Emmanuelle is brought in by his wife and one of his daughters four months later. They say that his illness has now progressed. There have been times when his depression has been marked by periods of agitation and anxiety, when he sits, wringing his hands and ruminating over his perceived troubles, and other times, as now, when he is composed, but sits for long periods without moving.

He complains of marked sleep disturbance with early morning wakening and diurnal mood shifts. He has lost a considerable amount of weight in the last four months.

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