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Managing psychotic depression and diagnostic uncertainty in liaison psychiatry
  1. Joanne E Davies1 and
  2. Sarah Johnson2
  1. 1 Department of Psychiatry, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
  2. 2 Liaison Psychiatry, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  1. Correspondence to Dr Sarah Johnson, sarah.johnson4{at}


A middle-aged woman presented with a history of symptoms of depression with psychotic features severely affecting her physical health. Neuroimaging of her brain suggested pathological changes out of keeping with her age, leading to further investigations including genetic testing for cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis was also considered as a differential diagnosis as an initial serum test for anti-NMDAR autoantibodies was positive. Her symptoms resolved following treatment with electroconvulsive therapy. Despite her initial neuroimaging, her genetic test for CADASIL was negative and her subsequent test for anti-NMDAR autoantibodies was negative, suggesting that the initial test may have been a false positive.

  • mood disorders (including depression)
  • depressive disorder
  • psychotic disorders (incl schizophrenia)

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  • Contributors Both authors were involved in direct patient care and management. SJ prepared some early draft notes and JD wrote the manuscript using these notes and further examination of patient files. SJ completed a literature search and JD did further literature search for the discussion. Both wrote learning points and edited the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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