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KEY ARTICLES: CONSCIOUSNESS | DOUBLE BLIND | HEAD INJURY | NARCOLEPSY | PAROXYSMAL DISORDERS | PRESCRIPTION PRINCIPLES | TARDIVE DYSKINESIA

Enduring Interest: Generic Substitution | Genius | Groundbreaking Paradigm Shifts | Zmail

DIAGNOSTIC EVALUATION

Based on the above findings, provisional ideas begin to develop. In the course of the time based evaluation these may change. We have found that a multi-axial schema is critical taking into account an amplification of DSM 4 psychiatrically and an equivalent schema neurologically. These are reflected below under two major sections - neurologic neuropsychiatric. This example is of a prototype patient with CHIT. The complexity of all these elements in this way can be perceived.

DIAGNOSIS

Evaluation Based on the above findings, the following provisional ideas seem appropriate.

  PREDOMINANT DIAGNOSIS Closed head injury of transient kind (CHIT)
Mixed elements:
Post traumatic syndrome, Post concussional syndrome
Possible contrecoup injury with frontal lobe features (residual focal)
Secondary sexual dysfunction BR> Secondary Pain syndrome predominantly hips
Tinnitus chronically
Abnormal EEG with right lateral temporal structural abnormality
Headache and dizziness both improving
Obesity
  NEUROLOGIC LABEL:  
1n Neurologic overview CHIT with PTS, PCS, Focal syndrome
1s Seizure Classification possible minor temporal lobe features: structural on EEG and clinically correlates with tinnitus? and headache?
1m Movement disorder no evidence at this time
1s Dyssomnia intermittent initial insomnia (mild, secondary to psychological elements)
1h Higher cortical elements high functioning individual previously; now Significant organizational - integration impairment with frontal lobe elements
1p Perceptual distortions tinnitus - chronic persistent since accident.
1h Pain syndrome headaches when tired
1 g General neurologic CHIT
1pn RELEVANT MEDICAL CONDITIONS no evidence at this time
1fn Family history No neurologic family history
2 l Learning style No evidence of pre-existing learning disability
2n Premorbid Intelligence: Normal range.
3p Physical condition As per examination, main complaints, social history
3n Links of Neurologic events to presentation Probably significant. Dynamically different coping styles exist. Organically different compensations for deficits occur.
3 c Cerebral Localization Temporolimbic phenomena not triggered or mobilized by hallucinogen or stimulant use
4 Special investigations as listed above
4e Electroencephalographic sleep and wake EEG 1993 slightly abnormal with bitemporal spiking ambulatory EEG right lateral temporal
4n Neuroradiologic tests as above MRI 1995 apparently normal
  Other test features: apparently normal blood tests
5n Course:  
  Deteriorating or not Non-deteriorating
  Chronicity degree Not chronic
6n Neuropharmacologic Response Carbamazepine has helped the explosive anger but not assisted with the amotivation and dysexecutive phenomena
  Compliance By history, expected to be reasonable
7n Neurologic onset age since head injury on 4/7/97

Prototype example of CHIT patient diagnostically (neuropsychiatric)

  NEUROPSYCHIATRIC FRAMEWORK:  
  Descriptive Psychopathology: atypical depression and anxiety confusional episodes
1 fp Family history family history negative except for one aunt
2 a Addictive disorder no evidence of alcoholism or drug dependency or abuse
2p Personality Elements: No relevant characterologic deficits. Anankastic personality features accentuated post-injury possibly as coping mechanism
3p Relevant Physical disorders: conditions above are major components to current psychopathologic manifestations
  Symptomatic relevance: major components to current psychopathologic manifestations
  Relatedness to illness: significant
4p Psychosocial components: &&&&& &&&&&&&&&
  Family support reasonable
  Patient Strengths self-perceived: "trying to get better"
  Predisposing factors: Constitutional diathesis. Environmental experience. Aggravating cerebral trauma
  Precipitating stressors: No significant new stressors. Chronic difficulties linked with impaired function
  Perpetuating factors: Predisposing elements
  Problem areas listed above
5p Functionality: &&&& &&&&&&&&&&
  Maximum expected in future: limited
  Highest functionality before insult: reasonable: normal days work
  Functionality currently: limited by deficits and unable to work though does daily chor$
6p Psychopharmacologic:  
  Psychopharmacologic Responsiveness: as listed above: buspirone has helped irritability and concentration
  Psychopharmacologic Compliance: historically reasonable
7p Age of onset of major psychopathology: since head injury on 4/7/97

 

 


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