Prevalence of major depression among patients with dementia is:
A. A major depressive episode is found in approximately 10% of patients, while nearly 50 to 75% show some features of subclinical depression. Depression reported by carers can range up to 85%. Depression is more common in the early than in the later stages of AD – this may be due to preserved insight during early stages or because of the fact that clinical assessment of depression becomes more difficult when dementia worsens.
Reference:
A 45-year-old man presents to A & E with complaints of hearing voices. On further questioning he claims amnesia for the content of these voices and reveals he has lost his tenancy the previous day due to aggressive behaviour.
An important diagnosis to consider is:
A. Malingering is often not considered seriously in general clinical practice. Though it may be difficult to establish, it should be suspected whenever obvious discrepancies exist in historical accounts and observed signs. Amnesia for the content of hallucinatory voices is distinctly unusual.
A 16-year-old boy presents with cycles of sleepiness lasting for weeks associated with excessive weight gain and hunger.
Which of the following is an appropriate diagnosis?
B. Kleine–Levin syndrome is characterized by recurrent episodes of prolonged sleep intermingled with periods of normal sleep. During the prolonged sleep phases, social withdrawal, apathy, irritability, and megaphagia (increased eating) can occur. Unexplained fever may occur in such patients. This is a rare illness with onset between the ages of 10 and 21 years. It is mostly self-limiting. Curiously, this is a favourite theme tested in MRCPsych exams!
Which one of the following sleep disturbances is associated with Parkinson’s disease?
D. REM behavioural disorder refers to episodes of complex, sometimes violent acting out of dreams. It is common in older men with a history of brain ischaemia. It can appear as an early event in the evolution of Parkinson’s disease or Lewy body dementia. Polysomnography shows failure of normal REM related hypotonia.
A 32-year-old man presents with beliefs that he has a chip in his brain that could neutralize all nuclear radiations in his presence. He stops often in mid sentence and continues conversation on a different theme altogether.
Which of the following neurological conditions mimics thought blocking?
C. Absence seizures can mimic thought blocking. Absence seizure is a type of generalized seizure where the episodes may often go unnoticed due to a lack of dramatic motor or sensory symptoms. Also called petit mal epilepsy, it usually begins in childhood and stops by puberty. A patient with absence seizures has a very brief loss of consciousness which can occur numerous times in a single day (up to 100 in some cases). EEG produces a characteristic pattern of threeper-second spike-and-wave.
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