POLYCYTHEMIA RUBRA VERA PRESENTING WITH DEPRESSION - RECOGNIZING THE SYNDROME ABULIA

A patient with polycythaemia rubra vera is described, presenting prima rily with symptoms attributed to depression. While in the ward she dev eloped a stroke, confirmed on CT scan of the head. Venesection alone p roduced marked improvement in her neurological and psychiatric symptom s. The clinical picture corresponds most accurately to the neurologica l syndrome of abulia, which is an important differential diagnosis of depression with psychomotor retardation. The pathophysiology of impair ed cerebral blood flow causing neuropsychiatric symptoms in polycythae mia is discussed.