Personality change due to a general medical condition JLC

This category, which is included in both ICD-10 and DSM-IV, describes syndromes affecting global features of behaviour, cognition, and emotions, and secondary to the physiological effects of general medical diseases.

The essential feature is a change in personality after a general medical disease. In childhood before a stable pattern of personality has been established, a marked deviation from normal development suggests the diagnosis.

A central feature is loss of control over the expression of emotions and impulses. Affect is commonly labile and shallow, although persistent mild euphoria or apathy may be present, especially when the frontal lobes are affected. The elevated mood of these patients is hollow and silly, unlike that of hypomania. Patients may appear childish, expansive, and disinhibited, but they may admit to not feeling happy. Other are indifferent and apathetic.

Exaggerated expressions of rage and aggression are usually present, often out of proportion to any stressor. Loss of impulse control is also shown in social and sexual disinhibition, inappropriate jokes, and overeating.

Aetiology

In most cases this disorder is associated with structural damage to the brain. Head trauma, cerebral neoplasms, vascular accidents, multiple sclerosis, Huntington's disease, and complex partial epilepsy may all cause personality change, especially when affecting frontal and temporal lobes. Systemic diseases involving the central nervous system, including endocrine disorders, AIDS, lupus erythematosus and chronic metal poisoning, may have the same effect.

Patients with this disorder generally have a clear sensorium but may be inattentive and have some mild cognitive dysfunction. They do not show intellectual deterioration.

Differential diagnosis

In dementia, personality change is accompanied by intellectual deterioration. However, personality change may predate the dementia. Distinction from schizophrenia and other personality disorders is based on the clinical history and the presence of a general medical disease capable of causing personality change.

Treatment

If possible, treatment is directed to the causative condition. Pharmacological treatment of specific symptoms may be useful when depression or inappropriate anger is present.

*The contributions of each author are indicated by JLC and DLT respectively. Chapter References

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Getting to Know Anxiety

Getting to Know Anxiety

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