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Case Reports in Psychiatry
Volume 2016, Article ID 1454781, 4 pages
Case Report

Differential Diagnosis of an Elderly Manic-Depressive Patient with Depersonalization and Other Symptoms

1Department of Biochemistry and Cellular Biology, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1 Ogahahigashi, Kodaira, Tokyo 187-8502, Japan
2Department of Psychiatry, Toshima Hospital, 33-1 Sasae, Itabashi-ku, Tokyo 173-0015, Japan
3Department of Neuropsychiatry, Tokyo Metropolitan Hiroo Hospital, 2-34-10 Ebisu, Shibuya-ku, Tokyo 150-0013, Japan

Received 15 December 2015; Revised 11 March 2016; Accepted 4 May 2016

Academic Editor: Erik Jönsson

Copyright © 2016 Shigehiro Ogata et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


The case study of an elderly man having persecutory delusions and bizarre complaints at the first psychiatric interview is reported. The patient complained: “I have no sense of time” and “I have no sense of money.” He refused nursing care. He had delusions centered on himself including that of his own death, which were difficult to diagnose but suggested the possibility of Cotard’s syndrome. We assumed that the man was depressed and treated him for depression. However, as a result of this treatment he became temporarily manic but finally recovered completely. After his recovery, we learnt the patient’s past history of hospitalization for psychiatric problems, and based on that history he was diagnosed as suffering from a bipolar I disorder. The lack of typical symptoms of depression and the remarkable depersonalization and derealization in this patient made it difficult to infer a depressive state. Nevertheless, being attentive to his strange feelings related to the flow of time would have helped us to make an accurate diagnosis earlier.