Deficit history

The patient may not be able to reliably report the history owing to cognitive or language deficits. A reliable history may have to come from a family member or another witness. 

Immunocompromised, history of CNS disease, new onset seizure, papilledema, altered consciousness, or focal neurologic deficit or delay in performance of diagnostic lumbar puncture... 

Fever and a history of headaches are the most common symptoms of cryptococcal meningitis, although altered mentation and evidence of focal neurologic deficits may be present. Diagnosis is based on the presence of a positive CSF, blood, sputum, or urine culture for Cryptococcus neoformans. 

The Folstein Mini-Mental State Examination (MMSE) can help to establish a history of deficits in two or more areas of cognition and establish a baseline against which to evaluate change in severity. The average expected decline in an untreated patient is 2 to 4 points per year. 

Dopamine-Stimulating Medications. A variety of drugs that increase the availability of dopamine have been studied in cocaine addicts including L-DOPA, bupropion, amantadine, and methylphenidate. In small uncontrolled trials, these have shown some benefit, but definitive studies have yet to be performed. In addition, some dopamine-stimulating medications (in particular, the stimulants like methylphenidate or the amphetamines) are themselves subject to abuse, though, of note, this is typically not a problem when they are prescribed to patients who do not have a history of substance abuse such as, for example, in the treatment of attention deficit-hyperactivity disorder. 

The increasing use of stimulants in the United States to treat attention deficit hyperactivity disorder (ADHD) has aroused parental concern and compelled both medical professionals and the media to question the safety and efficacy of this type of treatment. Because ADHD is among the most common reasons for seeking mental health services for children, these questions are more pertinent than ever. This chapter will examine the history of stimulant use, the mechanism of action, pharmacokinetics, side effects, and issues related to their clinical use in children and adolescents. More detailed information on clinical applications is provided in Section III. 

Biederman, J., Baldessarini, R.J., Wright, V., Keenan, K., and Fara-one, S. (1993b), A double-blind placebo controlled study of desipramine in the treatment of attention deficit disorder III. Lack of impact of comorbidity and family history factors on clinical response. J Am Acad Child Adolesc Psychiatry 32 199-204. 

Many clinical studies have now confirmed the existence of persistent cognitive deficits and dementia in association with neuroleptic use. However, to some extent, researchers have lost their enthusiasm for demonstrating over and over again that neuroleptics cause cognitive deficits, and textbooks of psychiatry simply do not want to mention it (e.g., Hales et al., 2003). This is reminiscent of the history of research into the brain-damaging effects of shock treatment (chapter 9). When repeated... 

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