摘要:

The more recent literature addressing the clinical phenomenology of presenile dementia is reviewed. This survey, spanning approximately the past 4 decades and comprising a large number of articles in scientific journals, reveals that reported epidemiological data, symptoms and signs, and results of ancillary tests often vary widely from study to study, especially as regards findings of history and of mental status and neurological examinations. There is considerable indication that diagnostic specificity in presenile dementia in the absence of pathological examination of the brain by tissue biopsy or at autopsy may not be as reliable as is generally thought to be the case. The observed problems with interstudy agreement are discussed and are seen to be due in large measure to methodological inconsistency and nonuniformity. Areas of difficulties in methods are identified and guidelines for subsequent, needed clinical studies are suggested.

ISSN:0022-3018    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

Fifty clinically diagnosed cases of presenile dementia were reviewed retrospectively, noting recorded symptomatology and findings on mental status, neurological and ancillary examinations at the time of definitive diagnosis. Manifest symptoms were numerous and varied over time but not in any uniform fashion which would allow the identification of stages of illness. The most frequent symptom was change in personality or behavior (78 per cent of the sample) whereas the most consistent symptom longitudinally was impairment of memory (present in at least 50 per cent of patients over time). A significant association of patient age at the time of symptom onset and at first physician contact with the character of the presenting symptoms at these times was identified. When symptoms were characteristically psychiatric rather than neurological in nature, patients had significantly earlier onset and earlier physician contact.Formal mental status examinations were notable in their consistently high frequency of classical signs of organic brain syndrome. Manifestations of psychosis and of a catastrophic reaction were uncommon. Neurological examination was abnormal in 84 per cent of the sample, with the most frequent finding being the presence of one or more release reflexes.Pneumoencephalography or computerized cerebral axial tomography was abnormal in all cases, in part a function of selection criteria. Electroencephalography was abnormal in 69 per cent of 48 cases, showing diffuse slowing in all but two instances. A normal electroencephalogram was present significantly more often when cerebral atrophy was limited to the cortical surfaces than when ventricular dilatation was present. Release reflexes were found to be significantly more common among patients with an abnormal as opposed to a normal electroencephalogram. No significant correlations among pattern and degree of cerebral atrophy, findings on neurological examination, signs of organic brain syndrome, and patient age and sex were apparent.Interpretation and implications of the results are discussed. The variability of clinical findings among patients, as well as over time, makes the establishment of specific diagnostic criteria difficult and raises again the question of whether presenile dementia constitutes a distinct clinical entity in the absence of tissue diagnosis.

ISSN:0022-3018    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

This paper reviews the rationale for correcting for chance agreement between two raters. It is suggested that under certain conditions correction for chance agreement is both unnecessary and inappropriate. When a chance correction is indicated, the chosen measure should be one that can be shown to be logically in accord with the two judges' method of determining each case's disposition. Two agreement measures, kappa (k) and Maxwell's Random Error Coefficient of Agreement (RE), are described in common terms and are then compared in terms of their assumptions about the judgment process. The plausibility ofk‘S assumptions are challenged, andk’S use is discouraged on the grounds that judgment table data are not treated in a way compatible with the process by which the table was constructed during the judgment process itself. Use of Maxwell's RE is recommended under conditions of equal proportions in the disagreement cells.

ISSN:0022-3018    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

The longstanding diagnostic controversy over the concept of “hysteria” has taken on new significance with the advent and development of the third edition of theDiagnostic and Statistical Manual(DSM-III). The problem of defining hysteria is therefore discussed and re-examined. A retrospective study of cases diagnosed as conversion reaction or hysterical neurosis, conversion type was then completed and analyzed. These cases were redefined using DSM-III criteria and were analyzed using a number of demographic and clinical variables. In a comparison of those patients classified as having conversion and those classified as having psychalgia, no significant differences were found. Those patients under the diagnosis of conversion and those carrying the diagnosis psychalgia differed significantly from a control group of patients with random “neurotic” diagnosis on five variables: a) symptoms are defensive; b) symptoms are expressive; c) secondary gain; d) previous physical trauma; and e) previous conversion sysmptoms.

ISSN:0022-3018    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

This case report extends the discussion of pseudodementia into the area of manic behavior. An elderly patient whose manic symptoms are considered to be an early sign of an organic brain syndrome should be given timely repeat evaluations before this diagnosis is allowed to guide treatment. Our case presentation emphasized the paucity of the data base we have to diagnose cognitive and emotional disturbances of the elderly. It is difficult to identify the essential features of cognitive dysfunction associated with primary neuronal degeneration especially in the early stages of the disease. A careful differential diagnostic evaluation is important to eliminate variables such as affective disorders and underlying physical conditions as causes of confusion and cognitive dysfunction in the elderly patient.

ISSN:0022-3018    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

Neuropsychological assessment is a rapidly expanding discipline combining skills from clinical psychology and neurology. Although neuropsychological correlates have been reported for a wide variety of clinical syndromes, little investigation of this kind has been done in the area of genetic abnormalities.The present case study concerned a child with a variant of Klinefelter's syndrome, genotype XXYY. Results of extensive neurological, psychological, and neuropsychological evaluations are presented and discussed. In addition, educational achievement and personality correlates of the syndrome are reported.Combined evaluation from all disciplines presented a picture of diffuse cortical impairment with slightly greater left hemisphere involvement, resulting in retardation. Previously proposed personality correlates of passivity, shyness, and dependency were also in evidence.On recommendation of the treatment team the child was placed in an educable mentally retarded classroom and a 6-month follow-up showed him to be adjusting socially and functioning well in this setting. Although conclusions cannot be drawn from the study of a single case, data such as these may serve as a basis for future multidisciplinary approaches studying genetic abnormalities.

ISSN:0022-3018    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

A case history is presented of a man who met the diagnostic criteria of Briquet's syndrome after a 7-year history of excessive use of psychiatric and medical health care services. Despite his having been seen by several psychiatrists, the diagnosis was made only following the use of the Schedule for Affective Disorders and Schizophrenia (SADS), a structured psychiatric interview, the results of which were applied to operationalized diagnostic criteria (Research Diagnostic Criteria [RDC]).This case demonstrates: 1) the fact that Briquet's Syndrome, commonly considered a female disorder, can occur in men; 2) the utility of structured interviews and defined diagnostic criteria in arriving at unexpected diagnoses; and 3) the importance of recognizing Briquet's Syndrome in order to avoid needless medical intervention for somatic complaints of psychological origins.

ISSN:0022-3018    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

Conversion reactions are considered rare in the elderly. The author offers a case report of an 82-year-old man with a conversion pain syndrome and points out that conversion reactions may occur at any age and among all personality styles.

ISSN:0022-3018    

出版商:OVID    

年代:1979

数据来源: OVID

ISSN:0022-3018    

出版商:OVID    

年代:1979

数据来源: OVID

ISSN:0022-3018    

出版商:OVID    

年代:1979

数据来源: OVID