Epidemiology : a national survey of US
citizens has found that 6% of them have a debilitating mental illness.
More startling, almost 50% of those surveyed were found to have had a mental
disorder at some point during their lives; > 25% had had 1 in the year
before the interview. Treatment is hard to get, and often not sufficient
when available. Only about 33% of those in care receive "minimally adequate
treatment", such as the appropriate drugs or a few hours of therapy over
a period of several monthsref1,
ref2,
ref3,
ref4.
The statistics are nearly impossible to compare with previous studies,
thanks to constantly changing definitions of mental illness, but in general
things don't seem to have changed much over the past decade. > 9,000 US
adults, chosen randomly, were visited in their homes as part of the National
Comorbidity Survey, which looks at the incidence of multiple mental
disorders. An interview then probed to see whether they had mental difficulties
as determined by the latest Diagnostic and Statistical Manual of Mental
Disorders. The study also classified the severity of disorders, separating
them into severe, moderate or mild conditions. The definition of disorders
used by the study was quite broad. A few instances of road rage, for example,
might qualify as an intermittent
explosive disorder. Such a wide net may not be any use in determining
who needs medication or treatment, but the survey does provide some useful
information. It reveals, for example, that 50% of those with a mental disorder
encountered problems before their 14th birthday. This indicates that watching
for signs of mental distress in early years could help to avert larger
problems in the future. Progress will be made in finding biological markers
that can help distinguish children who are simply shy or have a quick temper
from those whose difficulties are likely to degenerate into illness, perhaps
through an analysis of genes or brain scans. Meanwhile, the first order
of business is to improve the quality of treatment. The prevalence of mental
disorders did not change during the decade (29.4% between 1990 and 1992
and 30.5% between 2001 and 2003), but the rate of treatment increased.
Among patients with a disorder, 20.3% received treatment between 1990 and
1992 and 32.9% received treatment between 2001 and 2003. Overall, 12.2%
of the population 18 to 54 years of age received treatment for emotional
disorders between 1990 and 1992 and 20.1% between 2001 and 2003. Only about
half those who received treatment had disorders that met diagnostic criteria
for a mental disorder. Significant increases in the rate of treatment (49.0%
between 1990 and 1992 and 49.9% between 2001 and 2003) were limited to
the sectors of general medical services (2.59 times as high in 2001 to
2003 as in 1990 to 1992), psychiatry services (2.17 times as high), and
other mental health services (1.59 times as high) and were independent
of the severity of the disorder and of the sociodemographic characteristics
of the respondents. Despite an increase in the rate of treatment, most
patients with a mental disorder did not receive treatment. Continued efforts
are needed to obtain data on the effectiveness of treatment in order to
increase the use of effective treatmentsref.
Web resources : Do
I Need Therapy online test
psyche : the human faculty for thought, judgment, and emotion; the
mental life, including both conscious and unconscious processes; the mind
in its totality, as distinguished from the body.
situation : the combination of factors with which an individual
is confronted. In psychology, the total sum of physical, psychological,
and sociocultural factors that act on a person and influence his behavior
ego-syntonic : denoting aspects of a person's thoughts, impulses,
attitudes, and behavior that are felt to be acceptable and consistent with
the rest of their personality.
ego-dystonic : denoting aspects of a
person's thoughts, impulses, attitudes, and behavior that are felt to be
repugnant, distressing, unacceptable, or inconsistent with the rest of
their personality.
psychiatry : that branch of medicine which deals with the study,
treatment, and prevention of mental disorders.
geriatric psychiatry / geropsychiatry
:
a subspecialty of psychiatry dealing with mental illness in the elderly.
neuropsychiatry : the branch of medicine which includes both neurology
and psychiatry.
addiction psychiatry : a subspecialty concerned with the diagnosis
and treatment of addiction and other problems related to substance use.
administrative psychiatry : that concerned with the organization
and management of mental health programs and facilities, including public
and private hospitals, clinics, and centers.
biological psychiatry : that which emphasizes biochemical, neurological,
and pharmacological causes and treatment approaches.
community psychiatry : the branch of psychiatry concerned with the
detection, prevention, and treatment of mental disorders as they develop
within psychosocial, cultural, or geographical areas, with emphasis given
to environmental factors.
consultation liaison psychiatry : that which connects psychiatry
with other areas of medicine, bringing a psychosocial approach to the biological
treatment of organic illness
cross-cultural or transcultural psychiatry : the study of mental
illness and mental health among different societies, nations, and cultures
descriptive psychiatry : psychiatry based on the study of observable
symptoms and behavioral phenomena, rather than underlying psychodynamic
processes
dynamic psychiatry : psychiatry based on the study of the unconscious
mechanisms, conflicts, and other emotional processes that motivate and
underlie human behavior, rather than the more observable behaviors themselves
existential psychiatry : that based on the existential philosophy
of Kierkegaard, Heidegger, Jaspers, and others, holding the view that a
person takes responsibility for his own existence.
forensic psychiatry : psychiatry which deals with the legal aspects
of mental disorders.
industrial or occupational psychiatry : that concerned with the
diagnosis and prevention of mental illness in the work setting, including
aspects of absenteeism, accident proneness, personnel policies, occupational
fatigue, substance abuse, vocational adjustment, retirement, interpersonal
relations, and related phenomena.
military psychiatry : the study and treatment of psychiatric problems
done under the auspices of military organizations such as induction centers,
training facilities, and military hospitals; it includes emergency and
nonemergency treatment for active-duty and retired military personnel and
their dependents.
orthomolecular psychiatry : that based on the theory that psychiatric
illnesses are due to disturbances in the molecular environment of the brain
and can be cured by restoration of optimal concentrations of substances
normally present in the body, such as vitamins (orthomolecular therapy).
preventive psychiatry : that broadly concerned with the amelioration,
control, and limitation of psychiatric disability. It is often categorized
as primary—measures to prevent a disorder; secondary—therapeutic measures
to limit a disorder; and tertiary—measures and intervention to reduce impairment
or disability following a disorder.
social psychiatry : that concerned with the cultural, ecologic,
and sociologic facts that engender, precipitate, intensify, prolong, or
otherwise complicate maladaptive patterns of behavior and their treatment.
orthopsychiatry : an interdisciplinary field that combines psychiatry
with principles of psychology, sociology, social work, and other fields
in the study and practice of maintaining or restoring mental health, emphasizing
a prophylactic approach to mental disease.
psychobiology / biopsychology : a field of study examining
the relationship between brain and mind, studying the effect of biological
influences, including biochemical, neurological, and pharmacological factors,
on psychological functioning or mental processes. Adolf Meyer's school
of psychiatric thought, in which the human being is viewed as an integrated
unit, incorporating psychological, social, and biological functions, with
behavior a function of the total organism.
mental disorder : any clinically
significant behavioral or psychological syndrome characterized by the presence
of distressing symptoms, impairment of functioning, or significantly increased
risk of suffering death, pain, disability, or loss of freedom. Mental disorders
are assumed to be the manifestation of a behavioral, psychological, or
biological dysfunction in the individual. The concept does not include
deviant behavior, disturbances that are essentially conflicts between the
individual and society, or expected and culturally sanctioned responses
to particular events
emotional illness : a colloquialism roughly equivalent to “mental
disorder,” but not usually applied to those with a specific organic etiology
or to mental retardation.
organic mental disorder :
a term formerly used to denote any mental disorder with a specifically
known or presumed organic etiology; now discouraged because of the implication
that other mental disorders do not have an organic basis. The term was
also sometimes used to denote an organic mental syndrome. Current
classification divides these disorders into :
organic hallucinosis : a term
used in a former system of classification, denoting an organic mental syndrome
characterized by the presence of hallucinations caused by a specific organic
factor and not associated with delirium. Such disorders are now mainly
classified as substance-induced
psychotic disorders and psychotic
disorders due to general medical condition
increased consciousness (secondary to stress or mania)
restriction of consciousness
obnubilation / clouding of consciousness
/ mental fog / obtundation : a lowered level of consciousness with
loss of ability to respond properly to external stimuli.
torpor :lack of response to normal
or ordinary stimuli.
Aetiology : transient large (up to 300-fold
compared with control patients) increase of endozepine-4
content in CSF and serum, with a return to normal concentrations between
attacks
Symptoms & signs : episodes of stupor
lasting hours or days beginning between ages 18 and 67 years; sometimes
spontaneously disappearing after 4-6 years with symptoms
Laboratory examinations : fast (14- to
16-Hz), unreactive background activity at EEGs
Differential diagnosis : exogenous bendodiazepine
intoxication
Therapy : oral flumazenil
(0.25 mg i.v.)
dreamy or oniroid state : a state of altered consciousness lasting
for a few minutes and accompanied by hallucinations;
associated with temporal lobe lesions
expansion of consciousness (trance, psychostimulant
substances)
autopsychic depersonalization : experiences are felt as foreign
somatopsychic depersonalization : the body or some parts seem not
self, detached, or died
allopsychic depersonalization / derealization
: a loss of the sensation of the reality of one's surroundings; the feeling
that something has happened, that the world has been changed and altered,
that one is detached from one's environment. It is seen most frequently
in schizophrenic disorders.
déjà entendu [Fr. “already heard”] : the feeling that
one has heard or perceived something previously although it is in fact
new to one's experience
déjà éprouvé [Fr. “already tested”]
: a feeling that one has previously engaged in or experienced something
when one has not
déjà fait [Fr. “already done”] : a feeling that what
is happening has happened before.
déjà pensé [Fr. “already thought”] : a feeling
that one has thought the same thoughts before.
déjà raconté [Fr. “already told”] : a feeling
when telling someone about an experience that one had previously related
the same experience either to them or to someone else, when in fact one
had not. 2. a feeling that a long-forgotten event which is being
recalled was told to one before, when it was not.
déjà vécu [Fr. “already
lived”] . a feeling that a new experience has been encountered before,
in a previous existence.
jamais vécu [Fr. “never lived”] : a feeling that a common
experience has never been encountered before
déjà voulu [Fr. “already desired”] : a feeling that
one has entertained the same desires before.
déjà vu [Fr. “already seen”]
: an illusion in which a new situation is incorrectly
viewed as a repetition of a previous situation
jamais vu [Fr. “never seen”] : the sensation that familiar surroundings
are strangely unfamiliar; the illusion that one
has never seen anything like that before.
asemia / asemasia / asymbolia
: aphasia with inability to employ or to understand either speech or signs
aphasia : any of a large group of speech disorders
involving defect or loss in thought <=> speech conversion (the power
of expression by speech, writing, or signs, or of comprehending spoken
or written language), due to injury or disease of the brain or to psychogenic
causes in patients who had acquired the ability of speech. Less severe
forms are known as dysphasia.
An inability to process language needn't stop you from doing maths
: 3 men with severe aphasia, a linguistic impairment, can understand 'grammatical'
rules in mathematics even though they cannot handle analogous rules in
language. Aphasia leaves people unable to use or comprehend words, and
is often triggered by stroke or other brain injuries. The discovery challenges
a commonly held view that linguistic and mathematical mental processing
draw on the same cognitive resources. According to the view of cognition
developed by linguist Noam Chomsky, language processing is a fundamental
skill that is used for related grammatical tasks in the brain, such as
certain mathematical ones. Previous studies of the relationship between
linguistic and mathematical ability have lent some support to this notion.
For example, brain-imaging studies have shown that some areas of the brain
involved in language processing also become active when people are performing
mathematical tasks. But it has been unclear whether this use of neural
language centres is essential for maths: there are also indications that
the two mental functions can work independently. All 3 of their patients
were aged between 50 and 60 and were well educated; one had been a university
professor before incurring a brain lesion. The 3 men were almost entirely
unable to communicate verbally or in writing, but they clearly retained
much of their higher mental functioning and could communicate, for example,
through "highly expressive" drawings. Their impairments left them unable
to decode the grammatical relationships of simple sentences. For example,
they had great difficulty distinguishing subject and object in the phrase
"The boy chased the girl," which they were unable to differentiate from
"The girl chased the boy." Analogous object-relation problems are posed
by mathematical expressions such as 90 ÷ 30 and 30 ÷ 90.
More complex expressions might involve problems of nesting, such as the
use of brackets (90 - [(3 + 17) x 3]), which mirror linguistic sub-clauses
and embedded relations, such as in the phrase "The man who killed the lion
was angry." Although the patients were unable to decode such linguistic
expressions, they were all able to perform the mathematical calculations
accurately with pen and paper. They could interpret Arabic numerals correctly
even though they struggled to understand number words such as 'three' or
'ninety', when spoken or written. It might be possible to use this capacity
for mathematical grammar to help the patients find a way to interpret speech
and the written word.
monophasia : aphasia with ability to utter but one word or phrase
paraphasia / paragrammatism / paraphemia / paraphrasia : a type
of dysphasia in which the patient employs wrong words or uses words in
wrong and senseless combinations
central paraphasia : that due to a brain lesion.
literal paraphasia / paralalia literalis : utterance of certain
consonant sounds, often as part of stuttering
thematic paraphasia : incoherent speech characterized by wandering
from the subject.
agrammatism / agrammatologia / dysgrammatism : inability to speak
grammatically because of brain
injuryor
disease, usually with simplified sentence structure (telegraphic speech)
and errors in tense, number, and gender
syntactical aphasia : a type of agrammatism in which some necessary
elements for coherent sentences are lacking.
acquired epileptic aphasia / Landau-Kleffner syndrome : an epileptic
syndrome of childhood characterized by partial or generalized seizures,
psychomotor abnormalities, and aphasia progressing to mutism. The EEG from
bilateral temporal regions is abnormal, with spikes like those of benign
rolandic epilepsy.
anomic, amnesic, amnestic or nominal aphasia / aphasia nominnum / anomia
: defective recall of names of objects or words to verbalize his/her own
thought, with intact abilities of comprehension and repetition, due to
lesions of temporoparietooccipital carrefour. It is diagnosed when found
in > 20% of spontaneous speech
tactile aphasia : anomic aphasia characterized by inability to name
objects that are touched
acalculia : inability to do simple arithmetical
calculations
MRI
detects abnormal pulses of activity in the right intraparietal sulcus
Diagnosis is further complicated because many people simply dislike maths.
This might be due to mediocre teaching or low motivation
central aphasia : a term that has
been used as a synonym for various aphasias that involve disturbance in
word selection, grammar, and sentence structure apart from elementary auditory
or visual comprehension and the ability to write legible characters and
speak aloud. Many are presumed to be due to lesions of brain centers (motor
speech areas)
global, central, complete, expressive-receptive,
total or mixed aphasia : aphasia involving all the functions of spoken
or written language and comprehension, due to large lesions in speech areas
Broca's expressive, anterior, motor, frontocortical
or nonfluent aphasia / logaphasia : aphasia in which there is
impairment of the ability to speak (inertia, mutism) and write, owing to
a lesion in the insula and surrounding operculum, including Broca's motor
speech area. The patient understands many written and spoken words but
has difficulty uttering the words (loss of prosodia) => nosognosia
=> anger and depression. Often associated with manifest hemiplegia => the
patient is asked to write with the left hand as the right one is paretic.
Symptoms & signs : Dejerine-Lichtheim
sign or phenomenon : in some types of motor aphasia the patient cannot
speak but can indicate with fingers the number of syllables in a word being
thought of
Wernicke's receptive, impressive, posterior
or sensory aphasia : inability to understand written, spoken, or tactile
speech symbols, due to disease of the auditory and visual word centers.
The speech is began without difficulties and no motor deficiency is usually
associated.
acoustic or auditory aphasia / word deafness : a form of receptive
aphasia in which sounds are heard but convey no meaning to the person affected,
due to disease of the subcortical pathways leading to the main auditory
center of the brain, or disease of the center itself => hypo- or anosognosia
=> anger as he/she feels ununderstood
fluent aphasia: a type
of receptive aphasia in which speech is well articulated with satisfactory
melodic intonation, syllable stress, and phrasing but has gross errors
in grammatical structure and is lacking in content => "word salad"
(phonemic, verbal and semantic (within the same category) paraphasias,
neologisms)
semantic aphasia : aphasia characterized by a lack of recognition
of the full significance of words and phrases, or faulty use of words,
phrases, or sentences; words heard, seen, spoken, or written are misunderstood
or used incorrectly in place of other words in the same class.
associative, commissural or conduction
aphasia : a type of aphasia characterized by normal comprehension and
speech but inability to repeat words correctly; said to be caused
by lesions in the pathways connecting Broca's motor speech area and Wernicke's
area (arciform fasciculus)
transcortical aphasia : a type
of conduction aphasia believed to be caused by a lesion of a pathway between
the speech center and other cortical centers, but often reflecting large
lesions in brain areas other than the perisylvian region of the hemisphere
dominant for speech and language. The patient may repeat words (echolalia)
but cannot speak independently.
transcortical motor aphasia : due to lesions of anterior marginal
areas (premotor and prefrontal areas; secondary, marginal or accessory
areas). Symptoms are similar to those seen in Broca's aphasia (good comprehension
and reduced spontaneous speech), but repetition is impaired
transcortical fluent aphasia : due to lesions of posterior marginal
areas. Symptoms are similar to those seen in Wernicke's aphasia
conduite d'approche
phonemic
semantic
combined aphasia : aphasia of 2 or more forms occurring concomitantly
in the same person.
graphomotor aphasia / agraphia : impairment
or loss of the ability to write; it takes 2 forms, one involving poor morphology
of written letter forms and the other a reflection of the aphasia also
observed in spoken language
absolute or literal agraphia / agraphia atactica : loss of the power
to form even single letters.
acoustic agraphia : loss of the power of writing from dictation.
jargon agraphia / agraphia amnemonica : agraphia in which the patient
can write correctly formed letters but forms only senseless combinations
of letters or words.
cerebral or mental agraphia : agraphia due to inability to put thought
into phrases.
motor agraphia : inability to write because of lack of motor coordination.
musical agraphia : loss of the power to write musical symbols.
optic agraphia : inability to copy written or printed words, but
with ability to write from dictation.
verbal agraphia : ability to write single letters, with loss of
ability to combine them into words or sentences
dysgraphia : difficulty in writing
echographia / pseudoagraphia : a type of dysgraphia in which the
patient can copy writing, but cannot write to express ideas
micrographia : a dysgraphia in which
handwriting is tiny or decreases in size from normal to minute, seen in
parkinsonism
gibberish or jargon aphasia / jargonaphasia : utterance of meaningless
phrases, either neologisms or incoherently arranged known words; it is
sometimes a symptom of certain types of schizophrenia
bradylalia / bradylogia / bradyarthria / bradyphasia
: abnormally slow utterance of words due to a brain lesion or mental disorder
(e.g. parkinsonism)
Lichtheim test : if a patient is able to indicate the number of
syllables in a word which he cannot utter, it indicates that the cortex
is less involved than the association fibers.
Broadbent's test (for cerebral dominance of language function) :
different numbers (or words) are presented simultaneously to the 2 ears;
right-handed persons tend to report first the words going into the right
ear.
Liepmann's apraxia : loss of ability
to carry out familiar, purposeful movements in the absence of paralysis
or other motor or sensory impairment
akinetic apraxia : loss of ability to carry out spontaneous movement.
amnestic apraxia : loss of ability to carry out a movement on command
as a result of inability to remember the command, although ability to perform
the movement is present.
Cogan's congenital oculomotor apraxia : an absence or defect of
horizontal eye movements, so that when the patient tries to look at an
object off to one side, the head must turn to bring the eyes into line
with the object and the eyes exhibit nystagmus;
the cause is probably a brain lesion
constructional apraxia : a
type of deficit in motor skills characterized by lack of ability to copy
simple drawings or to reproduce patterns created with building blocks or
matchsticks.
dressing apraxia : inability to dress oneself properly, often on
just one side, as a result of a lesion in the parietal lobe, usually on
the nondominant side
buccofacial or facial apraxia : apraxia of the facial muscles with
inability to carry out movements for expression, articulation, and other
functions; caused by a lesion in either the supramarginal gyrus or the
motor association area on the dominant side. It may be associated with
ideokinetic apraxia
classic, ideokinetic, ideomotor or transcortical apraxia / apraxia
: inability to carry out movements that are part of normal activities when
requested, in imitation of a demonstration, or even when the person spontaneously
wishes to do them. The name is derived from the older concept that ideas
were not linked to movements
innervatory or motor apraxia : impairment of skilled movements that
is greater than or different in form from that caused by weakness of the
affected parts; the patient appears clumsy rather than weak
sensory or ideational apraxia : loss of ability to make proper use
of an object, due to lack of perception of its proper nature and purpose
or to gross disorganization of a plan of usage
apraxia of speech / aphemia : a speech disorder similar to motor
aphasia, due to apraxia of mouth and neck muscles because of a lesion
interfering with coordination of impulses from Broca's motor speech area
hemiapraxia : apraxia affecting one side
of the body only.
sensory or unilateral neglect / selective
inattention : hemiapraxia with failure to pay attention to bodily grooming
and stimuli on one side but not on the other, usually due to a lesion in
the CNS, as after a stroke
agnosia / pragmatagnosia :
pragmatamnesia / visual agnosia :
dysmnesia : properly said memory disorders,
impaired memory, as in the amnestic syndrome
quantitative disorders
hypermnesia : extreme retentiveness or
unusual clarity of memory
According to chronological succession of memories :
global amnesia
transient global amnesia
: an episode of short-term memory loss, usually nonrecurrent, and lasting
a few hours, without other signs or symptoms of neurological impairment;
the cause is usually unknown but may occasionally be an ischemic
or epileptic
attack. The patient is irrequiet and continuously repeats the same questions.
lacunar or localized amnesia : partial loss of memory; amnesia for
certain isolated experiences.
anterograde or fixation amnesia :
impairment of memory for events occurring after the onset of amnesia; inability
to form new memories
retrograde or reevocation amnesia
: inability to recall events that occurred before the actual onset of
amnesia; loss of memories of past events
retroanterograde amnesia
According to kinds to impaired memories :
simple amnesia : all kined of memories are impaired
systematic or selective amnesia : loss of memory for a group of
related events but not for other events occurring during the same period
of time.
episodic amnesia : amnesia for a particular episode or a small area
of experience.
Aetiology :
infantile amnesia : the usual inability to recall the events of
infancy and early childhood.
neurological amnesia : that caused by disease of or injury to the
nervous system.
post-traumatic or traumatic amnesia : amnesia resulting from concussion
or other brain injury
postconcussional amnesia : amnesia resulting from a concussion of
the brain.
posthypnotic amnesia : a directed forgetfulness of the subject for
experiences undergone while in the hypnotic state.
amnesic, amnestic-confabulatory or dysmnesic
syndrome : a mental disorder characterized by impaired memory with
anterograde
amnesia and sometimes retrograde amnesia
in a normal state of consciousness; i.e., the syndrome does not include
the impaired memory seen in dementia
or delirium.
There may be disorientation, confabulation, and lack of insight into the
memory deficit
any pathological process causing bilateral damage to parts of the medial
temporal lobe or diencephalon, such as the hippocampal formations, mammillary
bodies, or dorsal medial nuclei of the thalamus
bradyphrenia / bradyphrasia / mental insufficiency : stable
slowness of thought or fatigability of initiative, resulting from depression
or CNS disease
axis II : behavioural, polytethic diagnosis
(only some criteria have to be fulfilled => many false positives => repetibility
= 50%) : personality disorders, mental
retardation
problem related with interaction with legal system or criminality
other psychosocial or environmental problems
axis V : global assessment of functioning
(GAF) scale : a rating of psychiatric status from 1 (lowest level of
functioning) to 100 (highest level), assessing psychological, social, and
occupational functioning; widely used in studies of treatment effectiveness
(actual, at admission, at dimission, higher level in last year)
Social and Occupational Functioning Assessment Scale (SOFAS) : one
that describes the level of an individual's social and occupational functioning,
either present or past; unlike the GAF scale, it is not directly influenced
by the severity of the individual's psychological symptoms
disorders usually diagnosed for the first time in infancy, childhood,
or adolescence / developmental
disorders : a former classification of chronic disorders of mental
development with onset in childhood; such disorders are now classified
as ...
mental retardation : a mental disorder
characterized by significantly subaverage general intellectual functioning
associated with impairments in adaptive behavior and manifested before
age 18. It is classified on the basis of severity as ..
borderline mental retardation
: borderline intellectual functioning, that in which IQ is between 70 and
89.
mild mental retardation :
that in which IQ is between 50–55 and 69; the person can develop social
and communication skills during the preschool period, has minimal sensorimotor
impairment, by the late teens can acquire academic skills up to the sixth
grade level, and usually achieves social and vocational skills adequate
for minimal self-support.
moron : obsolete, offensive term for a person with mild mental retardation
imbecile : obsolete and offensive name for a person with an intermediate
level of mental retardation, now split into...
moderate mental retardation
: that in which IQ is between 35–40 and 49–55; the person may talk or learn
to communicate but has poor social awareness and only fair motor development,
is unlikely to progress to the second grade level in academic skills, but
can profit from vocational training and with moderate supervision can perform
personal care.
severe mental retardation :
that in which IQ is between 20–25 and 34–40; the person has poor motor
development and minimal speech in the preschool period, may learn to talk
by the late teens, can be trained in elementary hygiene skills, and as
an adult may learn to perform simple work under close supervision.
idiot savant [Fr. “learned idiot”] :
a person with severe mental retardation
in some respects, yet has a particular mental faculty that is developed
to an unusually high degree, as memory, mathematics, or music.
profound mental retardation
: that in which IQ is < 20–25; the person has limited sensorimotor development,
may achieve very limited self-care, and requires a highly structured environment
with constant supervision.
idiot : obsolete, offensive name for a person with profound mental
retardation
mongolian idiot : former name for a person affected with Down
syndrome;
now considered offensive
Aetiology : mutations in the gene polyglutamine
binding protein 1 (NPQBP1)
Symptoms & signs : in affected males
include mental retardation, microcephaly, short stature, spastic paraplegia
and midline defects.
Laboratory examinations : Denver Developmental
Screening test : a test for identification of infants and preschool
children with developmental delay.
Differential diagnosis :
learning disorders : a group of
disorders characterized by academic functioning that is substantially below
the level expected on the basis of the patient's age, intelligence, and
education, interfering with academic achievement or other functioning.
Included are :
reading disorder : a learning disorder in which the skill affected
is reading ability, including accuracy, speed, and comprehension
mathematics disorder : a learning disorder in which the skill affected
is mathematical calculation or reasoning.
disorder of written expression
:
a learning disorder in which the affected skill is written communication,
characterized by errors in spelling, grammar, or punctuation, by poor paragraph
organization, or by poor story composition or thematic development.
motor skills disorder : any
disorder characterized by inadequate development of motor coordination
severe enough to limit locomotion or restrict the ability to perform tasks,
schoolwork, or other activities. Included is
developmental coordination
disorder : problematic or delayed development of gross and fine motor
coordination skills, not due to a neurological disorder or to general mental
retardation; affected children appear to be clumsy rather than grossly
impaired. It may persist into adulthood.
Differential diagnosis :
specific neurological disorder (e.g. cerebral palsy, progressive cerebellar
lesions)
communication disorders :
mental disorders characterized by difficulties in speech or language, severe
enough to be a problem academically, occupationally, or socially; included
are
expressive language disorder
: a communication disorder occurring in children and characterized by problems
with the expression of language, either oral or signed. It includes difficulties
such as limited speech or vocabulary, vocabulary errors, difficulty or
hesitation in word selection, oversimplification of grammatical or sentence
structure, omission of parts of sentences, unusual word order, and slowed
acquisition of language skills. Two types are recognized, acquired and
developmental.
acquired aphasia associated with general medical condition
mixed receptive-expressive
language disorder : a communication disorder involving both the expression
and the comprehension of language, either spoken or signed. Patients have
difficulties with language production, such as in the selection of words
and the creation of appropriate sentences, and also have trouble understanding
words, sentences, or specific types of words
acquired aphasia associated with general medical condition
phonological disorder : a communication disorder of unknown etiology,
characterized by failure to use age- and dialect-appropriate sounds in
speaking, with errors occurring in the selection, production, or articulation
of sounds. The most common errors are omissions, substitutions, and distortions
of speech sounds
Epidemiology : 5% of people in the USA
at some time in their lives. Stuttering usually begins in the preschool
years, and there is a higher incidence in males. Stuttering usually starts
in the third and fourth years of life, after a period of apparently normal
speech development. Around 5% of children begin to stutter (Bloodstein
O. A handbook on stuttering. San Diego, CA: Singular Publishing Group,
1995). Although the recovery rate without professional intervention is
74%ref,
the natural recovery rate of cases presenting to clinics has not been researched.
To date, sex and family history of recovery are the major identified predictors
of natural recovery. Girls are more likely to recover than boys, and children
with a family history of recovery are more likely to recover than those
without such a history. Natural recovery does not seem to be related to
severity of stutteringref.
Aetiology : a complex interaction among
many factors, including genetic, language, motor and emotional. These findings
will help reduce the stigma – such as the myth that the disorder is the
result of poor parenting or a psychological problem – often associated
with stuttering
Pathogenesis : adults who stutter often
have great language skills, meaning they don't have problems with rules
of grammar or with the sounds we use to code the words of our language.
When they speak, however, their motor output falters, so they pause or
trip over words. The study of their brain activity when they were not stuttering
and, in fact, when they were not having to engage their speech motor systems
shows that individuals who stutter are using right hemisphere brain areas
to a greater extent to accomplish the rhyming tasks than those who don't
stutterref Symptoms & signs : a speech disorder
involving 3 factors:
dysfluency with repetition of words and parts of words, prolongations of
sounds, interjections of sounds or words, and long pauses
listener reaction, considering the dysfluency to be abnormal or unacceptable
the speaker's reaction to the dysfluency and to the listener's reaction,
with a self-conception as a stutterer.
Differential diagnosis :
auditory or other sensory deficit
word motory deficit
normal fluency anomalies that often occur in little babies
Therapy : the consensus now is that stuttering
should be treated in the preschool years, primarily because it becomes
less tractable as children get older. This is presumably because neural
plasticity decreases with age. Also, it is not possible to know in advance
whether an individual child will recover naturally. Early intervention
in the preschool years is therefore essential. Once stuttering becomes
chronic, communication can be severely impaired, with devastating social,
emotional, educational, and vocational effectsref1,
ref2.
Several treatments for early stuttering are currently available (Onslow
M, Packman A, eds. The handbook of early stuttering intervention. San Diego,
CA: Singular Publishing Group, 1999), but only one, the Lidcombe programme,
has been studied with phase I and II clinical trials (Onslow M, Packman
A,
Harrison E, eds. The Lidcombe program of early stuttering intervention:
a clinician's guide. Austin, TX: Pro-Ed, 2003). This programme is a behavioural
treatment developed specifically for stuttering in children of preschool
age (younger than 6). Considerable research into the programme has been
conducted. Preliminary studies have produced positive outcomes, and stuttering
has been shown to be no longer present, or remaining at very low levels,
two to seven years after treatmentref1,
ref2,
ref3
(Lincoln M, Onslow M. Long-term outcome of an early intervention for stuttering.
Am J Speech-Language Pathol 1997;6: 51-8). The social validity and safety
of the programme have been shown (Lincoln M, Onslow M, Reed V. Social validity
of an early intervention for stuttering; the Lidcombe program. Am J Speech-Lang
Pathol 1997;6: 77-84). It does not seem to change children's behaviour
other than speech or affect the attachment of children and parents or use
of languageref1,
ref2.
Duration of treatment and its predictors have been investigated in two
independent file audits of preschool children attending specialist clinics,
one in Australiaref
and one in the United Kingdomref.
Outcomes of the Lidcombe programme have consistently been shown to be positiveref1,
ref2,
ref3,
ref4,
ref5,
ref6,
ref7
(Lincoln M, Onslow M. Long-term outcome of an early intervention for stuttering.
Am J Speech-Language Pathol 1997;6: 51-8; Lincoln M, Onslow M, Reed V.
Social validity of an early intervention for stuttering; the Lidcombe program.
Am J Speech-Lang Pathol 1997;6: 77-84) even in a randomised controlled
trialref.
Waiting for an extended period to see if natural recovery occurs is not
acceptable because it seems that the Lidcombe programme is less efficacious
once children move into the school age years (Lincoln M, Onslow M, Wilson
L, Lewis C. A clinical trial of an operant treatment for school-age stuttering
children. Am J Speech-Lang Pathol 1996;5: 73-85). In addition, delaying
treatment until the school age years is not a viable option because of
the negative social and cognitive consequences of stuttering at this ageref.
If the disorder persists into the school age years a child is exposed to
the unacceptable risk of experiencing the disabling effects of chronic
and intractable stuttering throughout life.
stammering : a speech disorder marked by
involuntary pauses; sometimes used synonymously with stuttering, especially
in Great Britain.
communication
disorder-not otherwise specified (NOS)
rhotacism / pararhotacism : a speech disorder
consisting of imperfect pronunciation of the r sound
pervasive developmental
disorders (PDD) / autistic spectrum disorders (ASD) : a group of disorders
characterized by impairment of development in multiple areas, including
the acquisition of reciprocal
social interaction, verbal and nonverbal
communication
skills (e.g declarative pointing, gaze monitoring, gaze escape, mimicking),
and imaginative activity and by stereotyped interests and behaviors
Epidemiology : prevalence = 4-5 cases
every 1,000 people
autism / autistic disorder / infantile autism /
Kanner's syndrome : a severe pervasive developmental disorder with
onset
usually before 3 years of age and a biological basis related to neurologic
or neurophysiologic factors
autistic thinking / autism : self-absorption; preoccupation with
inner thoughts, drives, and idiosyncratic logic; egocentric, subjective
thinking lacking objectivity and preferring a narcissistic, inner, private
reality to that which is externally validated. Used interchangeably with
dereistic thinking, although differing in emphasis
dereistic thinking / dereism : thinking not in accordance with the
facts of reality and experience and following illogical, idiosyncratic
reasoning. Used interchangeably with autistic thinking, although not an
exact synonym: dereistic emphasizes disconnection from reality and autistic
emphasizes preoccupation with inner experience.
Epidemiology : frequency of the disorder increased
from approximately 2.5 cases every 10,000 in 1960-1970s to 1 every 1,000
children in 1990s, with a male to female ratio of 4:1.
Aetiology :
genetic predispositionref
to autism is evident from family (frequency of autism among siblings of
probands with autism = 2-4% (RR = 20-60)) and monozygotic twin (high concordance)
studies, and heritability in idiopathic autism is estimated at over 90%.
Family studies and several genome-wide linkage analyses support the hypothesis
of complex inheritance with involvement of as many as 5-10 genes of moderate
effect. All chromosomes except 14 have at least 1 patient with autism associted
with them : mendelian, double hit, trinucleotide repeats, mtDNA, or polygenic
inheritance has been proposed. There is an autism susceptibility gene on
chromosome 1 and further on chromosomes 6 and 19. 33% of autistic individuals
experience seizures. A susceptibility locus for autism was mapped near
a cluster of voltage-gated sodium channel genes on chromosome 2. Mutations
in 2 of these genes, SCN1A
and SCN2A,
result in the seizure disorder GEFS+. The variant R1902C in SCN2A is located
in the calmodulin binding site and was found to reduce binding affinity
for calcium-bound calmodulin. R542Q in SCN1A was observed in one autism
family and had previously been identified in a patient with juvenile myoclonic
epilepsy
endocrine
infectious
some cases of late-onset (regressive) autism may involve abnormal flora
because oral vancomycin,
which is poorly absorbed, may lead to significant improvement in these
children. Fecal flora of children with regressive autism was compared with
that of control children, and clostridial counts were higher. The number
of clostridial species found in the stools of children with autism was
greater than in the stools of control children. Children with autism had
9 Clostridium spp.
not found in controls, whereas controls yielded only 3 species not found
in children with autism. In all, there were 25 different clostridial species
found. In gastric and duodenal specimens, the most striking finding was
total absence of non-spore-forming anaerobes and microaerophilic bacteria
from control children and significant numbers of such bacteria from children
with autism. These studies demonstrate significant alterations in the upper
and lower intestinal flora of children with late-onset autism and may provide
insights into the nature of this disorderref
subacute, chronic Clostridium
tetani
infection of the intestinal tract as the underlying cause for symptoms
of autism observed in some individuals. A significant percentage of individuals
with autism have a history of extensive antibiotic use. Oral antibiotics
significantly disrupt protective intestinal microbiota, creating a favorable
environment for colonization by opportunistic pathogens. C. tetani
is an ubiquitous anaerobic bacillus that produces a potent neurotoxin.
Intestinal colonization by C. tetani, and subsequent neurotoxin
release, have been demonstrated in laboratory animals which were fed vegetative
cells. The vagus nerve is capable of transporting tetanus neurotoxin (TeNT)
and provides a route of ascent from the intestinal tract to the CNS. This
route bypasses TeNT's normal preferential binding sites in the spinal cord,
and therefore the symptoms of a typical tetanus infection are not evident.
Once in the brain, TeNT disrupts the release of neurotransmitters by the
proteolytic cleavage of synaptobrevin, a synaptic vesicle membrane protein.
This inhibition of neurotransmitter release would explain a wide variety
of behavioral deficits apparent in autism. Lab animals injected in the
brain with TeNT have exhibited many of these behaviors. Some children with
autism have also shown a significant reduction in stereotyped behaviors
when treated with antimicrobials effective against intestinal clostridia.
When viewed as sequelae to a subacute, chronic tetanus infection, many
of the puzzling abnormalities of autism have a logical basisref.
toxic :
attenuated measles
vaccine
(expecially in measles-mumps-rubella
(MMR) vaccine).
The UK government has been accused of blocking imports of measles and mumps
vaccines, sending prices soaring to force parents into using the controversial
measles, mumps, rubella (MMR) triple jab. Doctors in Edinburgh, Glasgow
and London are now charging more than £100 for a single measles or
mumps vaccine because it is increasingly difficult to get them in the UK.
In recent months, the government has cut supplies further, restricting
them to only 25 doses per day.
Pathogenesis : mirror neurons are brain cells
in the premotor cortex. First identified in macaque monkeys in the early
1990s, the neurons -- also known as "monkey-see, monkey-do cells" -- fire
both when a monkey performs an action itself and when it observes another
living creature perform that same action. Though it has been impossible
to directly study the analogue of these neurons in people (since human
subjects cannot be implanted with electrodes), several indirect brain-imaging
measures, including EEG, have confirmed the presence of a mirror neuron
system in humans. The human mirror neuron system is now thought to be involved
not only in the execution and observation of movement, but also in higher
cognitive processes -- language, for instance, or being able to imitate
and learn from others' actions, or decode their intentions and empathize
with their pain. Suppression of m rhythm (8–13
Hz) over sensorimotor cortex correlates with mirror neuron activity and
is defective in subjects with autism spectrum disorders : one therapeutic
possibility suggested by the study's findings is biofeedback. Another possible
therapy would involve ordinary mirrorsref Symptoms & signs : affected individuals
look normal at birth, and the symptoms manifest at the first 2-3 years
of life (median : 13.8 months), with medical diagnosis at median 2.7-6.8
years (differential diagnosis with mental
retardation or language disorders is stable if done before age 2, sure
since month 18). The spectrum of clinical symptoms and the severity of
the disorder are variable even among siblings. Qualitative impairment in
reciprocal social interaction (e.g., lack of awareness of the existence
of feelings of others, failure to seek comfort at times of distress, lack
of imitation), in verbal and nonverbal communication, and in capacity for
symbolic play, and by restricted and unusual repertoire of activities and
interests. Other characteristics sometimes include cognitive impairment
(> 66% have some degree of mental retardation), hyper- or hyporeactivity
to certain stimuli, stereotypic behaviors, neurological abnormalities such
as seizures or altered muscle tone, sleeping or eating pattern abnormalities,
and severe behavioral problems. As adults they develop OCD and mental
retardation (higher functioning PDD : high IQ in adulthood).
Laboratory examinations : several screening
instruments have been developed to quickly gather information about a child's
social and communicative development within medical settings. Among them
are
modified Checklist for Autism in Toddlers (M-CHAT)
Screening Tool for Autism in Two-Year-Olds (STAT)ref
Social Communication Questionnaire (SCQ)ref
(for children 4 years of age and older).
Some screening instruments rely solely on parent responses to a questionnaire,
and some rely on a combination of parent report and observation. Key items
on these instruments that appear to differentiate children with autism
from other groups before the age of 2 include pointing and pretend play.
Screening instruments do not provide individual diagnosis but serve to
assess the need for referral for possible diagnosis of ASD. These screening
methods may not identify children with mild ASD, such as those with high-functioning
autism or Asperger syndrome.
Differential diagnosis :
Epidemiology : 1:10,000 individuals, occurring
exclusively in females and present from birth
Aetiology : dominant mutations in the
MECP2
gene, a X-linked transcriptional repressor. A severe early-onset Rett phenotype
that often includes seizures or infantile spasms can be caused by mutation
in the CDKL5
gene
Pathogenesis : the timing of the period
of regression in RTT--during ages 1 to 2 years--parallels the period of
intense synaptic development. The effects of the MECP2 mutation also increases
concomitantly with peak synaptogenesis. Neuropathological findings in Rett
include the selective reduction of dendritric spines in the pyramidal cells
of RTT brains; this feature has also been reported in autism. Studies have
observed that MECP influences the expression of brain-derived neurotrophic
factor and thus may influence synaptic plasticity. Abnormalities in synapse
maintenance and modulation may contribute to regression in RTT and autism.
A recent study observed abnormal expression of MeCP2 in RTT and other neurodevelopmental
disorders such as autism. Although the genetic background and certain clinical
features differ in RTT and autism, a similar mechanism involving MeCP2
regulation and expression may contribute to regressionref.
Symptoms & signs : progressive and
is characterized by autistic behavior (but a preserved speech variant exists),
ataxia, dementia, seizures, and loss of purposeful
use of the hands, with cerebral atrophy, mild hyperammonemia, and decreased
levels of biogenic amines. During the regression stage, RTT girls display
many autistic features, such as loss of communication and social skills,
poor eye contact, and lack of interest, and initially may be given the
diagnosis of autism.
Differential diagnosis :
Experimental animal models : the phenotype
of one mouse model includes features such as regression and abnormal behavioral
and social interactions.
childhood disintegrative
disorder : pervasive developmental disorder characterized by marked
regression in a variety of skills, including language, social skills or
adaptive behavior, play, bowel or bladder control, and motor skills, after
at least 2, but less than 10, years of apparently normal development.
Asperger's syndrome : a pervasive
developmental disorder resembling autistic disorder,
being characterized by severe impairment of social interactions and by
restricted interests and behaviors, but lacking the delays in development
of language, cognitive function, and self-help skills that additionally
define autistic disorder. It may be equivalent to a high-functioning form
of autistic disorder.
Laboratory examinations : during the last
few years, screening instruments have been devised to screen for Asperger
syndrome and higher functioning autism. The Autism Spectrum Screening Questionnaire
(ASSQ)ref,
the Australian Scale for Asperger's Syndromeref,
and the most recent, the Childhood Asperger Syndrome Test (CAST)ref,
are some of the instruments that are reliable for identification of school-age
children with Asperger syndrome or higher functioning autism. These tools
concentrate on social and behavioral impairments in children without significant
language delay.
Differential diagnosis :
silent-treatment : a temporary act
of teenage rebellion, usually the result of being confronted by a parent;
extended silence used to avoid discussion about a drug or drinking problem
attention-deficit
/ hyperactivity disorder (ADHD) / hyperkinetic disorder (HKD) or syndrome
:
a childhood mental disorder
Epidemiology : prevalence = 3% to 10%
of the pediatric population. Datamonitor estimates that 23 million children
and adolescents across the 7 major pharmaceutical markets suffer from ADHD,
a physician perceived prevalence rate of about 15%. However currently only
12% of those, or only 1.8% of children in the total population, are actually
correctly diagnosed with ADHD. Despite the availability of numerous longer-acting
therapies, currently only 20% of newly diagnosed patients receive such
drugs as a first-line treatment, falling to 3% at second-line.
Pathogenesis : the number and density
of DATs and DAT binding sites are increased by up to 70 %
Symptoms & signs : inattention (such
as distractibility, forgetfulness, not finishing tasks, and not appearing
to listen), by hyperactivity and impulsivity (such as fidgeting and squirming,
difficulty in remaining seated, excessive running or climbing, feelings
of restlessness, difficulty awaiting one's turn, interrupting others, and
excessive talking) or by both types of behavior. The disorder is subtyped
as
combined type
predominantly inattentive type (attention-deficit
disorder (ADD))
predominantly hyperactive-impulsive type
Behavior must interfere with academic, social, or work functioning, with
impairment existing in at least two settings. Onset is before age 7 but
it can persist into adulthood.
Differential diagnosis :
stimulants, which, because of their addictive properties and potential
for abuse, are controlled substances. Although these drugs are the mainstay
of treatment for ADHD, nearly one third of patients may not respond to
or be able to tolerate them
amphetamines
d-threo-methylphenidate (d-MPH)
(a dopamine agonist that blocks DAT,
significantly increasing extra cellular dopamine, so correcting the dopamine
deficiency in the frontal lobes and basal ganglia (expecially the striatum)
structures, regions associated with attention and behaviouri. This is strikingly
similar to the mechanism of action of cocaine, a primary stimulant drug
of abuse. When administered intravenously, MPH like cocaine has reinforcing
effects (euphoria) at doses that exceed a DAT blockade threshold of 60%
(therapeutic doses of MPH block > 50% of DAT). When administered orally
at clinical doses, the pharmacological effects of MPH also exceed this
threshold, but reinforcing effects rarely occur). ADHD is a controversial
problem in sport since participants with this disorder often require banned
stimulant medication while competing.
disruptive behavior disorders
: a group of mental disorders of children and adolescents consisting of
behavior that violates social norms, is disruptive, and may be illegal,
often distressing others more than it does the person with the disorder.
It includes :
conduct disorder : a type of disruptive
behavior disorder of childhood and adolescence characterized by a persistent
pattern of conduct in which rights of others or age-appropriate societal
norms or rules are violated, with misconduct including aggression to people
or animals, destruction of property, deceitfulness or theft, and serious
violations of rules; depending on whether the behavior begins before or
after the age of 10, it is classified as
oppositional defiant disorder
:
a type of disruptive behavior disorder characterized by a recurrent pattern
of defiant, hostile, disobedient, and negativistic behavior directed toward
those in authority, including such actions as defying the requests or rules
of adults, deliberately annoying others, arguing, spitefulness, and vindictiveness
that occur much more frequently than would be expected on the basis of
age and developmental stage
feeding and eating disorders of infancy
or early childhood : any of several disorders in which abnormal feeding
habits are associated with psychological factors
bradyphagia : abnormal slowness in eating.
monophagia : desire for one kind of food only
pica : compulsive eating of nonnutritive
substances, such as
bone (osteophagia) due to a craving for phosphorus.
dung, or feces (coprophagy)
In children this syndrome, classified with the eating disorders in DSM-IV,
is a rare mental disorder with onset typically in the second year of life;
it usually remits in childhood but may persist into adolescence.
Aetiology :
pica and unusual food cravings (citta) are sometimes seen in pregnant
women
Kleine-Levin syndrome : episodic
periods of excessive sleep and overeating lasting for several weeks, with
amnesia for the attacks; it usually occurs in adolescent boys.
rumination disorder : an eating
disorder seen in infants under 1 year of age; after a period of
normal eating habits, the child begins excessive regurgitation and rechewing
of food, which is then ejected from the mouth or reswallowed
Prognosis : if untreated, death from malnutrition
may occur.
Differential diagnosis :
feeding
disorder of infancy or early childhood : loss of weight increase for
> 1 month in absence of gastrointestinal or other general medical condition
(e.g. gastroesophageal
reflux disease (GERD))
severe enough to explain the feeding anomaly and not attributable to other
mental disorder (e.g. rumination disorder)
or lack of available food.
selective mutism : a mental disorder
of childhood characterized by continuous refusal to speak in social situations
by a child who is able and willing to speak to selected persons.
nyctaphonia : elective mutism with loss of voice during the night.
reactive attachment disorder : a mental disorder of infancy or early
childhood, characterized by notably unusual and developmentally inappropriate
social relatedness, usually associated with grossly pathological care.
It may be :
inhibited type, with failure to initiate or respond to social interactions
disinhibited type, with indiscriminate sociability or attachment.
stereotypic movement disorder
: a mental disorder characterized by repetitive nonfunctional motor behavior,
such as hand waving, rocking, head-banging, or self-biting, which often
appears to be driven and can result in serious self-inflicted injuries
involuntary movements associated with neurological conditions
behaviours of self-stimulation appropriated to little babies developmental
stage (e.g. thumb suction, head hurting, ...)
behaviours of self-stimulation in subjects with sensory deficiencies (e.g.
blindness)
infancy, childhood, or adolescence disorder-not otherwise specified
(NOS)
delirium, dementia, amnestic disorders, and other cognitive disorders
delirium / acute (organic) brain syndrome
: an acute, transient disturbance of consciousness accompanied by
a change in cognition and having a fluctuating course. Characteristics
include reduced ability to maintain attention to external stimuli and disorganized
thinking as manifested by rambling, irrelevant, or incoherent speech; there
may also be a reduced level of consciousness, sensory misperceptions, disturbance
of the sleep-wake cycle and level of psychomotor activity, disorientation
to time, place, or person, and memory impairment.
Aetiology : conditions that result in
derangement of cerebral metabolism, including
postcardiotomy delirium / postcardiotomy
psychosis syndrome : anxiety,
confusion, and perceptual disturbances occurring > 3 days after open heart
surgery.
senile delirium : a form of senile
dementia, usually of acute onset and characterized by disorientation,
restlessness, insomnia, hallucinations,
and aimless wandering.
traumatic delirium : that which
follows severe head injury; superficially the patient is alert, but there
is marked disorientation, memory defect, and confabulation.
dementia : literally out of mind, loss of
self, i.e. a general acquired loss of intellectual and cognitive abilities,
including impairment of memory
as well as one or more of other abilities in subjects that have reached
normality (on the contrary of mental
retardation).
Aetiology :
primary or degenerative dementias
cortical dementias
dementia of the Alzheimer
type / Alzheimer-type dementia (ATD) (43.6-60% of all dementias) :
that occurring in Alzheimer's
disease,
being of insidious onset and gradually progressive course, with histopathological
changes characteristic of Alzheimer's disease and not due to other CNS,
systemic, or substance-induced conditions known to cause dementia. It is
subcategorized on the basis of accompanying features, including
Patients lose their ability to encode new memories, first of trivial and
then of important details of life => both declarative and nondeclarative
memory become profoundly impaired, and the capacities for reasoning, abstraction,
and language slip away.
presenile dementia / dementia of the
Alzheimer type, early onset : occurring before age 65
senile dementia / dementia of the Alzheimer
type, late onset : occurring after age 65
frontotemporal dementias
(FTD) (10%; higher in presenile cases, i.e. < 65 years) : due to
atrophy of frontal and eventually also temporal lobes
Pick disease / circumscribed cerebral atrophy
: a rare progressive degenerative disease of the brain very similar in
clinical manifestations and course to Alzheimer's
disease
but having a distinctive histopathology; cortical atrophy is symmetric
> asymmetric and is confined to the frontal and/or temporal lobes and
sometimes may involve the basal nuclei
Epidemiology : onset at age 40-60
Laboratory examinations : balloon degenerating
neurons contain Pick bodies
autosomal dominant frontotemporal dementia (FTD) linked to chromosome
3 (FTD3)
Aetiology : a mutation in CHMP2B, encoding
a component of the endosomal ESCRTIII complex, that results in aberrant
mRNA splicingref
Symptoms & signs : behavioural and appetite
disinhibition, emotive flattening, irritability, bulimia, weight gain,
preserved memory, copying, calculation, memory, socially inadequate behaviours
or isolation => rigidity and mutism (aphasia, echolalia),
impaired judgements and propriety sense, generally euphoric, hypocritical,
logorrheic, agitated, and with primitive reflexes.
diffuse Lewy
body
dementia (DLBD) (15.4%, the second most common degenerative dementia;
DLBD is diagnosed only when they are not associated with Alzheimer's
disease
)