Order Diogenes syndrome assessment

Order Diogenes syndrome assessment
A 76-year-old woman, with a threeyear history of dementia, lives at home
with her husband. She has been showing new aggressive behaviours, such as
attempting to hit the paid carers during personal care, kicking, scratching,
biting, spitting and ‘cursing’. At night,
in particular, she has been exhibiting
certain non-aggressive behaviours (e.g.
pacing up and down the corridor of the
flat, general restlessness and repetitive
mannerisms). She also appears to be
experiencing disengagement with the
environment around her. What would be
a reasonable first step in management?
A. carbamazepine
B. haloperidol
C. non-pharmacological interventions
for carers to use
D. repeated transcranial magnetic stimulation
E. tricyclic antidepressants
Specialty Topics 149
Question 245
Neighbours brought a 91-year-old Asian
man, who lived alone in a bungalow, to the
medical assessment unit of a district general hospital. The neighbours said they were
concerned that he was appearing to develop
dementia. Apparently, he disclosed to them
experiences of witnessing people and animals
in his house, including various-sized zebras
and ostriches, parrots and blue fish flying
across the room. He knew that these visions
were not real, but he was worried about
dementia being a likely diagnosis. The visions
lasted for minutes to hours, and the animals
were perceived to stare at him. His other
medical problems included chronic asthma.
He also was registered partially sighted, having been diagnosed with bilateral cataracts
and macular degeneration. He had never hallucinated before. What is the likely diagnosis?
A. Anton’s syndrome
B. Charles Bonnet syndrome
C. delirium
D. diffuse Lewy body disease
E. Diogenes syndrome (‘senile squalor
Question 246
A 72-year-old man appeared to remember nothing of his past, having travelled
suddenly and unexpectedly to attend
his ex-wife’s funeral. At the funeral, he
introduces himself using a different identity, and seems genuinely confused who
is. He was cognitively intact otherwise.
He had only sought neuropsychiatric
attention once he was seeking to recover
his original identity. He was a lifelong
non-drinker of alcohol. What is the most
likely diagnosis?
A. Alzheimer’s disease
B. delirium
C. Diogenes syndrome (‘senile squalor
D. dissociative fugue
E. transient global amnesia
Question 247
An 83-year-old white woman presented
with previous bilateral occipital lobe
infarcts. Despite her obvious blindness,
illustrated by her walking into objects,
she expressed total denial of visual loss
and demonstrated confabulation in her
accounts of her surroundings. On examination, she demonstrated a complete loss
of vision. Fundoscopy was unremarkable.
Ocular movements were found to be intact
if she was told in which direction to look,
however she was not be able to follow a
finger or light. Previous medical history
included coronary artery bypass graft surgery. Which is the most likely diagnosis?
A. Anton’s syndrome
B. Charles Bonnet syndrome
C. delirium
D. diffuse Lewy body disease
E. Diogenes syndrome (‘senile squalor
Question 24

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