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Pseudodementia in schizophrenia and mania.
The importance of differentiating depressive pseudodementia from true dementia seems to be well recognized by psychiatrists, yet there seems less recognition that other functional psychoses in the elderly can present with symptoms of cognitive impairment. In this report, we describe two patients--one suffering from late onset schizophrenia and one from a manic illness--who were diagnosed as suffering from dementia in the early stages of their illnesses. We discuss some of the difficulties in making diagnoses in these cases which include an historical tendency for clinicians, including psychiatrists, to assume an organic aetiology for first presentation psychoses in old age. Although the concept of pseudodementia has been criticised in recent years, we conclude that it retains its clinical utility in that it orientates the clinician to the importance of recognizing treatable functional psychoses in the elderly.
Malingered psychosis leading to involuntary psychiatric hospitalization.
OBJECTIVE: To describe a patient with feigned psychosis who was admitted to an acute psychiatric unit under the Mental Health Act, and to discuss the clinical features of malingering in this treatment setting. METHOD: Case report. RESULTS: A 40-year-old man with no known past psychiatric history was brought by police to the Emergency Department. He gave a history of paranoia, hallucinations and bizarre behaviour and was admitted to a secure ward. Treatment with parenteral medication was required due to hostile and aggressive behaviour. Collateral history was inconsistent with his reported symptoms and, when confronted with this information, he acknowledged fabricating his symptoms in order to obtain a disability pension. CONCLUSIONS: It is important to consider malingering as a differential diagnosis in patients who present with atypical features and have clear external incentives for their behaviour. With improved health literacy and access to health information, individuals who are marginalized in society and have limited social and occupational opportunities may malinger symptoms for obvious personal gain. Inconsistency between reported symptoms and clinical observations, as well as contradictory collateral information from multiple sources, are helpful tools in diagnosing malingering. It is important for clinicians to identify malingerers early and limit unnecessary admissions.
Dementia: what to do.
Dementia is a syndrome of acquired intellectual deterioration that interferes with personal or social functioning. Diagnosis requires historical information from the family and the mental status evaluation of orientation, recent memory, comprehension, calculation, and abstraction. Most dementias create permanent, even progressive cognitive deterioration, yet there are some presentations for which remission exists. Common reversible conditions include depression, drug toxicity, normal-pressure hydrocephalus, hypothyroidism, subdural hematoma, and neoplasm. Screening laboratory studies consist of urinalysis, chemistry profile, blood count, thyroid survey, vitamin B12 and folate measurements, serology, chest roentgenogram, computerized tomographic scan of the head, electroencephalogram, and electrocardiogram. Treatment focuses on potential reversibility, psychosocial issues, restoring deficits, and specific symptoms.
Questioning the concept of pseudodementia.
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The dexamethasone suppression test in two patients with severe depressive pseudodementia.
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Huntington's disease: phenomenological diversity of a neuropsychiatric condition that challenges traditional concepts in neurology and psychiatry.
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Reversible dementia and the misdiagnosis of dementia: a review.
Ten to 33 percent of the patients who present for evaluation of dementia are found to have a potentially reversible cause of dementia such as metabolic, structural, or psychiatric condition. Another group of patients who present with symptoms or complaints of impaired thinking are erroneously diagnosed as suffering from dementia. The author reviews the criteria for diagnosis of dementia, the laboratory and other tests advisable for use in evaluating the presence of dementia or guiding the treatment of irreversible dementia, and some factors that may lead to the misdiagnosis of dementia. He emphasizes that a thorough medical, psychiatric, and psychosocial evaluation of all patients presenting with cognitive impairments is essential.
Psychosis in anorexia nervosa and bulimia.
In a sample of 130 consecutive patients with a lifetime diagnosis of anorexia nervosa and/or bulimia, 17 displayed psychotic symptoms. In 16 patients, these symptoms appeared attributable to major affective disorder or schizo-affective disorder, while in one, they appeared to represent factitious psychosis. No cases of schizophrenia or organic psychosis were identified.
Self-mutilation: diagnosis and practical treatment.
The management of self-inflicted lesions requires an understanding of the dynamics of the act of self-mutilation. The overview of practical techniques allows the non-psychiatrist physician to deal with self-inflicted disorders more effectively. The efficacy of behavioral and psychotherapeutic techniques is enhanced when combined with psychopharmaca.
[Sleep polygraphy: diagnostic value in depressive pseudo-dementia. Attempt to improve visual scoring by digital periodic analysis].
ARGUMENT: Pseudo depressive dementia is a common pathology for elderly patients. Classically, it is said that depression is taking the mask of dementia, but very often deterioration and depression are present at the same time. Sleep EEG can help the clinician to differentiate dementia and depression in pseudo depressive dementia. Slow Wave Sleep (SWS) is a good indicator of deterioration process. We tried to improve the sleep recording and analysis and our ability to differentiate SWS in this indication. We use a portable digital recording material (Hypnotrace). The signal is analysed by the association of a visual standard method to Digital Periodic Analysis (DPA) which is very sensitive to SWS. The visual analysis gives informations about the macroarchitecture of the night. The Digital Periodic Analysis gives at any moment the value of the wave frequency and thus informations about the microarchitecture. Our hypothesis is that this association helps to better recognise SWS and thus improves sleep EEG as a diagnostic tool in this indication. METHODS: 23 inpatients meeting both the criteria for major depression and dementia (DSM IV) have been recorded during two nights after 15 days of wash out and before antidepressant treatment. The recordings are analysed with the visual standard method and with the help of DPA. The patients are evaluated every 15 days during two months in order to define three groups based on the clinical evolution. RESULTS: The scoring with DPA is more sensitive to Slow Wave Sleep, particularly for the patients with good clinical evolution (with the strongest depressive component). Thus, this method could be a good diagnostic tool to differentiate dementia and depression in pseudo depressive dementia.
[Depressive pseudodementia: clinico-therapeutical implications].
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Factitious patients with fictitious disorders: a note on Munchausen's syndrome.
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Factitious patients with fictitious disorders: a note on Munchausen's syndrome.
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Factitious patients with fictitious disorders: a note on Munchausen's syndrome.
OBJECTIVE OURS: To review historical aspects and note several contemporary manifestations of the Munchausen syndrome, including "Munchausen by proxy" and "pseudo-Munchausen", to offer our respect to the infamous McIIroy (the quintessential example), as well as to encourage interest and assuage irritation by medical attendants. THEIRS: Impatient to be patients, dying to see doctors, hooked on hospitals, and seeking "ill" gotten gains, they thrive on medical investigations.
[Diagnostic criteria of depressive pseudodementia].
Ten patients fulfilling the DSM III (A, B, C, D) criteria for both dementia and major depression and presenting the diagnostic dilemma of depressive pseudodementia were included in a prospective study in search of indices for the differential diagnosis of depressive pseudodementia (DPSD) and organic dementia (OD). Patients were assessed with the Hamilton Depression Rating Scale (HDRS), the Blessed Dementia Rating Scale (BDRS), the Wells's criteria, the Mini Mental State (MMS), computerized tomography (CT scan) of the brain, the dexamethasone suppression test (DST), total plasma 3-methoxy-4-hydroxyphenylglycol (MHPG) and sleep electroencephalograms (EEG). Patients suffering from DPSD were defined as showing an improvement higher than 50% in both the HDRS et BDRS scores following adequate antidepressant treatment. Wells's criteria, MMS scores, CT scan and DST do not contribute to the separation of DPSD (n = 6) and OD (n = 4). On the contrary, plasma MHPG levels higher than 35 ng/ml and EEG measures of sleep structure and REM sleep significantly differentiate the two groups.
[Cyclothymia ending in dementia. A case report].
Three cases of manic-depressive illness are presented which, with various manifestations of pseudodementia, end in dementia. The relationship of cyclothymia to dementia is discussed, and the need for diagnosis with the aid of equipment is stressed. Notwithstanding the absence of systematic theories, it seems most probable that senile dementia (Alzheimer dementia) may be associated with cyclothymia.
[Problem of transient dementias of old age (clinico-diagnostic aspect)].
On the basis of the literature data and their own findings the authors discuss the problem of "transient" senile dementia. A special emphasis is given to depressive pseudodementias and somatogenic confusion imitating oligophrenia, particularly to their differentiation from true oligophrenia. The authors also describe supplementary differential-diagnostic tests with the administration of antidepressants (or tranquilizers) and psychostimulators (or nootropic agents), and control examination of mental functions prior to and after drug administration.