<Case Reports>A case of major depression presenting as psychosomatic disease-for better diagnosis and treatment based on the Diagnostic and Statistical Manual for Mental Disorders-IV Edition (DSM-IV)

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A patient, whose chief complaint was an abnormal sensation of the oral cavity, also complained of a depressive mood, insomnia, suicidal ideas and anorexia therefore, oral cyst treatment was administered. The complaints were diagnosed as "Undifferentiated Somatoform Disorder"; 300.81 (diagnostic code) and "Major Depressive Disorder, single episode, severe"; 296.23 (diagnostic code) for Axis-I (main mental disorder diagnosis) and "Oral-Cyst" for Axis-III (physical disease diagnosis) based on the Diagnostic and Statistical Manual for Mental Disorders-IV Edition (DSM-IV) from the psychiatric perspective. The patient was also diagnosed with psychosomatic disease of the oral cavity according to the traditional criteria of psychosomatic medicine. Minor tranquilizers were not very effective. However, the addition of sulpiride provided gradual relief of the symptoms. The patient was initially diagnosed with both major depressive disorder and a psychosomatic disease of the oral cavity. Nevertheless, considering the response and course of treatment, the patient should have been diagnosed with only major depressive disorder. It is considered that certain major depressive disorders can involve psychosomatic disease. DSM-IV is very useful for diagnosing borderline patient who are between depression and psychosomatic disease.
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