Patients who have senile depression with somatization symptoms are commonly encountered in clinical practice. The present case reports on a patient with senile depression who was repeatedly hospitalized and had somatic symptoms. Although the patient recovered after the first hospitalization, she suffered from a relapse one year later. As we followed up, due to the neurological findings and the response to treatment, we found that the patient is in line with the diagnoistic criteria for multiple system atrophy (MSA). The process of diagnosis and treatment of this case reminds us that clinicians need to consider differential diagnosis for refractory senile depression, especially in those patients with prominent somatization. In this case, rapid eye movement sleep behavior disorder (RBD) serves as a characteristic feature of the organic mental disorder.
老年抑郁症患者伴有躯体化症状在临床上非常常见。本病例报告了一例反复住院治疗，伴躯体症状的老年抑郁症患者。虽然在首次住院治疗获得了临床痊愈，但一年后病情复发，经过随访以及神经内科诊治，我们发现这其实是一例多系统萎缩（multiplesystem atrophy, MSA）。这个病例的诊治过程提示我们对于一些反复治疗、疗效欠佳的老年抑郁症患者，尤其对于“ 躯体化症状” 突出的病例，临床医生需要考虑是否存在躯体疾病，仔细寻找器质性病因。而快速动眼睡眠行为障碍（rapid eye movement sleep behaviordisorder，RBD）作为一个特征性的脑器质性疾病标志值得精神科医生重视.
Keywords: case report; multiple system atrophy; rapid eye movement sleep behavior disorder; senile depression.