Mood disorder, 'pre-ictal' psychosis and temporal lobe damage

Article Abstract:

Temporal lobe epilepsy has long been known to be associated with the subsequent development of psychotic symptoms such as those associated with manic-depressive disorder. However, in a very unusual case, the order of appearance of epileptic seizures and psychotic symptoms seems to have been reversed. A 19-year-old man who had been sexually assaulted at age 15 had an intermittent history of psychiatric illness, and he would become almost manic on several occasions. At age 18, he had become irritable and impulsive, and took a billiard cue into the street, where he began to pound on an occupied car. The patient was diagnosed as hypermanic and placed on lithium, which is used to control manic-depression. His condition eventually deteriorated, and treatment with the mood drug chlorpromazine caused him to become forgetful and disoriented. Abnormalities on electroencephalograms suggested a CT scan of his brain be performed, which revealed sclerosis in the right temporal lobe. The patient, who had now begun to see ghosts and believe he had been transformed into a vampire, was at last treated with diazepam, and then switched to carbamazepine, the drug of choice for temporal lobe epilepsy. What is remarkable about this case is that the mania preceded, rather than followed, the ictal (seizure) phase of epilepsy, and only when the manic attacks abated, did the temporal lobe seizures begin. The authors suggest that the link between epilepsy and mania is more than coincidental. In this case, both disorders probably had a common origin in a right temporal lobe abnormality. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Causes of, Drug therapy, Affective disorders, Mood disorders, Temporal lobe epilepsy

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Extrapyramidal signs, primitive reflexes and frontal lobe function in senile dementia of the Alzheimer type

Article Abstract:

Extrapyramidal signs (EPS) involve brain structures affecting bodily movement, excluding the motor neurons, motor cortex and pyramidal tract. EPS, such as rigidity, mask-like facial expressions, and loss of power of voluntary motion (akinesia), are very common among patients with Alzheimer-type dementia. EPS are thought to be related to several neurotransmitter systems, particularly to deficits in the dopamine system. To explore the associations among the presence of EPS, cognitive deficits, frontal lobe functioning (e.g., verbal fluency, repetitive behavior and primitive reflexes), and neuroleptics (antipsychotic drugs), 146 elderly patients with Alzheimer's disease were evaluated. The patient group included 102 women whose average age was 82.4 years and 44 men with an average age of 82.1 years. Patients underwent extensive diagnostic, psychological and neurological examinations. Patients who were taking neuroleptics had significantly higher scores in EPS measures. Neuroleptic-free patients had fewer EPS except for tremor, rigid posture, and rigid gait. High EPS ratings were associated with poor verbal fluency and high functional dementia ratings, suggesting that the presence of EPS is related to dementia severity. High EPS scores were also related to the presence of primitive reflexes such as the grasp reflex, and to repetitive behavior, aggressiveness and duration of cognitive impairment. The findings suggest the possibility of a common link among EPS, cognitive function, frontal lobe signs and the dopamine system. (Consumer Summary produced by Reliance Medical Information, Inc.)

Dementia, Alzheimer's disease, Extrapyramidal tracts

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Psychiatric manifestations of frontal lobe tumours

Article Abstract:

Patients with frontal lobe brain tumors may have symptoms of confusion, dementia, and behavior or mood disturbances. In confusional states, patients can exhibit disorientation, clouding of consciousness, indifference to the environment, euphoria, and loss of insight. Cognitive deterioration can include memory loss, loss of drive, and slowed though processes. Common behavior and mood disturbances include mild movement disorders, irritability, and depression. The frontal lobes are divided into the pre-motor cortex and the prefrontal area. Damage to the former results in arm and leg weakness, immobility, loss of bladder control, mutism, the inability to perform purposeful movements (apraxia), and Broca's aphasia (loss of speech). Damage to pre-frontal areas results in attention deficits, shallowness, impulsivity and lack of emotional control. There have been reports describing long-term psychiatric patients with undiagnosed frontal lobe tumors. Although incorrect diagnoses have serious implications, a careful clinical history and physical examination are usually adequate predictors of brain pathology. When tumors are suspected, new imaging techniques such as computerized tomography allow for non-invasive diagnosis. Patients with strictly diagnosed schizophrenia or mood disorders usually do not have brain tumors unless neurological signs are present. However, patients who demonstrate frontal lobe syndrome or have indications of raised intracranial pressure should have a thorough neurological examination. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Abnormalities, Neurology, Motor cortex, Diagnosis, Psychiatric disability evaluation, Frontal lobes, editorial

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