Electromyography diagnosis of laryngeal paralysis

The differential diagnosis of laryngeal muscle paralysis can be improved by electromyographical and neurographical analysis. The findings of 30 patients with recurrent paralysis were put forward and compared with the results among 30 test people.     

Differential diagnosis of cluttering and stuttering in Bulgaria

Fifteen stutterers, primarily children, who visited the Medical Pedagogical Department at the University of Blagoevgrad were evaluated for a variety of criteria used in Bulgaria to differentiate cluttering, stuttering, and mixed cluttering and stuttering. The same battery of tests was administered to all subjects. Based on these criteria, five subjects were diagnosed as clutterers, six as stutterers, and four as mixed. Daly's (1992–1993) Checklist for Possible Cluttering, Experimental Edition was also utilized to classify the subjects. Differences between the differential diagnostic criteria used by Bulgarian logopedists and other authors are discussed.     

Differential diagnosis of malingering and factitious disorder with physical symptoms

The present article attempts to clarify the difficult diagnostic discrimination between malingering and factitious disorder with physical symptoms. It is proposed that diagnostic evaluations focusing on the patient's observed symptomatology will be limited in their accuracy and utility. Instead, a longitudinal approach is needed to include the course of the disorder over time, its response to treatment, and the proposed etiology of the disorder. It is hoped that with a better understanding of these two disorders, prompt and accurate diagnosis can lay the foundation for effective management of both malingering and factitious disorders.     

Differential diagnosis and different etiologies of monopolar and bipolar phasic psychoses

Monopolar and bipolar phasic psychoses can be differentiated not only on the course but also on the symptom pattern. This applies also to the euphoric forms which usually are still assigned to Manic-depressive illness. The differential diagnosis is presented. Aetiology is completely different in the monopolar and the bipolar phasic psychoses. Manic-depressive illness has a hereditary basic, whereas in the monopolar ("pure") forms loading is very low. Particularly few psychoses among the relatives have been found in the euphoric forms which demonstrates their independency for if they would belong to Manic-depressive illness they necessarily would show the heavy genetic loading of this bipolar illness. In the pure phasic psychoses external causes were detected when we focused on the sibships in which the probands had grown up. The euphoric patients had relatively many older siblings, the depressive ones relatively few older siblings. A similar difference was found in two cycloid psychoses. Transcultural observations as well as shifts in the incidence rate of the psychoses in our times confirmed our results. Prophylactic measures can be derived.     

Differential diagnosis of endogenous psychoses in relation to a symptom catalog

The paper introduces a catalog of symptoms to promote in the field of endogenous psychoses differentiated diagnosis, at the same time constituting a prognosis. Symptoms should be more minutely differentiated than is customary in psychiatric questionnaires. Manic-depressive disorders and purely phasal psychoses are distinguished solely in the clinical evaluation. Thus benign cycloid psychoses can be distinguished from malignant unsystematic schizophrenia.     

Differential diagnosis between apraxia and dysarthria based on acoustic analysis

Acoustic analysis provides objective quantitative measures of speech that enable a comprehensive and accurate understanding of motor disorders and complement the traditional measures. This paper aims to distinguish between normal and pathological speech, more specifically between apraxia of speech and spastic dysarthria in native Spanish speaking patients using acoustic parameters. Participants (4 aphasic with apraxia of speech, 4 with spastic dysarthria, and 15 without speech disorders) performed three different tasks: repeating the syllable sequence [pa-ta-ka], repeating the isolated syllable [pa] and repeating the vowel sequence [i-u]. The results showed that the normative values of motor control, in general, coincide with those obtained in previous research on native English speakers. They also show that damage to motor control processes results in a decrease in the rate of alternating and sequential movements and an increase in the inter-syllabic time for both types of movements. A subset of the acoustic parameters analyzed, those that measure motor planning processes, enable differentiation between normal population and apraxic and dysarthric patients, and between the latter. The differences between the pathological groups support the distinction between motor planning and motor programming as described by van der Merwe's model of sensorimotor processing (1997).     

Differential diagnosis of steroid-dependent nephrotic syndrome with psychosis: Practical and ethical issues

The present case illustrates practical and ethical issues that can be encountered by clinical psychologists providing consultation services in medical settings. The neuropsychological consultation service was asked to evaluate a 22-year-old male with psychosis, steroid-dependent nephrotic syndrome, and a family history of schizophrenia. MRI revealedmarked cortical atrophy. Clinical findings were consistent with (1) steroid inducedapparent atrophy, which has been shown to be reversible with withdrawal of steroids; (2) uremia secondary to steroid withdrawal; (3) cortical atrophy, found in some schizophrenics; or (4) an atypical, diffuse degenerative disorder. Clinical interview and psychological testing revealed significant thought disorder, prominent delusions, somatic hallucinations, and mood disturbance. Deterioration in social and academic functioning was also present. Except for impaired attention and concentration, neuropsychological evaluation showed no clear evidence of brain-based dysfunction. Further, neuropsychological results effectively ruled out a degenerative process and were not consistent with a steroid effects profile. A conclusive differential diagnosis of steroid induced psychosis versus severe psychopathology would require withdrawal from steroids and antipsychotics. In addition to the practical and ethical issues of withholding antipsychotics, steroid withdrawal would require either dialysis or renal transplant surgery. Decision making regarding dialysis dependency and the possibility of postsurgical psychosis secondary to true psychopathology were salient issues to both the patient and the treatment team.     

Sleep paralysis and hallucinosis

Background: Sleep paralysis is one of the many conditions of which visual hallucinations can be a part but has received relatively little attention. It can be associated with other dramatic symptoms of a psychotic nature likely to cause diagnostic uncertainty. Methods and results: These points are illustrated by the case of a young man with a severe bipolar affective disorder who independently developed terrifying visual, auditory and somatic hallucinatory episodes at sleep onset, associated with a sense of evil influence and presence. The episodes were not obviously related to his psychiatric disorder. Past diagnoses included nightmares and night terrors. Review provided no convincing evidence of various other sleep disorders nor physical conditions in which hallucinatory experiences can occur. A diagnosis of predormital isolated sleep paralysis was made and appropriate treatment recommended. Conclusions: Sleep paralysis, common in the general population, can be associated with dramatic auxiliary symptoms suggestive of a psychotic state. Less common forms are either part of the narcolepsy syndrome or (rarely) they are familial in type. Interestingly, sleep paralysis (especially breathing difficulty) features prominently in the folklore of various countries.     

The functional anatomy of a hysterical paralysis

The concept of a conversion disorder (such as hysterical paralysis) has always been controversial (Ron, M.A. (1996). Somatization and conversion disorders. In: B.S. Fogel, R.S. Schiffer & S.M. Rao (Eds.), Neuropsychiatry. Williams and Wilkins, Baltimore, MD). Although the diagnosis is recognised by current psychiatric taxonomies, many physicians still regard such disorders either as feigned or as failure to find the responsible organic cause for the patient's symptoms. We report a woman with left sided paralysis (and without somatosensory loss) in whom no organic disease or structural lesion could be found. By contrast, psychological trauma was associated with the onset and recurrent exacerbation of her hemiparalysis. We recorded brain activity when the patient prepared to move and tried to move her paralysed (left) leg and when she prepared to move and did move her good (right) leg. Preparing to move or moving her good leg, and also preparing to move her paralysed leg, activated motor and/or premotor areas previously described with movement preparation and execution. The attempt to move the paralysed leg failed to activate right primary motor cortex. Instead, the right orbito-frontal and right anterior cingulate cortex were significantly activated. We suggest that these two areas inhibit prefrontal (willed) effects on the right primary motor cortex when the patient tries to move her left leg.