help mental deasease

Simone Palmeri s.palmeri at comune.livorno.it
Wed Jun 11 14:09:51 EST 1997


ATTENTION READ ME !!!!!!!!!!!!!!!!!!


A young boy suffers from a disease which, at the moment, has not found
solution.

Here you can find a detailled medical description of his disease.


University of Siena
Institute of Nervous and Mental Diseases
Director: Prof. P. C.

RESULTS OF THE INSTRUMENTAL ANALYSIS MADE BY MR. G. V.

On the 18th November 1996 Mr G. V. was recovered by the day hospital
in
this Centre for an obsessive-compulsive disturb and treated with
Clorazepam (2 mg/die), Fluoxetine (40 mg/die), Clomipramine (37,5
mg/die).
The anamnesis reveals a positive familiarity with obsessive-compulsive
behaviour, anxiety disturbs and the presence of obsessive-compulsive
behaviour indicating unsureness.
The clinical situation has begun with a symptomatology characterized
by
obsessive ideation on his own body, dubitative obsession,
ablutomanical
rituals, and the appearance of a lingual tic. An ipomaniacal episode
and
disturbs of the feeding (bulimical crisis) are present in comorbidity.
Testistical and instrumental analysis have been made during the
degency.
The elaboration of clinical questionaries (Autovaluation scale for
obsessions and compulsions, Leyton Questionary for the
obsessive-compulsive disturb, Yale Brown Scale for the
obsessive-compulsive disturb, Valuation Scale for the
psychopatological
symptoms-SCL-90) reveals the obsessive necessity to know or remember
something, control and cleaning rituals, compulsive repetition of
words or
sentences, difficulties in concentrating.
The control of the patient over obsessions and compulsions is good and
the
interference with daily activities is moderate. Other significant
psychopatological components are absent.
>From neuropsychological exam no important deficit for the cognitive
functions examined is revealed, except for Manari's Towers Test, which
shows a certain difficulty for the patient to identify an operative
strategy and to foresee its consequentiality. This deficit can,
together
with the strategy used to realise Rey's Figure, be ascribed to a
little
disfunction of the left frontal lobe, which anyway admits normal
results
for the other tests.
The SPECT has shown iperfixation of the prefrontal bilateral cortex,
peculiarly on the right side and on the right temporal-occipital
region.
Prevailing flux' distribution on the right temporal-frontal side and
on
the left lenticular nucleus as regard to the respective counterlateral
structures. Nothing to be noticed concerning cerebrellum.
Consequently the exams are in agreement for the diagnosis of
Obsessive-Compulsive Disturb, which gravity is medium. This typology
of
disturb is typical for dubitative obsession, polarization on one's own
body, ablutomanical rituals. This clinical situation can be confirmed
by
the scintigraphy as regards to the iperfixation of the contrast liquid
on
the prefrontal level, even if this would normally be found on the left
part, as far as the obsessive patients are concerned. While a
disfunction
of subcortical structures (the lenticular nucleus in the examined
case) is
described in the DOC, testifying an alteration of the
frontal-striated-talamic-frontal circuit, the other cortical areas
(temporal-occipital and frontal-temporal areas), which are seriously
damaged in the examined case (under the SPET exam), are not normally
involved in cases of typical obsessives. It is not rare to notice,
peculiarly in persisting disturbs, an "extension" of the disfunction
to
other cerebral parts, which clinical significance is not clear
(comorbidity? other atipical synthomatological aspects? resistance to
therapies?).
Considering the whole clinical situation and the course of this
disturb,
medium-long times of specifical therapy are forecast.


							The Director
							   Prof. P.C.


This is a very important problem for the patient and for his
relatives, as
far as he is married and he has children to take care of.
The patient has already made several specifical exams, but these have
not
given any useful solution for his disease. 


If you can help us, please put yourself in countact with us through
this
e-mail address:     s130922 at studenti.ing.unipi.it

or you can write to:
Vezzi Giancarlo
Via W.Tobagi, 12
56022 Castelfranco di Sotto (PI)
Italy

We would like to thank anyone who will show their interest for the
disease, and who can help us in solving it.












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