"My mind goes dead I cannot speak": an expression of DPD.

INTRODUCTION: Here we present a case of Depersonalisation-Derealisation Disorder which involves an unusual environmental trigger and profile of symptoms in a patient with an underlying left frontal encephalomalacia. METHODS: The clinical information has been collected from multiple neurological, psychiatric, neuropsychological examinations and from the patient's medical records. RESULTS: The neuropsychiatric assessment showed depersonalisation, derealisation, de-somatisation and de-affectualisation, along with a good response to SSRI + Lamotrigine; all typical features of DPD. The neuropsychological assessment showed language problems, and other mild cognitive difficulties that may provide a neuropsychological foundation contributing to the DPD episodes. DISCUSSION AND CONCLUSION: Given Mr R's underlying neuropsychological deficit, hearing voices without speech-associated gestures might place excessive demands on his ability to process the information, exacerbating his feelings of threat. This sets up the pattern of suppressed insula activation, and possibly the suppression of the auditory cortex leading to the presented unusual DPD symptoms.

Imagine that: cholinesterase inhibitor treatment of complex visual hallucinations of unknown aetiology.

Introduction: Our objective is to highlight the value of the neurophenomenological classification of complex visual hallucinations (VHs). This approach enabled the authors to successfully treat VHs of uncertain aetiology with cholinesterase inhibitors because the content of the hallucinations suggested dysfunction in cholinergic modulated networks.Methods: We utilise the single case report to describe the nature and content of chronic VHs experienced by a 49-year-old woman following a prolonged admission to ITU. Despite extensive investigation, no clear cause was identified for these hallucinations and the patient did not respond to rationalisation of medications or trials of antipsychotics. We therefore adopted the neurophenomenological approach to classifying and treating her VHs.Results: After several years of distressing visual hallucinations, a course of Rivastigmine was trialed despite no evidence suggestive of a Parkinsonian syndrome. Nevertheless, the patient reported a dose-effect response with significant reduction in the frequency and intensity of her hallucinations, almost to complete resolution.Conclusions: At present there is limited evidence about the medical management of visual hallucinations. This case report suggests that cholinesterase inhibitors may be of benefit, even in the absence of clear parkinsonsian features, if the form and content of the VHs suggest dysfunction in cholinergic modulated attentional networks.

Role of p53 assessment in management of Barrett's esophagus.

The risk of developing gastroesophageal adenocarcinoma is increased in patients with Barrett's esophagus. The management of dysplasia in Barrett's esophagus remains controversial. Understanding of the sequence of events preceding malignancy is essential before screening protocols for early diagnosis and preventive measures can be implemented. The aim of this review is to examine the published data on the role p53 assessment may play in the management of Barrett's esophagus. Relevant papers were identified by an extensive text word search of the Medline database and a review of quoted articles. The p53 abnormality occurs more frequently in highly dysplastic epithelium than in nondysplastic epithelium. However, the retrospective nature of most of the available data could be a significant confounding factor. Our current knowledge suggests that p53 protein overexpression does not seem to predict future progression to cancer or determine disease outcome. The p53 abnormality alone can not be reliably used to predict progression of Barrett's esophagus to cancer. We must await long-term evaluation of patients to determine the percentage of patients with p53 gene abnormality, and nondysplastic Barrett's who will progress to dysplasia or carcinoma. Large randomized controlled long-term follow-up studies are much needed.