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At least 397 records · Page 22Linked to original sources
PubMed2004

Conversion pseudodementia in older people: a descriptive case series.

METHODS: This paper reports a case series of ten patients collected over a 12-year period of clinical work in old age psychiatry in the UK by the author. RESULTS: The core features of the syndrome are: apparent cognitive impairment, regression and increasing physical dependency beginning in late middle or early old age, without evidence for an organic dementia from investigations or from taking into account the course of the illness. The syndrome is more common in women from a higher socio-economic background with past psychiatric histories dominated by depressive symptoms. The syndrome usually progresses to the point where long term institutional care is needed although the mean survival from onset is 13 years. CONCLUSIONS: The author suggests that conversion pseudodementia in older people is caused by a catastrophic reaction to cumulative loss in later life in individuals who have predisposing borderline and narcissistic personality traits. Treatment using psychotherapeutic approaches may limit the progression of the syndrome if it is recognised at an early stage.

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PubMed1998

Problems of differential diagnosis between depressive pseudodementia and Alzheimer's disease.

Today, pseudodementia seems to be a blurred and misleading term. It is more precise to speak about cognitive disorders which can be observed in both depressed and demented patients. Guidelines which can help to differentiate between depression and dementia are proposed for both the history and the course of the disorders. Additional brain imaging can give further indications. Ergopsychometric setting, which obeys directed burden under speed conditions may be helpful. SSRIs may reduce the HPA axis hyperactivity in depressive patients with Alzheimer disease. Therefore this medication can help to improve the state of these patients.

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PubMed1990

Diagnostic problems in liaison psychiatry and the ICD-10.

Liaison psychiatry is an area fraught with diagnostic problems due to the complex overlap between psychopathology and physical illness. The worst difficulties arise where patients also exhibit maladaptive behaviour such as deliberate self harm. In these situations a number of professionals may become involved including physicians, psychiatrists and social workers. As the level of complexity of a case increases an accurate formulation and diagnosis become essential. The International Classification of Diseases 10th revision (ICD-10) in its 1986 draft is currently being field tested. Chapter V (F) 'Mental, Behavioural and Developmental Disorders, is a descriptive clinical psychiatric classification, which will soon be incorporated into a multi-axial schema. This draft classification was used to make a diagnosis for 50 consecutive referrals to a liaison psychiatrist working in a large District General Hospital. This report assesses the applicability of ICD-10, V (F) in liaison psychiatry, and also comments on the characteristics of this group of patients. This leads to a discussion of the requirements for the other axes that would be needed to produce a multi-axial schema capable of allowing complex problems to be accurately formulated.

Adjustment Disorders↗
PubMed1985

Pseudodementia.

The term pseudodementia is applied to the range of functional psychiatric conditions such as depression, schizophrenia and hysteria that may mimic organic dementia, but are essentially reversible on treatment. Depression is the commonest cause of pseudodementia in the elderly and is also the commonest treatable condition misdiagnosed as dementia. Diagnosis and management of depressive pseudodementia are discussed, and the systematic and thorough treatment of the depression is emphasized. Issues such as the diagnosis of early dementia, mental stress in the elderly resulting in confusion, patients with nonprogressive intellectual or neurological deficits, patients with a diagnosis of mixed depression and dementia, and depression as a precursor of dementia are all briefly considered.

Depressive Disorder↗
PubMed1989

Structural brain CT changes and cognitive deficits in elderly depressives with and without reversible dementia ('pseudodementia').

Twenty-six elderly (greater than 60 yrs) patients with DSM-III major depression were compared to 13 patients with NINCDS/ADRDA probable Alzheimer's disease (AD), and to 31 screened normal controls. Subjects were matched on age and sex. Fifteen of the 26 depressed patients were cognitively impaired on the Mini-Mental State Examination (MMSE) upon admission, but after treatment returned to the normal range. These 15 patients were defined as having the dementia syndrome of depression (DOD). The remaining 11 depressed patients were termed depressed, cognitively normal (DCN). All subjects received standardized cranial CT scans for assessment of ventricular brain ratio (VBR) and CT attenuation numbers. Subjects also received neuropsychological evaluation. CT values for the 26 depressed patients lay between those of AD patients and normal controls. CT values for the DOD subgroup clustered near those of AD patients. Patterns of cognitive deficits and correlations of CT attenuation values with cognitive measures were also similar in AD and DOD. Most patients were reassessed at a mean of two years after initial testing; of the 11 of the 15 DOD re-examined, only one had undergone cognitive decline. By contrast, all AD patients retested had declined significantly. Episodes of DOD and DCN tended to 'breed true'. This study suggests that while patients with DOD may have underlying structural brain abnormalities, obvious short-term progression to AD does not commonly occur.

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PubMed1989

Electroencephalographic sleep in late-life neuropsychiatric disorders.

Late-life depression and dementia of the Alzheimer's type both have profound, although different, effects on electroencephalographic (EEG) sleep patterns. Thus, while depression is associated with REM sleep disinhibition and extreme sleep fragmentation (e.g., sleep onset REM periods and early morning awakenings), Alzheimer's disease is associated with deficits in the production of phasic activity during sleep (e.g., rapid eye movements and K-complexes) and with increased rates of sleep-disordered breathing. These differences have been shown to be reliable in large numbers of patients during the past five years and appear to extend to differences in sleep between depressive pseudodementia and dementia with secondary depression. Preliminary data also suggest that pretreatment sleep onset REM periods may be associated with enhanced vulnerability to recurrent depression. In summary, sleep physiological measures provide useful diagnostic and prognostic indexes in late-life neuropsychiatric disorders.

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PubMed2002

Conversion motor paralysis disorder: overview and rehabilitation model.

It is important to consider a differential diagnosis between paralysis on an organic basis and paralysis and disability due to psychological mechanisms in people with physical impairment secondary to trauma, without evidence of organic etiology. We review the most dramatic type of conversion disorder (CD)-'Conversion Motor Paralysis'. Recent important medical literature concerning the accepted treatment and rehabilitation management will be reviewed and discussed. The inter-disciplinary in-patient team management approach in a rehabilitation setting offers the benefits of a comprehensive assessment and treatment. The diagnosis is temporary and conditional, since there may be a long delay until the appearance of organic findings. A complete medical assessment is essential in order to rule out any possibility of an organic etiology. In as many as 25% to 50% of patients diagnosed as conversion, an organic medical diagnosis was found.

Behavior Therapy↗
PubMed2002

[Depressive pseudodementia].

Elderly depressive patients complaining about cognitive symptoms are at particular risk of being labelled as demented. It is well documented that depressive disorders frequently cause mild cognitive deficits which manifest in psychometric procedures. A wide spectrum of potentially reversible cognitive deficits related to a depressive syndrome are summarized under the term of "Depressive Pseudodementia (DPD)". Most depressive patients who are referred to "DPD" suffer from cognitive dysfunctions outside the range of dementia. The clinical interface between depression and dementia is complex. There is some evidence that depression may be a risk factor for the expression of Alzheimer's disease in later life and that depression may occur as a prodrome for Alzheimer dementia. Moreover, depression often complicates the course of dementing disorders. However, there is no evidence that depressive disorders cause dementia without coexisting depressive symptoms. It is essential to search for depressive symptoms even after cognitive symptoms have been found.

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PubMed1993

[Early diagnostic differentiation of primary dementia from primary depressive syndromes in the aged--a contribution to the discussion of pseudodementia].

The syndromes associated with dementia and depression in old age show a considerable overlap and even coincidence, not only for statistical reasons. Starting with a critical evaluation of the term "pseudodementia", possibilities for a differentiation of both types of syndromes by characteristics of clinical features and history and by additional investigations are shown. A critical review of the literature with focus on the differentiating properties of the following methods is given: neuropsychology and rating scales (e.g., "cortical" mediated versus motivational changes), neurophysiology (electroencephalography, EEG; evoked potentials, EP; event-related potentials, ERP), sleep physiology (REM-sleep changes; sleep deprivation results), neuroendocrinology (dexamethasone suppression test), neuroradiology (cranial computed tomography, CCT; magnetic resonance imaging, MRI) and especially the dynamic imaging methods of nuclear medicine (cerebral glucose metabolism with fluorodeoxyglucose and positron emission tomography, FDG-PET; cerebral blood flow (CBF) measurements with PET and single photon emission tomography, SPET). Developments during recent years concerning better imaging of early hippocampal lesions (MRI) or analysis of CBF--changes induced by activation methods may be very helpful. In conclusion, one can say that the diagnosis of dementia and depression remains primarily a clinical one that can be ascertained by means of valuable diagnostic tools.

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PubMed1999

Diagnostic criteria for malingered neurocognitive dysfunction: proposed standards for clinical practice and research.

Over the past 10 years, widespread and concerted research efforts have led to increasingly sophisticated and efficient methods and instruments for detecting exaggeration or fabrication of cognitive dysfunction. Despite these psychometric advances, the process of diagnosing malingering remains difficult and largely idiosyncratic. This article presents a proposed set of diagnostic criteria that define psychometric, behavioral, and collateral data indicative of possible, probable, and definite malingering of cognitive dysfunction, for use in clinical practice and for defining populations for clinical research. Relevant literature is reviewed, and limitations and benefits of the proposed criteria are discussed.

Cognition Disorders↗
PubMed1999

Fabricated trauma exposure: an analysis of cognitive, behavioral, and emotional factors.

The 1995 Oklahoma City bombing was a disaster of unparalleled dimension in the United States. The professional response included the development of systematic clinical and research programs. This article describes the case of a child who, as a participant in a research study, appeared to fabricate a story of bomb-related loss. The research and clinical records of this child were examined and analyzed according to the factors and conditions that might underlie this fabrication. These include issues related to memory and suggestibility, symptom contagion, and mass hysteria. The report describes the role of psychological vulnerability in trauma and this child's coping and adaptation.

Adaptation, Psychological↗