This short report deals with “neurological disorders with psychiatric mask”, the aim is to present and summarize neurological illnesses that can mimic all kinds of psychiatric illnesses or disorders. This paper is part of the teaching given by Mrs Evrard in the first year Master’s degree (HPS7-3B: Cognitive Functioning and Dysfunction in Adults and the Elderly). The purpose of this article is to inform psychology students and professionals working on this topic. In my opinion, this knowledge is necessary for retirement home psychologist. In addition, it allows adequate care since the very beginning.
“Neurological disorders with psychiatric mask” are particularly misleading since it involves primary manifestations similar to certain psychiatric diseases or disorders. When these symptoms predominate, patients can be referred to psychiatry as a first line of treatment, especially if they have a psychiatric history. Moreover, it is known that these misguided orientations can lead to delays in diagnosis, the outcomes of which can be deleterious and dramatic for the patient.
First of all, it is necessary to define these neurological affections with a psychiatric mask. Among these illnesses we consider different disorders, the latter being multiple we will not focus exhaustively on all of them in this article; however, further reading is offered at the end of the article if you wish to know more about this subject. In this article we focus in particular on “frontal variant fronto-temporal degeneration” (fv-FTD), the other pathologies being: brain tumour, vascular, infectious and inflammatory pathologies. This neurological disorder mimics some of the symptoms of depression, bipolarity and mania. Its definition, clinical description and differential diagnoses will then be presented.
Fv-FTD-vf is also known as “Pick’s disease”, it appears early (approx. 45 to 50 years old) and affects both women and men. It involves an atrophy of the frontal and temporal lobes. This neurological condition can affect functions such as: language, behavior regulation, cognitive functions, initiative and emotions. It is characterized by insidious changes in behavior and personality. These changes are often blamed on fatigue or stress. In this affection, 2 major forms exist, the apathetic (or pseudo-depressive) form and the uninhibited (or pseudo-psychopathic) form. So far there is no curative treatment for this disease, the affected patients will gradually reach a bedridden state.
If we look at the clinical description of this pathology, 8 main symptoms should be considered. First of all, it is physical and domestic neglect (1). Physical neglect can take many forms, from hair and nail care to wearing soiled clothes or losing one’s coquetry. Domestic neglect can be characterized by the abandonment of the maintenance of the housing, the Situation of carelessness or the Syndrome of Diogenes. Changes in eating behavior (2) are also characteristic of this pathology, they are often characterized by a new attraction for sweets and alcohol (Hyperphagia, gluttony, Hyperorality or Selective feeding) as well as significant weight gain. The Verbal and cognitive disinhibition (3) implies for patients a loss of social conventions, hurtful remarks or sexual disinhibition. Collectionism (4) and reckless spending (5) are also among the symptoms of this disorder. Emotional control disorders (6) are also representative, and may include sudden outbursts of anger, aggression, indifference with loss of empathy, or emotional reactions inappropriate to the context. Apathy (7), or loss of interest/initiative and social avoidance should also be considered. Finally, fixed ideas and “stereotypes” (8) (Obsessive Compulsive Disorder, Behavioural Rigidity, Ideal Perseverations, etc.) can also be part of the clinical picture.
This neurological affection involves various differential diagnostics, which must be distinguished and considered in order to make up for inadequate orientations and diagnostic errors. To illustrate this, I will mention, in a non-exhaustive way, some of the symptoms of fv-FTD that may be associated with certain psychopathological disorders and what is more in favour of one or the other.
If we take the example of Changes in eating behavior (2), we can see that in the case of an eating disorder (Bulimia, Hyperphagia), there is voluntary and induced vomiting as well as an awareness of the pathological character associated with a painful experience. In the case of vf-FTD, there is total indifference, no guilt and no voluntary and induced vomiting. If we now focus on emotional control disorders and social avoidance, the symptoms of fv-FTD (Apathy, Emotional Control Disorders) should not be confused with anti-social behaviour. In fv-FTD there is emotional indifference with loss of empathy, an indifference to respect rules without the will to break them, and insensitivity to the consequences of actions. Whereas in anti-social behaviour it is not an inability to conform to social norms, but rather a willingness to transgress rules, the rights of others in order to satisfy these desires, whether for profit or desire.
As a psychologist or future psychologist, you will potentially be confronted with this type of situation. Then, this information may perhaps enable you to make your hypotheses taking this information into account and thus orient more accurately the patients who fit into this type of clinical picture. I hope that this information will have been useful to you, that it will allow you to enrich your knowledge about these neurological diseases and that in the long term we will be able to promote the future of patients with this type of pathology.
To learn more about these pathologies, I recommend that you read some of the articles:
Gigi, A., Pirrotta, R., Kelley-Puskas, M., Lazignac, C., & Damsa, C. (2006). Troubles du comportement aux urgences, ou démence fronto-temporale? Un défi pour les psychiatres. L’Encéphale, 32(5), 775-780.
Walter, C., Greth, P., & Weibel, H. (2005). De la psychose à la démence : un cas de démence à corps de Lewy en psychiatrie. L’Information Psychiatrique, 81(8), 727-731.
Riquin, E., Malka, J., Dubas, F., & Duverger, P. (2013). Encéphalite limbique à expression psychiatrique chez une adolescente. Quelle place pour le sujet ?. Neuropsychiatrie de l’enfance et de l’adolescence, 61(2), 125-130.