Intractable depression or psychosis.

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. METHOD 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. CONCLUSION 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.