Absolutely Therapy-Resistant Depression and Mixed Movement Disorder in an Unusual Case of Polycythemia Vera

This report presents a 64-year-old female patient with unusual psychiatric and neurological complications in polycythemia vera. Six years after onset of the hematologic disorder the patient succumbed to an absolutely therapy-resistant depression, from which she has been suffering for the past four years--intensive and broad--spectrum drug and electroconvulsive treatment has failed to ameliorate the condition. In addition, the patient has developed a mixed movement disorder with rhythmical movements, mainly affecting the trunk, akathisia, hyperventilation, and pleurothotonus ("Pisasyndrome"). The paper discusses a possible link between hypoxic cerebral damage, caused by hyperviscosity of the blood due to polycythemia vera, and the therapy resistance of the depression. The case confirms that organic factors may cause therapy resistance in depressive disorders.