By Petr Carsky, Miroslav Urban
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A more recent series (Johnson 1984) had twice the prevalence of ‘organic’ cases. This may reflect advances in diagnostic techniques, especially non-invasive neuroimaging. In JoystonBechal’s (1966) series almost half of the stupors resolved within a week, and only one-fifth lasted more than a month. The six patients who remained in stupor for more than 6 months were all severely brain damaged. Knowledge of the antecedent psychiatric history is often invaluable in suggesting the cause, and a careful neurological examination is always essential with special attention to signs that may indicate a diencephalic or upper brainstem lesion (see Diencephalon and brainstem, earlier in chapter).
Typically the patient with uncomplicated depression is able to give a more coherent account of his discomforts and a more accurate chronology of his illness than would be possible in the presence of cerebral disease. These important aspects of differential diagnosis are considered more fully in the section on depressive pseudodementia (Chapter 9). Personality disorder is especially liable to be suspected where frontal lobe dysfunction is concerned, for example following injury or in the early stages of a frontal dementia.
Non-dominant lesions impair the learning and retention of non-verbal patterned stimuli, such as music, or faces and drawings to which a name cannot be attached. Personality disturbances identical with those accompanying frontal lesions may occur, but will more commonly be associated with intellectual and neurological deficits. Basic Concepts in Neuropsychiatry | Chronic temporal lobe lesions are notorious for their association with disturbance of personality, and particularly with emotional instability and aggression.
Ab Initio Calculations: Methods and Applications in Chemistry by Petr Carsky, Miroslav Urban