CLINICAL CASE: NEUROLOGICAL SYSTEM worth 10 points. To the best of n 11-year-old
ID: 79004 • Letter: C
Question
CLINICAL CASE: NEUROLOGICAL SYSTEM worth 10 points. To the best of n 11-year-old Caucasian girl with acute delusions and aggressive behavior was admitted to our acute In-patient Child Psychiatry Unit This patient was the first child, born at term by Caesarean section with a birth weight of 3.450kg. The neonatal period was regular, with maternal nursing at onomous walking occumed at 14 months and the first words were spoken Aut 12 months with a subsequent normal language development. The patient showed normal learning abilities and good social skills before the and onset of the psychiatric symptoms, even her parents described her as shy a moreover, they reported behavioral modifications with reduction of interests and social withdrawal a few months before the beginning Her parents was reserved and unstable A month before admission to the in-patient unit the gil started to develop suspicious thoughts with features concerning the possibility of being harmed by her parents, accompanied by a high level ofanxiety. These symptoms soon worsened and the patient o the Emergency Service for a clinical picture characteriz by auditory believed that after a persecutory delusions towards her parents. In detail, she short trip, her parents had been replaced by impostors and that the new them were planning showed a depressive with frequent of energy and difficulties sleeping and concentrating. Delusion was not extended person or inanimate object, ond was not associated with redupicative sia. Her parents showod at he time of a sense of guilt and a depressive mood with unsupportivo interactions with their child. At the following visit they revealed an by difficulties in caring for herself. Nevertheless, their their child, frustration, and angor toward t overal social skills in interaction and communication were within the normal A nosis o Delusional Episode' based on the Diagnostic and Statistical Manual of Mental Disorders (4th edition) was performed using Schedule for Affective Disorders and Schizophrenia for Sc e Children. The qualitative pattern of the delusion, concerning the identity of her parents despite still recognizing the semblance of their body, is typical of Capgras syndrome, which misidentification syndromes 12l The girl was is the best known among delusional physical and neurological examinatlon. The electroencephalography was also normal whereas the resonance imaging (MR showed a cerebellar arachnoid cyst of non-patholog relevance. The results of other diagnostic tests including electrocardiography sequential multiple analysis comprehensive metabolic panel, complete blood ina child with Capgros syndrome: a case d. Clinical picture and treatment implication reporte Joumal Medical Cooe Reports 2012, 406 http/Awnnmedsgacomtreeotscomloontentialll40sExplanation / Answer
1. Temporal lobe of brain is ultimately malfunctioning in the case of ‘Capgras Syndrome’.
Capgras syndrome occur due to a disconnection between the temporal cortex, where faces are usually recognized and the limbic system, involved in emotions. More specifically, the disconnection occurs between the amygdala and the inferotemporal cortex. That’s why the girl cannot recognize her parent as her own.
2. In Capgras syndrome, the patient has the delusional belief in the existence of identical doubles of significant people in patient’s life or the patient’s himself or herself. That’s why in this disease a person holds a delusion that a friend, spouse, parent, or other close family member (or pet) has been replaced by an identical-looking impostor.
Due to this reason the girl might suffering from depression withsadness, crying, and anxiety.
3. An EEG revealed normal background rhythm without epileptic foci. That’s why it is unremarkable in Capgras syndrome.
4. The basic difference beween Alzheimer disease and Capgras syndrome is –