIONS
  A subgroup of patients with intractable depression may have an underlying thought disorder that can be identified with the Rorschach and successfully treated with low-dose antipsychotic medication.
authors.affiliation: Department of Psychiatry and Neurology, College of Community Health Science, University of Alabama School of Medicine, Tuscaloosa, AL 35487-0326, USA.
authors.forename: N J
authors.initials: NJ
authors.lastname: Rubin
authors.forename: J M
authors.initials: JM
authors.lastname: Arceneaux
mesh_terms: D000368:Aged; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology; D003937:Diagnosis, Differential; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D010469:Perceptual Distortion; D012008:Recurrence; D018967:Risperidone / Q000008:administration & dosage; D012392:Rorschach Test; D012559:Schizophrenia / Q000175:diagnosis* / Q000188:drug therapy; D012565:Schizophrenic Psychology; D013850:Thinking / Q000187:drug effects
chemical_list: D018967:Risperidone