In this study, we report the case of a patient experiencing hallucinations of faces that could be reliably precipitated by looking at trees. Using functional Magnetic Resonance Imaging (fMRI), we found that face hallucinations were associated with increased and decreased neural activity in a number of cortical regions. Within the same fusiform face area, however, we found significant decreased and increased neural activity according to whether the patient was experiencing hallucinations or veridical perception of faces, respectively. These findings may indicate key differences in how hallucinatory and veridical perceptions lead to the same phenomenological experience of seeing faces.
Abstract Patients with right and left hemisphere stroke (RH, LH) and a control group (CG) were administered a structured clinical interview (SCID-R) and rating scales for anxiety and depression (Center for Epidemiologic Studies Depression Scale, Beck Anxiety Inventory, and Hamiliton Dpression Rating Scale). The three groups did not differ when compared for the mean level of distress on the rating scales or frequency of mood or anxiety disorder diagnosis using the SCID-R. By contrast, participants in the LH group were more likely to be classified as distressed using rating scales cutoff scores and on measures of severity when compared only to the RH group. The rating scales were sensitive to psychiatric disorders, but lacked specificity in all groups. There were significant correlations between scales suggesting the rating scales measure a common factor in the controls, while in the stroke groups associations were weaker and less likely to be significant. Together, these results suggest the need for caution in using rating scales of depression and anxiety in neurologic patients and support the notion that these scales are sensitive to distress rather than specific for identifying depressive and anxiety disorders.
The purpose of this Chapter is to describe an approach to the clinical assessment of patients presenting to a physician for evaluation of cognitive, behavioral, and/or psychiatric symptoms, in the setting of known or suspected diseases of the central nervous system, as seen from the perspective of a behavioral neurologist working in a psychiatric hospital. Given the increasing convergence of behavioral neurology and neuropsychiatry (guided by recent advances in cognitive neuroscience, and exemplified by the recent joint annual meetings of the American Neuropsychiatric Association and the Behavioral Neurology Society), we believe that the approach described here is representative of contemporary practice in neuropsychiatry as well as behavioral neurology. For convenience and lack of a better term, "neurobehavioral assessment" will be used to refer to this method of clinical evaluation. Objectives of such an assessment are multiple and typically include diagnosis, identification of treatment goals, selection of medications and other treatment modalities, and prognostication. As the examination proceeds, syndromic, anatomical, and etiological differential diagnoses are narrowed and modified "on the fly," so that by the end of the evaluation the examiner has a relatively narrow set of possibilities to choose from with the aid of laboratory studies, as well as an idea of what treatment strategies are indicated and what prognostic advice can be given to the patient and significant others. We stress the need for clinicians to explicitly consider each of the above-mentioned "levels" of diagnosis for several reasons.
This study reports the case of a 16‐year‐old male who presented with a history of prominent psychotic symptoms and paranoid delusions which overshadowed subtle signs and symptoms of cognitive and motor dysfunction. Intensive neurobehavioral and biochemical investigations eventually led to the diagnosis of Niemann–Pick disease, type C (NPC), an autosomal recessively inherited storage disease that is associated with the accumulation of cholesterol in lysosomes and difficulties in the processing of exogenously derived cholesterol. Clues to the presence of a neurological disorder included: a history of insidiously declining academic and athletic performance which antedated the onset of psychosis; abnormalities on mental status examination, including psychomotor slowing, memory difficulties, and impairment of higher attentional functions; physical findings of subtle downgaze impairment, mild symmetrical hyperreflexia, and lower‐extremity hypertonia with flexor plantar responses, marked impairment of upper‐extremity rapid alternating movements, action tremor, and bilateral posturing with stress gait maneuvers. This case demonstrates the importance of careful and persistent neurodiagnostic evaluation in adolescents with psychotic presentations, particularly when cognitive and motor deterioration is suspected, and even when head CT and MRI scans are judged to be normal.
