Which one of the following clinical signs and diseases is correctly paired?
C. In Wilson’s disease athetosis with wing beating movements are noted. Huntington’s disease is characterized by chorea while a patient with pseudobulbar palsy shows exaggerated jaw jerk and emotional lability. In motor neurone disease combined upper and lower motor neurone signs are noted. Ataxia typically occurs in posterior column, cerebellar, or vestibular damage. The tremor in Parkinson’s is described as pill rolling tremor.
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A 40-year-old man develops irritability and depressed mood with significant personality change. His father committed suicide at age of 45 and grandmother suffered from memory problems before she died at age 57.
Which is the most important diagnosis to consider in this case?
C. The clues in this case are young age of onset, presence of irritability, and personality change with family history including a degree of ‘anticipation’ over generations. Premature death, suicide, and psychiatric problems point to Huntington’s disease in family members. The onset is usually during the fourth decade with significant numbers showing juvenile presentation with successive generations. The course is almost always a deteriorating pattern with death occurring around 10–12 years after diagnosis. Fahr’s disease refers to idiopathic bilateral basal ganglia calcification.
A 45-year-old man develops auditory hallucinations that are initially fragmented but later turns into second person derogatory. The most important aspect of personal history in this case is:
B. In alcoholic hallucinosis, psychotic symptoms start either during intoxication or withdrawal, but in a clear sensorium. The most common symptoms are auditory hallucinations; these are usually unstructured voices which can develop into persecutory or derogatory content. The hallucinations usually last for a short period and any persistence beyond 6 months is a strong suspicion for other psychotic illnesses such as schizophrenia.
Mr Smith considers himself as an alcoholic. He uses the same brand of whisky everyday and drinks at the same pub around the same time.
Which of the following features is he exhibiting?
C. Narrowed repertoire of drinking was included as one of the criteria for alcohol dependence by Griffith Edwards and Milton Gross in 1976. Heavy drinkers may have a wide drinking repertoire. This narrows as dependence advances. The dependent person may start to drink in a restricted pattern and manner every day, which would ensure a constant blood-alcohol level avoiding any symptoms of alcohol withdrawal. This is different from salience wherein priority is given to alcohol over other important areas of life and even painful consequences are disregarded.
Which of the following clinical feature of schizophrenia adds support to a neurodevelopmental hypothesis?
A. The peak ages of onset are 10 to 25 years for men and 25 to 35 years for women. Age of onset of schizophrenia is quoted as a supporting feature of neurodevelopmental hypothesis. A substantial reorganization of cortical connections, involving a programmed synaptic pruning, takes place during adolescence in humans. An excessive pruning of the prefrontal synapses, perhaps involving the excitatory glutamatergic inputs to pyramidal neurones, may underlie schizophrenia. This is called the Feinberg hypothesis.
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