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Frontotemporal lobar degeneration with motor neurone disease (FTLD/MND): Presentations in psychiatric practice
S Sathasivam1, M Doran, A J Larner
1Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Liverpool, UK.
Abstract:
Background. Concurrence of frontotemporal lobar degeneration with clinical features of motor neurone disease (FTLD/MND) is a recognised cause of dementia with widely accepted diagnostic criteria, but it is not mentioned in DSM-IV-TR. Aim. To draw attention to cases of FTLD/MND referred by psychiatrists, or already under the care of psychiatrists at time of referral, to a dedicated Cognitive Function Clinic. Methods. Prospective study of FTLD/MND cases, 1999-2007 inclusive; case note review. Results. Nine of 13 cases of FTLD/MND were either referred by or already under the care of a psychiatrist. Although most had been identified as having a dementia, in none had the correct diagnosis been made. All patients had signs of motor neurone pathology on clinical examination, sometimes subtle, in addition to cognitive and psychiatric features. A wide variety of drugs had been prescribed including antidepressants, antipsychotics, cholinesterase inhibitors, and memantine. Conclusions. A high index of clinical suspicion is required to identify cases of possible FTLD/MND, and thereby initiate appropriate investigations and management and avoid inappropriate medication. Absence of FTLD/MND in DSM-IV-TR may further handicap psychiatrists in making this diagnosis.
Insights
Frontotemporal lobar degeneration with motor neurone disease (FTLD/MND) is often missed by psychiatrists. Early recognition of FTLD/MND is crucial for accurate diagnosis and appropriate patient management.
Area of Science:
- Neurology
- Psychiatry
- Dementia Research
Background:
- Frontotemporal lobar degeneration with motor neurone disease (FTLD/MND) is a recognized cause of dementia.
- Diagnostic criteria exist, but FTLD/MND is not included in the DSM-IV-TR.
- This study focuses on FTLD/MND cases managed by psychiatrists.
Purpose of the Study:
- To highlight FTLD/MND cases referred to a Cognitive Function Clinic by psychiatrists.
- To assess the diagnostic accuracy and management of FTLD/MND in psychiatric care.
- To emphasize the need for increased awareness among psychiatrists.
Main Methods:
- Prospective study of FTLD/MND cases from 1999-2007.
- Inclusion of patients referred by or under the care of psychiatrists.
- Review of case notes for diagnostic and treatment patterns.
Main Results:
- Nine out of 13 FTLD/MND cases were under psychiatric care or referred by psychiatrists.
- Most patients were diagnosed with dementia, but not specifically FTLD/MND.
- All patients exhibited subtle or overt motor neurone signs alongside cognitive and psychiatric symptoms.
- A range of psychotropic medications and dementia drugs were prescribed inappropriately.
Conclusions:
- A high index of suspicion is necessary for identifying FTLD/MND.
- Accurate diagnosis is vital to initiate appropriate investigations and management.
- The absence of FTLD/MND in DSM-IV-TR may hinder psychiatric diagnosis.
- Avoiding inappropriate medication is a key outcome of correct diagnosis.
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