A 62-year-old man with a history of schizophrenia but stable for many years presented with a 2-month history of aggressive behaviour, persecutory delusions and depression subsequent to defaulting his psychiatric treatment. His daughter reported that his current symptoms had been preceded by forgetfulness, a gait disturbance and urinary incontinence of 1 year's duration.On mental state examination, he had psychomotor slowing, appeared depressed and had a blunted affect. He scored 17/30 on the mini-mental state examination. He had scars on his body (which he attributed to falling) and a broad-based magnetic-type gait. A cerebrospinal fluid tap test was positive. His mental state improved after each lumbar puncture but declined approximately 5 days later.All blood investigations were normal. A computed tomography scan of the brain showed enlarged ventricles but no significant cortical atrophy (Fig. 1). The fourth ventricle and aqueduct were relatively small on magnetic resonance imaging, and late-onset aqueductal stenosis was suspected.An endoscopic third ventriculostomy was performed and the patient's psychiatric symptoms, cognition and functioning improved significantly after surgery. DiscussionThe patient's non-adherence to treatment was probably caused by cognitive impairment, which is a cardinal symptom of normalpressure hydrocephalus (NPH).[1] Collateral history revealed the chronology of symptoms that led us to consider this diagnosis. It was critical not to attribute the psychiatric symptoms to the chronic disorder alone without carefully reviewing the full clinical picture.Patients with NPH often present with psychiatric symptoms, of which apathy, depression and anxiety are the most common. [2,3] NPH is one of the reversible causes of dementia [4] and is misdiagnosed in approximately 80% of cases.[4] This case illustrates the importance of considering a diagnosis of NPH in any elderly patient who presents with psychiatric symptoms. A 62-year-old man presented with a 2-month history of psychiatric symptoms. These were preceded by cognitive deterioration, urinary incontinence and an abnormal gait. A diagnosis of normal-pressure hydrocephalus (NPH) was made, and the patient improved after surgery.
BackgroundGlobally, the number of older people is rising. As a consequence of greater longevity, an increased burden on both medical and mental health care is expected. As a first step towards developing strategies to provide quality mental health care for this growing population, practitioners need to have a thorough understanding of the composition and needs of these patients.AimTo profile the inpatient population of a psychogeriatric unit in terms of demographics, diagnostic makeup, average length of stay and selected outcomes.SettingThis study was conducted at the psychogeriatric unit of Stikland Hospital, Western Cape, South Africa.MethodsDemographic and clinical data were retrospectively collected from patient files, discharge summaries and an admission database over a 3-year period.ResultsA total of 903 patients were referred to Stikland Hospital during a 3-year period. Of the 498 patients who were admitted, 56 were readmissions. The mean age of patients was 67 years, and more than 57% of patients were female. The majority of patients (97.1%) were admitted as involuntary mental health users. The diagnosis of a cognitive disorder was made in 49.5% of admissions followed by psychotic disorders in 36.9% and mood disorders in 23.2%. The median length of stay was 53 days.ConclusionThe findings of this study illustrate that mental health services for the elderly in the Western Cape are insufficient, as only patients with severe illness and comorbidity could be admitted. The study emphasises the need for the restructuring of resources and the implementation of strategies, which may decrease the frequency of admissions to inpatient geriatric units.
This site is maintained by the Head Injury Hotline, a non-profit making organisation based in Seattle, USA. They comprise a multidisciplinary team including consultants, lawyers, nurses, neuropyschologists, paraprofessionals, victims of traumatic brain injury and their families. It is a well designed, user friendly site which clearly sets out its goals and directs the visitor painlessly to the relevant aspect of head injury that they require. The comprehensive self help section encourages the user to be a major influence in the long term physical and psychological recovery of themselves or of their loved ones. Overall this is a well established, regularly updated and exhaustive site.***** Head Injury-familydoctor.org http://familydoctor.org This site gives a brief account which only concentrates on the acute and physical aspects of head injury. We found it to be visually uninspiring and factually bare. The user is provided with minimal helpful information and the site gives exceedingly little in the way of direction to other relevant sites. The most useful information given is the advice on signs and symptoms to look for after minor head injury. We would not recommend this site for a comprehensive review of head injury.* Head Injury: A Family Guide http://www.state.sc.us/ddsn/pubs/hinjury/sec1.htm This site covers most aspects of head injury from a layman's perspective, concentrating especially on the psychosocial ramifications. Although thorough, the content is presented in reams of text which quickly becomes tedious. However, the table of contents makes it easy to find the relevant section quickly. The glossary section is extremely useful in helping the user to understand potentially confusing medical phraseology. Although there is a reference section there is a paucity of links to related web sites. To conclude, a good website that could be improved upon.*** HEALTH PROFESSIONAL ORIENTATED NICE Guidelines on Head Injury http://www.nice.org.uk *****CONSIDER BUYING SHARES ****TELL YOUR FRIENDS
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