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At least 487 records · Page 27Linked to original sources
PubMedDate not supplied

[Neurological problems in the aged subject].

The neurological problems in elderly patients are dominated by cerebral vascular accidents and dementias. The incidence and the prevalence of cerebral vascular accidents has greatly decreased following measures of primary, secondary and tertiary prevention. The problem raised by dementias is one of a positive diagnosis (presently according to DSM III criteria) and mostly the problem of the differential diagnosis, i.e. the diagnosis of curable dementias or "false dementias".

Aged↗
PubMed1985

Recognition of pseudodementia.

The most common features of cognitive impairment due to pseudodementia are a relatively acute onset, symptoms of six to 12 months duration; past psychiatric history, particularly depressive illness; age over 50; frequent "don't know" as opposed to "near miss" answers; normal electroencephalogram and computed tomographic scan of the brain, and absence of nocturnal worsening. With this profile, or three or four of these clinical features, a carefully monitored, aggressive trial of an antidepressant regimen is justified.

Aged↗
PubMedDate not supplied

[Mythomania: an identity quest].

The romantic fictions of the mythomaniac are fascinating in the conviction they arouse in others and in the ambiguous connections their author keeps with reality. When behind his fables, Mr D. reveals a demand for love, it essentially represents a desperate search of identity realized through stories he successively tests with us. So, confronting him without any therapeutical support to the imaginary nature of his productions would just mean depriving him of any possible meaning.

Adolescent↗
PubMed1997

[Dermatitis artefacta].

We report a case of a 29-year-old man presenting skin ulcerations on both sides of the mandible. The diagnosis of dermatitis artefacta was based on the morphology and evolution of the lesions, on the patient's borderline personality, on the objects found in his possession, and a later admission of having an involvement in the aggravation of the lesions.

Adult↗
PubMed1997

[Self-injury behavior].

BACKGROUND: Self-damage is defined as intentional injury of the own body. Patients with this disorder often consult and deceive surgeons. In case of factitious disease the diagnosis of self-injurious behavior can be difficult. METHODS: A literature review on self-injuring behavior was done with special emphasis on its clinical presentation in surgical departments, its psychodynamic background and the therapeutic consequences. RESULTS: Self-damaging behavior is most frequent in adolescent females. Both a disturbed relation with the own body and with fellow-beings is the problem of all patients. Deprivation, physical or sexual abuse are common in the biography of these patients. The feelings of internal emptiness and unbearable psychic tension are the immediate psychodynamic causes of the self-damaging act. Psychotherapeutic strategies are aimed at learning to express emotions in a better way, to care for the own body, and to establish confidential and stable relationships. CONCLUSIONS: The knowledge of the psychodynamic background facilitates the therapeutic approach to patients with self-injuring behavior.

Adolescent↗
PubMed1992

Diagnosis, management and prognosis of a group of 128 patients with non-epileptic attack disorder. Part I.

Three hundred and forty three patients with attack disorder labelled as epilepsy were admitted for assessment to a Neuropsychiatry ward in a small English mental hospital over a 5 year period. After assessment it was decided that 63% (215) of these patients had epilepsy, but in 128 (37%) a diagnosis of non-epileptic seizures was made. Just over a third of these patients (46) had an additional history of present or past epileptic seizures as well, so that 24% of the total population had non-epileptic seizures only. The methods used to make this diagnosis are reviewed and an attempt made to classify the non-epileptic attacks from which the patients were suffering. A variety of management strategies were offered and at discharge from hospital the majority of patients had practically lost their non-epileptic seizures. At follow-up 2 years later, seizures had returned in most patients. In 8% of the patients it was clear that the diagnosis of non-epilepsy had been erroneous. The importance of classifying the kind of non-epileptic event the patient suffers from and of translating treatment in hospital to the community is emphasized.

Adult↗
PubMed2006

Long-term outcome of depressive pseudodementia in the elderly.

BACKGROUND: The term depressive pseudodementia has proved to be a popular clinical concept. Little is known about the long-term outcome of this syndrome. AIMS: To compare depressed elderly patients with reversible cognitive impairment and cognitively intact depressed elderly patients. METHODS: All patients suffering from moderate or severe depression admitted to St Margaret's Hospital, UK as inpatients or day hospital outpatients between January 1 1997 and December 31 1999 (n=182) were screened for entry into the study. Eligible patients were divided into those presenting with pseudodementia and those who were cognitively intact and followed up for 5 to 7 years. RESULTS: Seventy-one point four percent of those suffering from pseudodementia had converted into dementia at follow-up compared to only 18.2% in the cognitively intact group. The relative risk was 3.929 (95% CI: 1.985 to 7.775) and the 'number needed to harm' 1.88. CONCLUSIONS: Reversible cognitive impairment in late-life moderate to severe depression appears to be a strong predictor of dementia. Inpatients and day hospital outpatients with depressive pseudodementia should probably have a full dementia screening, comprehensive cognitive testing and ongoing monitoring of their cognitive function.

Aged↗
PubMed1990

Neuropsychological deficits and CT scan changes in elderly depressives.

A number of computerized tests were used to study visual attention, memory and learning in elderly depressed patients. Impairment was found in approximately 70% of depressed patients and was seen particularly in memory and in measures of latency. Depressed patients showed equivalent impairment in short-term memory but less impairment in conditional associative learning compared to a group of patients with early dementia of the Alzheimer-type (DAT), matched for age and pre-morbid IQ. With respect to qualitative differences between depression and DAT, depressed patients showed a different pattern of errors and a consistently prolonged latency of response which was independent of delay in a delayed matching-to-sample test. On recovery from depression, although improvement was seen in most test scores, performance in measures of latency and in a number of tests of memory and learning failed to reach the level seen in a group of matched control subjects and approximately 35% of patients continued to show impairment. For the depressed patients, ventricular brain ratio (VBR) correlated with measures of slowing. In addition, in the 'recovered-depressives', VBR correlated with poor performance at high levels of task difficulty. These findings are discussed with respect to previous literature on the pattern of cognitive impairment and CT scan findings in depression.

Aged↗
PubMed1994

The differentiation of depression from dementia by temporal lobe magnetic resonance imaging.

Temporal lobe Magnetic Resonance Imaging (MRI) was performed in 43 patients with NINCDS/ADRDA Alzheimer's disease (AD) (33 probable, 7 possible, 3 definite) and 32 subjects with DSM-III-R Major Depression (DEP) matched for age, sex and level of education. Hippocampus (anterior and posterior, right and left), amygdala, entorhinal cortex, parahippocampal gyrus and cerebral cortex were rated for atrophy on a 4-point scale. Good discrimination between groups could be achieved using a cut-off of 2 or more on anterior hippocampal atrophy rating (sensitivity 93%; specificity 84%; 89% cases correctly grouped overall). Even among a subgroup of 9 mild AD subjects and 10 cognitively impaired DEP subjects (matched on mini-mental state score), the same cut-off correctly grouped 84% (16/19) cases. Hippocampal atrophy increased with age in both AD and DEP subjects leading to a reduction in specificity (but not sensitivity) for those aged over 75. Within the AD group a significant correlation was observed between length of history and atrophy of the entorhinal cortex (r = 0.39, P = 0.009). We conclude that temporal lobe atrophy on MRI can provide good discrimination between AD and DEP subjects, including those DEP patients with cognitive impairment apparent on screening tests of cognitive function.

Aged↗
PubMed1986

Differential diagnosis of the dementias of unknown origin: a clinician's view.

The close cooperation of clinical and laboratory research has helped to clarify the etiology of some of the dementing processes of the senium. However, the necessary investigations are complicated, laborious, expensive and can be carried out only in well equipped centres in larger cities. This restricts the number of patients who eventually may benefit from these investigations to a small number. What is needed for the psychogeriatric practice particularly in rural areas and smaller cities are simple diagnostic guidelines for the psychiatrist to answer the question whether the patient suffers from a dementia and if so whether the dementia is in all probability due to a primary degenerative process of the brain parenchyma or of the cerebral vasculature or is it due to another cause. If degeneration of the brain parenchyma seems the prevalent pathogenetic mechanism one would like to establish in a given case which of the known degenerative processes is most probably present in order to avoid mistakes in clinical judgement with their often life threatening consequences.

Alzheimer Disease↗