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sd04
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Dementia or Schizophrenia
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02.14.06 (2 years ago)
#1
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A 55 YO man is brought to the ER because of recent alarming change in his personality, he has been acting strangely, telling jokes at the wrong time and place, showing increasingly poor judgement and expressing ideas of grandiosity. Physical examination and blood serology is normal. What is your diagnosis?
a) multiple sclerosis
b) late onset schizophrenia
c) hypomanic state
d) presenile dementia
b or d?plz help 
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sea_corel
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02.14.06 (2 years ago)
#2
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Thats a dice situation...
I dont know if inference can be sought from this text below....????
Late onset schizophrenia
Late-onset schizophrenia was only included in the standard US definition of schizophrenia in 1994 (with the publication of DSM-IV). Some have suggested that late-onset schizophrenia is distinct from early-onset schizophrenia in that it is primarily a neurodegenerative condition.
Diagnostic Criteria for LOS
To diagnose LOS, the patient should meet the DSM-III-R (2) criteria for schizophrenia (including duration of at least 6 months), with the additional requirement that the onset of symptoms (including the prodrome) be at or after age 45. The prototypical patient is a middle-aged or elderly person who functioned moderately well through early adulthood (despite some premorbid schizoid or paranoid personality traits) and who exhibits persecutory delusions and auditory hallucinations and shows some improvement in positive symptoms with low-dose neuroleptic therapy, yet has a chronic course.
Late-onset schizophrenia is often characterized by bizarre delusions, which have a predominantly persecutory flavor. Auditory hallucinations are the second most prominent psychotic symptom. Systematized delusions of physical or mental influence are seen in many of the patients. Grandiose, erotic, or somatic delusions may occur in some cases.
LOS patients show a female predominance
The profile of late onset schizophrenia - both demographic and clinical - does appear different. Late onset people with schizophrenia are more likely to be women, and tend to exhibit more positive than negative symptoms. Neuroimaging studies have also shown that the thalamus in people with late-onset schizophrenia is enlarged.
Personality traits differ in that, adults with late onset are premordidly suspicious, querulous, socially isolated and seclusive
Prognosis for elderly with late onset diagnosis of schizophrenia is more positive and have a more optimistic chance of treatment due to a higher responsiveness (48.1%) to neuroleptic medications and remission. 
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sea_corel
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02.15.06 (2 years ago)
#3
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read the text below too....
m jus referin the terms here..will find more on it....
Alzheimer’s disease is often considered a synonym or a condition closely related to the following:
Presenile Dementia
Primary Degenerative Dementia
Senile Dementia of the Alzheimer's Type (SDAT)
Senile Dementia/Alzheimer's Type (SDAT)
The following classification is commonly used for Alzheimer’s disease:
290.0 senile dementia, uncomplicated
290.10 presenile dementia, uncomplicated
331.0 alzheimer's disease
so can we ans the question asked as presenile dementia or (Alzheimer's classification 290.10 uncomplicated PSD)?????
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usmle1
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02.22.06 (2 years ago)
#4
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hypomanic state
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sea_corel
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02.22.06 (2 years ago)
#5
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plz explain...
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sd04
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Re: Dementia or Schizophrenia
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02.23.06 (2 years ago)
#6
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| sd04 wrote: |
A 55 YO man is brought to the ER because of recent alarming change in his personality, he has been acting strangely, telling jokes at the wrong time and place, showing increasingly poor judgement and expressing ideas of grandiosity. Physical examination and blood serology is normal. What is your diagnosis?
a) multiple sclerosis
b) late onset schizophrenia
c) hypomanic state
d) presenile dementia
b or d?plz help |
well its presenile dementia as all s/s in dis scenario r in fdavour of dementia lets look at it again:
disorientation,anxiety,emotional lability.personality disturbences,hallucinations n deliusions also can be seen so only based on idea of grandiosity can say dis pat is in HYPOMANIAC state,is always of short duration n usually pat is depressed wen sleep n wake up v thia state but not gvn any depressive or mood disorder but its very impt dd.
we acll dementia a presenile one wen age or presentation <65 n if age >65 its dementia
if any doubt ask me,together will find more ref den 
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sd04
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02.23.06 (2 years ago)
#7
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| sea_corel wrote: |
read the text below too....
m jus referin the terms here..will find more on it....
Alzheimer’s disease is often considered a synonym or a condition closely related to the following:
Presenile Dementia
Primary Degenerative Dementia
Senile Dementia of the Alzheimer's Type (SDAT)
Senile Dementia/Alzheimer's Type (SDAT)
The following classification is commonly used for Alzheimer’s disease:
290.0 senile dementia, uncomplicated
290.10 presenile dementia, uncomplicated
331.0 alzheimer's disease
so can we ans the question asked as presenile dementia or (Alzheimer's classification 290.10 uncomplicated PSD)????? |
thanx sea_corel for ur ref,well i think alz'mer is the cause of dementia in 50-60% cases n this classification is based on severity,n onset of s/s od dementia,so in this scenario pat is psnting v sudden n early age onset dat all indicates that this is in presenile stage of dementia n will progress n take full flown pic of alz'mr in future if left untttd so ttt shud be done as soon as possible in this patnt to avoide further imairing of cognition n emotional support assuerance will be helpfull!
wat do u say?
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sea_corel
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02.23.06 (2 years ago)
#8
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ur right...
i was in delima but thanx for clearing my doubts...
i now m sure that ans is presenile dementia....
many thanx sd04
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usmle1
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Re: Dementia or Schizophrenia
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02.28.06 (2 years ago)
#9
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| sd04 wrote: |
| sd04 wrote: |
A 55 YO man is brought to the ER because of recent alarming change in his personality, he has been acting strangely, telling jokes at the wrong time and place, showing increasingly poor judgement and expressing ideas of grandiosity. Physical examination and blood serology is normal. What is your diagnosis?
a) multiple sclerosis
b) late onset schizophrenia
c) hypomanic state
d) presenile dementia
b or d?plz help |
well its presenile dementia as all s/s in dis scenario r in fdavour of dementia lets look at it again:
disorientation,anxiety,emotional lability.personality disturbences,hallucinations n deliusions also can be seen so only based on idea of grandiosity can say dis pat is in HYPOMANIAC state,is always of short duration n usually pat is depressed wen sleep n wake up v thia state but not gvn any depressive or mood disorder but its very impt dd.
we acll dementia a presenile one wen age or presentation <65 n if age >65 its dementia
if any doubt ask me,together will find more ref den |
with due respect i disagree with pre-senile dementia. i will still go for hypomania.
it is highly unlikely for presenile dementia presenting with:
acting strangely,
telling jokes at the wrong time and place,
showing increasingly poor judgement
expressing ideas of grandiosity.
the only point that support presenile dementia is the alarming change in his personality, but patient with hypomania do have prominent personality change(s) due to their social dysfunction and inability to maintain interpersonal relationship.
another key word in the presenile dementia should be mild to moderate anterograde amnesia. no mention of amnesia at all !!!
all said and done the best answer to fit this should be frontal lobe syndrome, i wonder why it was not included in the options.
any more thoughts???
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rajju077
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02.28.06 (2 years ago)
#10
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Dementia is the right answer, atleast thats what i think
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