What is behind the silence? a case report of mutism.

Introduction: Mutism is a symptom which can be found as a part of different psychiatric disorders: selective mutism, schizophrenia and other psychotic disorders, hysteria, stupor, major depressive disorder, etc. In this work we present the case of a woman 50 years old who arrives to the hospital because see suffers from an atypical thoracic pain. Moreover, she is more focused on her religious devotion than usual, and verbalizes delusional ideas of prejudice. When the doctors suggest she should be evaluated by Psychiatry, she stops talking and doesn't respond to verbal or pain stimulation. Objectives: To describe a peculiar case of mutism, and to discuss the differential diagnosis which lead to an appropriate management of this case, with a rapid resolution. Methods: The clinical history of the patient was collected guaranteeing her anonymity, and a comprehensive literature research was conducted via Pubmed, Web of Science, and Up to Date, using key words such as "mutism", "persistent delusional disorder", and "psychotic symptoms". Results: Complementary exams were run to exclude organic pathology. The patient received treatment with two intramuscular injections of Zuclopenthixol acetate 50 mg/ml in a few days. Shortly after that, she started talking normally again, and the behaviour disorder associated to the delusional ideas improved. Conclusions: According to the symptoms and vital history of the patient, the diagnosis was a persistent delusional disorder. However, we must not forget the importance of the organic evaluation, and the fact that a systematic anamnesis and differential diagnosis lead to a good outcome. [ABSTRACT FROM AUTHOR]