1/2. Two cases of variant Creutzfeldt-Jakob disease (vCJD) referred to the Department of Community mental health, Aldershot Garrison in 2003.In the year 2003 the Department of Community mental health (DCMH) at Aldershot Garrison received referrals of two soldiers, a sergeant and a lance corporal, who presented with a complex picture of neurological and psychiatric symptoms. Both had been investigated very thoroughly by neurologists who, owing to the mainly negative results of their investigations, were unable to make a diagnosis. Of the two patients one had also been assessed as a psychiatric in-patient in a civilian hospital and had been referred to the Aldershot DCMH for continuing care. The other had been transferred, after investigations, to the Defence Services Medical rehabilitation Centre (DSMRC) at Headley Court but, failing to make progress, was also referred for psychiatric assessment. Both patients were obviously unwell but the nature of their illnesses remained obscure. Within a few months both had died and the diagnosis of one of the human transmissible spongiform encaphalopathies (TSEs), vCJD, was made at autopsy in one of them, but both were registered by the National CJD Surveillance Unit (3) with a diagnosis of vCJD. The circumstances were so unusual and prompted the writing of this paper by one of the psychiatrists involved.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/2. Evaluation and diagnosis of psychogenic disorders in neurological patients.patients with psychogenic neurological symptoms present a diagnostic challenge. There are certain elements in a history that are indicative of a psychogenic condition. These include sudden onset of symptoms, highly emotional events at the time of symptom onset, paroxysmal nature of symptoms, and migrating or changing complaints. Likewise, some findings on examination are more often seen in psychogenic cases than in organic disorders. Multiple symptoms that do not correspond to any identifiable neuroanatomical abnormality, distractibility, entrainment, and false weakness or sensory complaints, are all possible clues that a condition is emotional rather than organic. However, none of these features is an absolute indication of psychogenicity and each must be taken in the context of the complete clinical picture.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |