Nonsensory Hallucinations or Obsessive Symptoms?: A Diagnostic and Therapeutic Dilemma in a Psychotic Patient

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The study of this particular case provided the opportunity to discuss both diagnostic and therapeutic issues raised, concerning not only the evaluation and diagnostic classification of complex and fluctuating symptoms—including abnormal thought content (obsessions or delusional ideas) accompanied by auditory hallucinations that evolved at a later stage during the process of the disorder—but also the response of such symptoms to the various medications applied. Differential diagnosis should include obsessive-compulsive disorder, unipolar schizoaffective disorder, and tardive Tourette’s syndrome. Questions raised concerning the beneficial or worsening effect of specific medications applied with regard to the prominent psychopathology during the course of the disorder as well as the optimal treatment for such a case are also discussed.

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