The Great Pretender

Mr B first presented to an Accident and Emergency department in Bristol, having taken an overdose of fifty paracetamol tablets. He had became depressed over a period of six months, with biological features, including weight loss of two stones. There were no obvious precipitants. He was offered admission, but refused. Subsequently he was started on dothiepin and referred to outpatients. Further assessment revealed that he had been acting unusually prior to the overdose. His behaviour had become regressive during the preceeding three months. On occasions he would suck his thumb for long periods and when he spoke it was monosyllabically, in rather an infantile manner. At other times he had been getting on his hands and knees and acting like a dog. It was noted then that he had suffered considerable stresses. His fourth wife was in the process of divorcing him, and he