Table of contents :

Epidemiology : a national survey of US citizens has found that 6% of them have a debilitating mental illness. More startling, almost 50% of those surveyed were found to have had a mental disorder at some point during their lives; > 25% had had 1 in the year before the interview. Treatment is hard to get, and often not sufficient when available. Only about 33% of those in care receive "minimally adequate treatment", such as the appropriate drugs or a few hours of therapy over a period of several months^{ref1, ref2, ref3, ref4}. The statistics are nearly impossible to compare with previous studies, thanks to constantly changing definitions of mental illness, but in general things don't seem to have changed much over the past decade. > 9,000 US adults, chosen randomly, were visited in their homes as part of the National Comorbidity Survey, which looks at the incidence of multiple mental disorders. An interview then probed to see whether they had mental difficulties as determined by the latest Diagnostic and Statistical Manual of Mental Disorders. The study also classified the severity of disorders, separating them into severe, moderate or mild conditions. The definition of disorders used by the study was quite broad. A few instances of road rage, for example, might qualify as an intermittent explosive disorder. Such a wide net may not be any use in determining who needs medication or treatment, but the survey does provide some useful information. It reveals, for example, that 50% of those with a mental disorder encountered problems before their 14th birthday. This indicates that watching for signs of mental distress in early years could help to avert larger problems in the future. Progress will be made in finding biological markers that can help distinguish children who are simply shy or have a quick temper from those whose difficulties are likely to degenerate into illness, perhaps through an analysis of genes or brain scans. Meanwhile, the first order of business is to improve the quality of treatment. The prevalence of mental disorders did not change during the decade (29.4% between 1990 and 1992 and 30.5% between 2001 and 2003), but the rate of treatment increased. Among patients with a disorder, 20.3% received treatment between 1990 and 1992 and 32.9% received treatment between 2001 and 2003. Overall, 12.2% of the population 18 to 54 years of age received treatment for emotional disorders between 1990 and 1992 and 20.1% between 2001 and 2003. Only about half those who received treatment had disorders that met diagnostic criteria for a mental disorder. Significant increases in the rate of treatment (49.0% between 1990 and 1992 and 49.9% between 2001 and 2003) were limited to the sectors of general medical services (2.59 times as high in 2001 to 2003 as in 1990 to 1992), psychiatry services (2.17 times as high), and other mental health services (1.59 times as high) and were independent of the severity of the disorder and of the sociodemographic characteristics of the respondents. Despite an increase in the rate of treatment, most patients with a mental disorder did not receive treatment. Continued efforts are needed to obtain data on the effectiveness of treatment in order to increase the use of effective treatments^ref.
Web resources : Do I Need Therapy online test
 

• geriatric psychiatry / geropsychiatry : a subspecialty of psychiatry dealing with mental illness in the elderly.
• neuropsychiatry : the branch of medicine which includes both neurology and psychiatry.

• addiction psychiatry : a subspecialty concerned with the diagnosis and treatment of addiction and other problems related to substance use.
• administrative psychiatry : that concerned with the organization and management of mental health programs and facilities, including public and private hospitals, clinics, and centers.
• biological psychiatry : that which emphasizes biochemical, neurological, and pharmacological causes and treatment approaches.
• community psychiatry : the branch of psychiatry concerned with the detection, prevention, and treatment of mental disorders as they develop within psychosocial, cultural, or geographical areas, with emphasis given to environmental factors.
• consultation liaison psychiatry : that which connects psychiatry with other areas of medicine, bringing a psychosocial approach to the biological treatment of organic illness
• cross-cultural or transcultural psychiatry : the study of mental illness and mental health among different societies, nations, and cultures
• descriptive psychiatry : psychiatry based on the study of observable symptoms and behavioral phenomena, rather than underlying psychodynamic processes
• dynamic psychiatry : psychiatry based on the study of the unconscious mechanisms, conflicts, and other emotional processes that motivate and underlie human behavior, rather than the more observable behaviors themselves
• existential psychiatry : that based on the existential philosophy of Kierkegaard, Heidegger, Jaspers, and others, holding the view that a person takes responsibility for his own existence.
• forensic psychiatry : psychiatry which deals with the legal aspects of mental disorders.
• industrial or occupational psychiatry : that concerned with the diagnosis and prevention of mental illness in the work setting, including aspects of absenteeism, accident proneness, personnel policies, occupational fatigue, substance abuse, vocational adjustment, retirement, interpersonal relations, and related phenomena.
• military psychiatry : the study and treatment of psychiatric problems done under the auspices of military organizations such as induction centers, training facilities, and military hospitals; it includes emergency and nonemergency treatment for active-duty and retired military personnel and their dependents.
• orthomolecular psychiatry : that based on the theory that psychiatric illnesses are due to disturbances in the molecular environment of the brain and can be cured by restoration of optimal concentrations of substances normally present in the body, such as vitamins (orthomolecular therapy).
• preventive psychiatry : that broadly concerned with the amelioration, control, and limitation of psychiatric disability. It is often categorized as primary—measures to prevent a disorder; secondary—therapeutic measures to limit a disorder; and tertiary—measures and intervention to reduce impairment or disability following a disorder.
• social psychiatry : that concerned with the cultural, ecologic, and sociologic facts that engender, precipitate, intensify, prolong, or otherwise complicate maladaptive patterns of behavior and their treatment.
• orthopsychiatry : an interdisciplinary field that combines psychiatry with principles of psychology, sociology, social work, and other fields in the study and practice of maintaining or restoring mental health, emphasizing a prophylactic approach to mental disease.

• emotional illness : a colloquialism roughly equivalent to “mental disorder,” but not usually applied to those with a specific organic etiology or to mental retardation.
• organic mental disorder : a term formerly used to denote any mental disorder with a specifically known or presumed organic etiology; now discouraged because of the implication that other mental disorders do not have an organic basis. The term was also sometimes used to denote an organic mental syndrome. Current classification divides these disorders into :
• delirium, dementia, amnestic and other cognitive disorders
• mental disorders due to a general medical condition
• substance-related disorders
• organic hallucinosis : a term used in a former system of classification, denoting an organic mental syndrome characterized by the presence of hallucinations caused by a specific organic factor and not associated with delirium. Such disorders are now mainly classified as substance-induced psychotic disorders and psychotic disorders due to general medical condition
• disorders of consciousness
• quantitative (hypnoid) alterations
• increased consciousness (secondary to stress or mania)
• restriction of consciousness
• obnubilation / clouding of consciousness / mental fog / obtundation : a lowered level of consciousness with loss of ability to respond properly to external stimuli.
• torpor : lack of response to normal or ordinary stimuli.
• idiopathic recurrent stupor (IRS) / endozepine stupor

Aetiology : transient large (up to 300-fold compared with control patients) increase of endozepine-4 content in CSF and serum, with a return to normal concentrations between attacks
Symptoms & signs : episodes of stupor lasting hours or days beginning between ages 18 and 67 years; sometimes spontaneously disappearing after 4-6 years with symptoms
Laboratory examinations : fast (14- to 16-Hz), unreactive background activity at EEGs
Differential diagnosis : exogenous bendodiazepine intoxication
Therapy : oral flumazenil (0.25 mg i.v.)
• coma
Aetiology :
• pharmacological (ethanol, cannabinoids)
• epilepsy
• complex partial seizure
• petit mal epilepsy
• transient global amnesia
• psychiatric disorders
• loss of consciousness
• malingering
• syncope
• generalized tonic-clonic epilepsy
• qualitative alterations (disorders of structuration of consciousness)
• disorientation
• confusional state (delirium)
• crepuscolar state
• dreamy or oniroid state : a state of altered consciousness lasting for a few minutes and accompanied by hallucinations; associated with temporal lobe lesions
• expansion of consciousness (trance, psychostimulant substances)
• disorders of self consciousness (depersonalization : alteration in the perception of the self so that the usual sense of one's own reality is lost, manifested in a sense of unreality or self-estrangement, in changes of body image, or in a feeling that one does not control his own actions and speech; seen in disorders such as depersonalization disorder, depression, dissociative disorders, hypochondriacal neurosis / hypochondriasis, temporal lobe epilepsy, schizophrenic disorders, and schizotypal personality disorder. Some do not draw a distinction between depersonalization and derealization, using depersonalization to include both.
• autopsychic depersonalization : experiences are felt as foreign
• somatopsychic depersonalization : the body or some parts seem not self, detached, or died
• allopsychic depersonalization / derealization : a loss of the sensation of the reality of one's surroundings; the feeling that something has happened, that the world has been changed and altered, that one is detached from one's environment. It is seen most frequently in schizophrenic disorders.
• déjà entendu [Fr. “already heard”] : the feeling that one has heard or perceived something previously although it is in fact new to one's experience
• déjà éprouvé [Fr. “already tested”] : a feeling that one has previously engaged in or experienced something when one has not
• déjà fait [Fr. “already done”] : a feeling that what is happening has happened before.
• déjà pensé [Fr. “already thought”] : a feeling that one has thought the same thoughts before.
• déjà raconté [Fr. “already told”] : a feeling when telling someone about an experience that one had previously related the same experience either to them or to someone else, when in fact one had not.  2. a feeling that a long-forgotten event which is being recalled was told to one before, when it was not.
• déjà vécu [Fr. “already lived”] . a feeling that a new experience has been encountered before, in a previous existence.
• jamais vécu [Fr. “never lived”] : a feeling that a common experience has never been encountered before
• déjà voulu [Fr. “already desired”] : a feeling that one has entertained the same desires before.
• déjà vu [Fr. “already seen”] : an illusion in which a new situation is incorrectly viewed as a repetition of a previous situation
• jamais vu [Fr. “never seen”] : the sensation that familiar surroundings are strangely unfamiliar; the illusion that one has never seen anything like that before.
• disorders of attention
• hyperprosexia : a condition in which the mind is occupied by one idea to the exclusion of others, e.g. in mania
• hypoprosexia : distraction, difficult concentration, attention deficit
• disorders of memory
• asemia / asemasia / asymbolia : aphasia with inability to employ or to understand either speech or signs
• aphasia : any of a large group of speech disorders involving defect or loss in thought <=> speech conversion (the power of expression by speech, writing, or signs, or of comprehending spoken or written language), due to injury or disease of the brain or to psychogenic causes in patients who had acquired the ability of speech. Less severe forms are known as dysphasia.

An inability to process language needn't stop you from doing maths : 3 men with severe aphasia, a linguistic impairment, can understand 'grammatical' rules in mathematics even though they cannot handle analogous rules in language. Aphasia leaves people unable to use or comprehend words, and is often triggered by stroke or other brain injuries. The discovery challenges a commonly held view that linguistic and mathematical mental processing draw on the same cognitive resources. According to the view of cognition developed by linguist Noam Chomsky, language processing is a fundamental skill that is used for related grammatical tasks in the brain, such as certain mathematical ones. Previous studies of the relationship between linguistic and mathematical ability have lent some support to this notion. For example, brain-imaging studies have shown that some areas of the brain involved in language processing also become active when people are performing mathematical tasks. But it has been unclear whether this use of neural language centres is essential for maths: there are also indications that the two mental functions can work independently. All 3 of their patients were aged between 50 and 60 and were well educated; one had been a university professor before incurring a brain lesion. The 3 men were almost entirely unable to communicate verbally or in writing, but they clearly retained much of their higher mental functioning and could communicate, for example, through "highly expressive" drawings. Their impairments left them unable to decode the grammatical relationships of simple sentences. For example, they had great difficulty distinguishing subject and object in the phrase "The boy chased the girl," which they were unable to differentiate from "The girl chased the boy." Analogous object-relation problems are posed by mathematical expressions such as 90 ÷ 30 and 30 ÷ 90. More complex expressions might involve problems of nesting, such as the use of brackets (90 - [(3 + 17) x 3]), which mirror linguistic sub-clauses and embedded relations, such as in the phrase "The man who killed the lion was angry." Although the patients were unable to decode such linguistic expressions, they were all able to perform the mathematical calculations accurately with pen and paper. They could interpret Arabic numerals correctly even though they struggled to understand number words such as 'three' or 'ninety', when spoken or written. It might be possible to use this capacity for mathematical grammar to help the patients find a way to interpret speech and the written word.
• monophasia : aphasia with ability to utter but one word or phrase
• paraphasia / paragrammatism / paraphemia / paraphrasia : a type of dysphasia in which the patient employs wrong words or uses words in wrong and senseless combinations
• central paraphasia : that due to a brain lesion.
• literal paraphasia / paralalia literalis : utterance of certain consonant sounds, often as part of stuttering
• thematic paraphasia : incoherent speech characterized by wandering from the subject.
• agrammatism / agrammatologia / dysgrammatism : inability to speak grammatically because of brain injuryor disease, usually with simplified sentence structure (telegraphic speech) and errors in tense, number, and gender
• syntactical aphasia : a type of agrammatism in which some necessary elements for coherent sentences are lacking.
• acquired epileptic aphasia / Landau-Kleffner syndrome (LKS) : an epileptic syndrome in which children, usually 3-8 years of age who have developed age-appropriate speech, experience language regression with verbal auditory agnosia, abnormal epileptiform activity, behavioral disturbances, and sometimes overt partial or generalized seizures, psychomotor abnormalities, and aphasia progressing to mutism. The EEG from bilateral temporal regions is abnormal, with spikes like those of benign rolandic epilepsy.

Therapy : there are no controlled clinical trials investigating the therapeutic options for LKS. Only open-label data are available. Early diagnosis and initiation of prompt medical treatment appear to be important to achieving better long-term prognosis. Several antiepileptic drugs have been reported to be beneficial in treating this syndrome. These include valproic acid, diazepam, ethosuximide, clobazam, and clonazepam. Reports on the efficacy of lamotrigine, sultiame, felbamate, nicardipine, vigabatrin, levetiracetam, vagal nerve stimulation, and a ketogenic diet are few and more experience is needed. Carbamazepine and possibly phenobarbital and phenytoin have been reported to occasionally exacerbate the syndrome. As initial therapy, valproic acid or diazepam is often empirically chosen. Subsequently, other antiepileptic drugs, corticosteroids, or IVIG therapy are often used. GR agonists therapy should probably not be delayed > 1-2 months after the initial diagnosis. Various corticosteroid regimens including oral prednisone and, recently, high doses of intravenous pulse corticosteroids, as well as ACTH have been reported to be effective in LKS. Oral corticosteroids are used more often and usually need to be maintained for a long period of time to prevent relapses. The use of IVIG has been associated with an initial dramatic response in only a few patients. In our experience, a long-term worthwhile improvement has been noted in only 2 of 11 patients. These two patients had an immediate response to IVIG initially and after relapses before eventually achieving a long-term sustained remission.Surgical treatment by multiple subpial transection, which is reserved for patients who have not responded to multiple medical therapies, has been followed in selected cases by a marked improvement in language skills and behavior. However, a widely accepted consensus about suitable candidates for this surgery and about its efficacy is still lacking. Speech therapy, including sign language, and a number of classroom and behavioral interventions are helpful in managing LKS, and should be used in all patients^ref
• anomic, amnesic, amnestic or nominal aphasia / aphasia nominnum / anomia : defective recall of names of objects or words to verbalize his/her own thought, with intact abilities of comprehension and repetition, due to lesions of temporoparietooccipital carrefour. It is diagnosed when found in > 20% of spontaneous speech
• tactile aphasia : anomic aphasia characterized by inability to name objects that are touched
• acalculia : inability to do simple arithmetical calculations

Aetiology : Gerstmann's syndrome
• dyscalculia : impairment of the ability to do mathematical problems because of brain injury or disease

Aetiology : Turner's syndrome
Laboratory examinations :
• cognitive tests.
• MRI detects abnormal pulses of activity in the right intraparietal sulcus
Diagnosis is further complicated because many people simply dislike maths. This might be due to mediocre teaching or low motivation
• central aphasia : a term that has been used as a synonym for various aphasias that involve disturbance in word selection, grammar, and sentence structure apart from elementary auditory or visual comprehension and the ability to write legible characters and speak aloud. Many are presumed to be due to lesions of brain centers (motor speech areas)
• global, central, complete, expressive-receptive, total or mixed aphasia : aphasia involving all the functions of spoken or written language and comprehension, due to large lesions in speech areas
• Broca's expressive, anterior, motor, frontocortical or nonfluent aphasia / logaphasia : aphasia in which there is impairment of the ability to speak (inertia, mutism) and write, owing to a lesion in the insula and surrounding operculum, including Broca's motor speech area. The patient understands many written and spoken words but has difficulty uttering the words (loss of prosodia) => nosognosia => anger and depression. Often associated with manifest hemiplegia => the patient is asked to write with the left hand as the right one is paretic.

Symptoms & signs : Dejerine-Lichtheim sign or phenomenon : in some types of motor aphasia the patient cannot speak but can indicate with fingers the number of syllables in a word being thought of
• Wernicke's receptive, impressive, posterior or sensory aphasia : inability to understand written, spoken, or tactile speech symbols, due to disease of the auditory and visual word centers. The speech is began without difficulties and no motor deficiency is usually associated.
• acoustic or auditory aphasia / word deafness : a form of receptive aphasia in which sounds are heard but convey no meaning to the person affected, due to disease of the subcortical pathways leading to the main auditory center of the brain, or disease of the center itself => hypo- or anosognosia => anger as he/she feels ununderstood
• fluent aphasia : a type of receptive aphasia in which speech is well articulated with satisfactory melodic intonation, syllable stress, and phrasing but has gross errors in grammatical structure and is lacking in content => "word salad" (phonemic, verbal and semantic (within the same category) paraphasias, neologisms)
• semantic aphasia : aphasia characterized by a lack of recognition of the full significance of words and phrases, or faulty use of words, phrases, or sentences; words heard, seen, spoken, or written are misunderstood or used incorrectly in place of other words in the same class.
• associative, commissural or conduction aphasia : a type of aphasia characterized by normal comprehension and speech but inability to repeat words correctly; said to be caused by lesions in the pathways connecting Broca's motor speech area and Wernicke's area (arciform fasciculus)
• transcortical aphasia : a type of conduction aphasia believed to be caused by a lesion of a pathway between the speech center and other cortical centers, but often reflecting large lesions in brain areas other than the perisylvian region of the hemisphere dominant for speech and language. The patient may repeat words (echolalia) but cannot speak independently.
• transcortical motor aphasia : due to lesions of anterior marginal areas (premotor and prefrontal areas; secondary, marginal or accessory areas). Symptoms are similar to those seen in Broca's aphasia (good comprehension and reduced spontaneous speech), but repetition is impaired
• transcortical fluent aphasia : due to lesions of posterior marginal areas. Symptoms are similar to those seen in Wernicke's aphasia
• conduite d'approche
• phonemic
• semantic
• combined aphasia : aphasia of 2 or more forms occurring concomitantly in the same person.
• graphomotor aphasia / agraphia : impairment or loss of the ability to write; it takes 2 forms, one involving poor morphology of written letter forms and the other a reflection of the aphasia also observed in spoken language
• absolute or literal agraphia / agraphia atactica : loss of the power to form even single letters.
• acoustic agraphia : loss of the power of writing from dictation.
• jargon agraphia / agraphia amnemonica : agraphia in which the patient can write correctly formed letters but forms only senseless combinations of letters or words.
• cerebral or mental agraphia : agraphia due to inability to put thought into phrases.
• motor agraphia : inability to write because of lack of motor coordination.
• musical agraphia : loss of the power to write musical symbols.
• optic agraphia : inability to copy written or printed words, but with ability to write from dictation.
• verbal agraphia : ability to write single letters, with loss of ability to combine them into words or sentences
• dysgraphia : difficulty in writing
• echographia / pseudoagraphia : a type of dysgraphia in which the patient can copy writing, but cannot write to express ideas
• micrographia : a dysgraphia in which handwriting is tiny or decreases in size from normal to minute, seen in parkinsonism
Aetiology : Gerstmann's syndrome
• gibberish or jargon aphasia / jargonaphasia : utterance of meaningless phrases, either neologisms or incoherently arranged known words; it is sometimes a symptom of certain types of schizophrenia
• bradylalia / bradylogia / bradyarthria / bradyphasia : abnormally slow utterance of words due to a brain lesion or mental disorder (e.g. parkinsonism)
• visual aphasia / alexia
Aetiology :
• functional aphasia : aphasia associated with a psychogenic disorder.
• intellectual or true aphasia : aphasia due to a lesion of any one of the speech centers
• acute : TIA
• chronic : space-occupying lesions
Laboratory examinations :
• Lichtheim test : if a patient is able to indicate the number of syllables in a word which he cannot utter, it indicates that the cortex is less involved than the association fibers.
• Broadbent's test (for cerebral dominance of language function) : different numbers (or words) are presented simultaneously to the 2 ears; right-handed persons tend to report first the words going into the right ear.
Web resources : National Aphasia Association
• Liepmann's apraxia : loss of ability to carry out familiar, purposeful movements in the absence of paralysis or other motor or sensory impairment
• akinetic apraxia : loss of ability to carry out spontaneous movement.
• amnestic apraxia : loss of ability to carry out a movement on command as a result of inability to remember the command, although ability to perform the movement is present.
• Bruns' apraxia of gait / Bruns' frontal ataxia
• Cogan's congenital oculomotor apraxia : an absence or defect of horizontal eye movements, so that when the patient tries to look at an object off to one side, the head must turn to bring the eyes into line with the object and the eyes exhibit nystagmus; the cause is probably a brain lesion
• constructional apraxia : a type of deficit in motor skills characterized by lack of ability to copy simple drawings or to reproduce patterns created with building blocks or matchsticks.

Aetiology : Gerstmann's syndrome
• dressing apraxia : inability to dress oneself properly, often on just one side, as a result of a lesion in the parietal lobe, usually on the nondominant side
• buccofacial or facial apraxia : apraxia of the facial muscles with inability to carry out movements for expression, articulation, and other functions; caused by a lesion in either the supramarginal gyrus or the motor association area on the dominant side. It may be associated with ideokinetic apraxia
• classic, ideokinetic, ideomotor or transcortical apraxia / apraxia : inability to carry out movements that are part of normal activities when requested, in imitation of a demonstration, or even when the person spontaneously wishes to do them. The name is derived from the older concept that ideas were not linked to movements
• innervatory or motor apraxia : impairment of skilled movements that is greater than or different in form from that caused by weakness of the affected parts; the patient appears clumsy rather than weak
• sensory or ideational apraxia : loss of ability to make proper use of an object, due to lack of perception of its proper nature and purpose or to gross disorganization of a plan of usage
• apraxia of speech / aphemia : a speech disorder similar to motor aphasia, due to apraxia of mouth and neck muscles because of a lesion interfering with coordination of impulses from Broca's motor speech area
• hemiapraxia : apraxia affecting one side of the body only.
• sensory or unilateral neglect / selective inattention : hemiapraxia with failure to pay attention to bodily grooming and stimuli on one side but not on the other, usually due to a lesion in the CNS, as after a stroke
• agnosia / pragmatagnosia :
• pragmatamnesia / visual agnosia :
• dysmnesia : properly said memory disorders, impaired memory, as in the amnestic syndrome
• quantitative disorders
• hypermnesia : extreme retentiveness or unusual clarity of memory
• permanent hypermnesia (e.g. Pico della Mirandola)
• idiot savant
• transient hypermnesia : mania, hypomania, hysteria
• hypomnesia : defective memory
• amnesia : lack or loss of memory; inability to remember past experiences.
• circumscribed or localized amnesia : loss of memory for all events during a discrete, specific period of time
• generalized amnesia : loss of memory encompassing the individual's entire life.
• continuous amnesia : loss of memory for all events after a certain time, continuing up to and including the present.
• tactile amnesia / astereognosis
• visual amnesia / alexia
According to chronological succession of memories :
• global amnesia
• transient global amnesia : an episode of short-term memory loss, usually nonrecurrent, and lasting a few hours, without other signs or symptoms of neurological impairment; the cause is usually unknown but may occasionally be an ischemic or epileptic attack. The patient is irrequiet and continuously repeats the same questions.
• lacunar or localized amnesia : partial loss of memory; amnesia for certain isolated experiences.
• anterograde or fixation amnesia : impairment of memory for events occurring after the onset of amnesia; inability to form new memories
• retrograde or reevocation amnesia : inability to recall events that occurred before the actual onset of amnesia; loss of memories of past events
• retroanterograde amnesia
According to kinds to impaired memories :
• simple amnesia : all kined of memories are impaired
• systematic or selective amnesia : loss of memory for a group of related events but not for other events occurring during the same period of time.
• episodic amnesia : amnesia for a particular episode or a small area of experience.
Aetiology :
• infantile amnesia : the usual inability to recall the events of infancy and early childhood.
• dissociative or psychogenic amnesia
• neurological amnesia : that caused by disease of or injury to the nervous system.
• post-traumatic or traumatic amnesia : amnesia resulting from concussion or other brain injury
• postconcussional amnesia : amnesia resulting from a concussion of the brain.
• posthypnotic amnesia : a directed forgetfulness of the subject for experiences undergone while in the hypnotic state.
• amnesic, amnestic-confabulatory or dysmnesic syndrome : a mental disorder characterized by impaired memory with anterograde amnesia and sometimes retrograde amnesia in a normal state of consciousness; i.e., the syndrome does not include the impaired memory seen in dementia or delirium. There may be disorientation, confabulation, and lack of insight into the memory deficit

Aetiology :
• thiamine deficiency from chronic alcohol abuse (Wernicke-Korsakoff syndrome)
• any pathological process causing bilateral damage to parts of the medial temporal lobe or diencephalon, such as the hippocampal formations, mammillary bodies, or dorsal medial nuclei of the thalamus
• brain injury
• brain tumors
• brain infarction
• cerebral hypoxia
• carbon monoxide poisoning
• herpes simplex encephalitis
• paramnesia : qualitative disorders, a disturbance of memory in which reality and fantasy are confused
• allomnesia / memory illusion : deformation of actual memories, incomplete memories, or inadequate in spatiotemporal location, alterated in meaning, easily correctable (e.g. holothymic thought, paranoid states, ...)
• pseudomnesia / memory hallucination : not correctable
• false identifications : new situations are seen as memories (dejà vu)
• false memories : incapacity to differentiate between fantasy and reality (e.g. confabulation, false memories in holothymic or delirating thought)
• disorders of intelligence
• bradyphrenia / bradyphrasia / mental insufficiency : stable slowness of thought or fatigability of initiative, resulting from depression or CNS disease
• dementia : generally evolutive deficiency
• axis I : symptomatology, monothetic diagnosis (all criteria have to be fulfilled => many false negatives => repetibility = 80%) : developmental disorders, delirium, dementia, and amnestic disorders, substance-related disorders, psychoses, neuroses, factitious disorders, sleep disorders, impulse control disorders, adjustement disorders
• axis II : behavioural, polytethic diagnosis (only some criteria have to be fulfilled => many false positives => repetibility = 50%) : personality disorders, mental retardation
• axis III : general medical conditions
• axis IV : psychosocial and environmental problems
• problems with main supporting group
• problems related to social environment
• learning disorders
• job problem
• house problem
• economical problems
• problems with access to health care services
• problem related with interaction with legal system or criminality
• other psychosocial or environmental problems
• axis V : global assessment of functioning (GAF) scale : a rating of psychiatric status from 1 (lowest level of functioning) to 100 (highest level), assessing psychological, social, and occupational functioning; widely used in studies of treatment effectiveness (actual, at admission, at dimission, higher level in last year)
• Social and Occupational Functioning Assessment Scale (SOFAS) : one that describes the level of an individual's social and occupational functioning, either present or past; unlike the GAF scale, it is not directly influenced by the severity of the individual's psychological symptoms

• mental retardation : a mental disorder characterized by significantly subaverage general intellectual functioning associated with impairments in adaptive behavior and manifested before age 18. It is classified on the basis of severity as ..
• borderline mental retardation : borderline intellectual functioning, that in which IQ is between 70 and 89.
• mild mental retardation : that in which IQ is between 50–55 and 69; the person can develop social and communication skills during the preschool period, has minimal sensorimotor impairment, by the late teens can acquire academic skills up to the sixth grade level, and usually achieves social and vocational skills adequate for minimal self-support.
• moron : obsolete, offensive term for a person with mild mental retardation
• imbecile : obsolete and offensive name for a person with an intermediate level of mental retardation, now split into...
• moderate mental retardation : that in which IQ is between 35–40 and 49–55; the person may talk or learn to communicate but has poor social awareness and only fair motor development, is unlikely to progress to the second grade level in academic skills, but can profit from vocational training and with moderate supervision can perform personal care.
• severe mental retardation : that in which IQ is between 20–25 and 34–40; the person has poor motor development and minimal speech in the preschool period, may learn to talk by the late teens, can be trained in elementary hygiene skills, and as an adult may learn to perform simple work under close supervision.
• idiot savant [Fr. “learned idiot”] : a person with severe mental retardation in some respects, yet has a particular mental faculty that is developed to an unusually high degree, as memory, mathematics, or music.
• profound mental retardation : that in which IQ is < 20–25; the person has limited sensorimotor development, may achieve very limited self-care, and requires a highly structured environment with constant supervision.
• idiot : obsolete, offensive name for a person with profound mental retardation
• mongolian idiot : former name for a person affected with Down syndrome; now considered offensive
• mental retardation-not otherwise specified (NOS)
Aetiology :
• hyperphenylalaninemia
• Cockayne syndrome (CS)
• von Hippel-Lindau (VHL) syndrome
• cerebrotendinous xanthomatosis
• Alport's syndrome
• Usher syndrome
• fragile site mental retardation (FMR)
• Patau syndrome
• Edwards syndrome
• Down syndrome
• X-linked mental retardation (XLMR)

Aetiology : mutations in the gene polyglutamine binding protein 1 (NPQBP1)
Symptoms & signs : in affected males include mental retardation, microcephaly, short stature, spastic paraplegia and midline defects.
Laboratory examinations : Denver Developmental Screening test : a test for identification of infants and preschool children with developmental delay.
Differential diagnosis :
• normal variations in school results
• lack of opportunities
• poor teaching
• cultural factors
• visual or auditory insufficiency
Web resources : Mental retardation at CDC
• learning disorders : a group of disorders characterized by academic functioning that is substantially below the level expected on the basis of the patient's age, intelligence, and education, interfering with academic achievement or other functioning. Included are :
• reading disorder : a learning disorder in which the skill affected is reading ability, including accuracy, speed, and comprehension
• mathematics disorder : a learning disorder in which the skill affected is mathematical calculation or reasoning.
• disorder of written expression : a learning disorder in which the affected skill is written communication, characterized by errors in spelling, grammar, or punctuation, by poor paragraph organization, or by poor story composition or thematic development.

Differential diagnosis :
• poor graphia
• developmental coordination disorder
• motor skills disorder : any disorder characterized by inadequate development of motor coordination severe enough to limit locomotion or restrict the ability to perform tasks, schoolwork, or other activities. Included is
• developmental coordination disorder : problematic or delayed development of gross and fine motor coordination skills, not due to a neurological disorder or to general mental retardation; affected children appear to be clumsy rather than grossly impaired. It may persist into adulthood.

Differential diagnosis :
• specific neurological disorder (e.g. cerebral palsy, progressive cerebellar lesions)
• mental retardation
• pervasive developmental disorders
• attention-deficit/hyperactivity disorder (ADHD)
• communication disorders : mental disorders characterized by difficulties in speech or language, severe enough to be a problem academically, occupationally, or socially; included are
• expressive language disorder : a communication disorder occurring in children and characterized by problems with the expression of language, either oral or signed. It includes difficulties such as limited speech or vocabulary, vocabulary errors, difficulty or hesitation in word selection, oversimplification of grammatical or sentence structure, omission of parts of sentences, unusual word order, and slowed acquisition of language skills. Two types are recognized, acquired and developmental.

Differential diagnosis :
• mixed receptive-expressive language disorder
• autistic disorder
• mental retardation
• auditory or other sensory deficit
• word motory deficit
• severe environmental deprivation
• disorder of written expression
• selective mutism
• acquired aphasia associated with general medical condition
• mixed receptive-expressive language disorder : a communication disorder involving both the expression and the comprehension of language, either spoken or signed. Patients have difficulties with language production, such as in the selection of words and the creation of appropriate sentences, and also have trouble understanding words, sentences, or specific types of words

Differential diagnosis :
• expressive language disorder
• autistic disorder
• mental retardation
• auditory or other sensory deficit
• word motory deficit
• severe environmental deprivation
• disorder of written expression
• selective mutism
• acquired aphasia associated with general medical condition
• phonological disorder : a communication disorder of unknown etiology, characterized by failure to use age- and dialect-appropriate sounds in speaking, with errors occurring in the selection, production, or articulation of sounds. The most common errors are omissions, substitutions, and distortions of speech sounds

Differential diagnosis :
• mental retardation
• auditory or other sensory deficit
• severe environmental deprivation
• stuttering
• communication disorder-not otherwise specified (NOS)
• stuttering / psellism

Epidemiology : 5% of people in the USA at some time in their lives. Stuttering usually begins in the preschool years, and there is a higher incidence in males. Stuttering usually starts in the third and fourth years of life, after a period of apparently normal speech development. Around 5% of children begin to stutter (Bloodstein O. A handbook on stuttering. San Diego, CA: Singular Publishing Group, 1995). Although the recovery rate without professional intervention is 74%^ref, the natural recovery rate of cases presenting to clinics has not been researched. To date, sex and family history of recovery are the major identified predictors of natural recovery. Girls are more likely to recover than boys, and children with a family history of recovery are more likely to recover than those without such a history. Natural recovery does not seem to be related to severity of stuttering^ref.
Aetiology : a complex interaction among many factors, including genetic, language, motor and emotional. These findings will help reduce the stigma – such as the myth that the disorder is the result of poor parenting or a psychological problem – often associated with stuttering
Pathogenesis : adults who stutter often have great language skills, meaning they don't have problems with rules of grammar or with the sounds we use to code the words of our language. When they speak, however, their motor output falters, so they pause or trip over words. The study of their brain activity when they were not stuttering and, in fact, when they were not having to engage their speech motor systems shows that individuals who stutter are using right hemisphere brain areas to a greater extent to accomplish the rhyming tasks than those who don't stutter^ref
Symptoms & signs : a speech disorder involving 3 factors:
• dysfluency with repetition of words and parts of words, prolongations of sounds, interjections of sounds or words, and long pauses
• listener reaction, considering the dysfluency to be abnormal or unacceptable
• the speaker's reaction to the dysfluency and to the listener's reaction, with a self-conception as a stutterer.
Differential diagnosis :
• auditory or other sensory deficit
• word motory deficit
• normal fluency anomalies that often occur in little babies
Therapy : the consensus now is that stuttering should be treated in the preschool years, primarily because it becomes less tractable as children get older. This is presumably because neural plasticity decreases with age. Also, it is not possible to know in advance whether an individual child will recover naturally. Early intervention in the preschool years is therefore essential. Once stuttering becomes chronic, communication can be severely impaired, with devastating social, emotional, educational, and vocational effects^{ref1, ref2}. Several treatments for early stuttering are currently available (Onslow M, Packman A, eds. The handbook of early stuttering intervention. San Diego, CA: Singular Publishing Group, 1999), but only one, the Lidcombe programme, has been studied with phase I and II clinical trials (Onslow M, Packman A, Harrison E, eds. The Lidcombe program of early stuttering intervention: a clinician's guide. Austin, TX: Pro-Ed, 2003). This programme is a behavioural treatment developed specifically for stuttering in children of preschool age (younger than 6). Considerable research into the programme has been conducted. Preliminary studies have produced positive outcomes, and stuttering has been shown to be no longer present, or remaining at very low levels, two to seven years after treatment^{ref1, ref2, ref3} (Lincoln M, Onslow M. Long-term outcome of an early intervention for stuttering. Am J Speech-Language Pathol 1997;6: 51-8). The social validity and safety of the programme have been shown (Lincoln M, Onslow M, Reed V. Social validity of an early intervention for stuttering; the Lidcombe program. Am J Speech-Lang Pathol 1997;6: 77-84). It does not seem to change children's behaviour other than speech or affect the attachment of children and parents or use of language^{ref1, ref2}. Duration of treatment and its predictors have been investigated in two independent file audits of preschool children attending specialist clinics, one in Australia^ref and one in the United Kingdom^ref. Outcomes of the Lidcombe programme have consistently been shown to be positive^{ref1, ref2, ref3, ref4, ref5, ref6, ref7} (Lincoln M, Onslow M. Long-term outcome of an early intervention for stuttering. Am J Speech-Language Pathol 1997;6: 51-8; Lincoln M, Onslow M, Reed V. Social validity of an early intervention for stuttering; the Lidcombe program. Am J Speech-Lang Pathol 1997;6: 77-84) even in a randomised controlled trial^ref. Waiting for an extended period to see if natural recovery occurs is not acceptable because it seems that the Lidcombe programme is less efficacious once children move into the school age years (Lincoln M, Onslow M, Wilson L, Lewis C. A clinical trial of an operant treatment for school-age stuttering children. Am J Speech-Lang Pathol 1996;5: 73-85). In addition, delaying treatment until the school age years is not a viable option because of the negative social and cognitive consequences of stuttering at this age^ref. If the disorder persists into the school age years a child is exposed to the unacceptable risk of experiencing the disabling effects of chronic and intractable stuttering throughout life.
• stammering : a speech disorder marked by involuntary pauses; sometimes used synonymously with stuttering, especially in Great Britain.
• communication disorder-not otherwise specified (NOS)
• rhotacism / pararhotacism : a speech disorder consisting of imperfect pronunciation of the r sound
• pervasive developmental disorders (PDD) / autistic spectrum disorders (ASD) : a group of disorders characterized by impairment of development in multiple areas, including the acquisition of reciprocal social interaction, verbal and nonverbal communication skills (e.g declarative pointing, gaze monitoring, gaze escape, mimicking), and imaginative activity and by stereotyped interests and behaviors

Epidemiology : prevalence = 4-5 cases every 1,000 people
• autism / autistic disorder / infantile autism / Kanner's syndrome : a severe pervasive developmental disorder with onset usually before 3 years of age and a biological basis related to neurologic or neurophysiologic factors
• autistic thinking / autism : self-absorption; preoccupation with inner thoughts, drives, and idiosyncratic logic; egocentric, subjective thinking lacking objectivity and preferring a narcissistic, inner, private reality to that which is externally validated. Used interchangeably with dereistic thinking, although differing in emphasis
• dereistic thinking / dereism : thinking not in accordance with the facts of reality and experience and following illogical, idiosyncratic reasoning. Used interchangeably with autistic thinking, although not an exact synonym: dereistic emphasizes disconnection from reality and autistic emphasizes preoccupation with inner experience.
Epidemiology : frequency of the disorder increased from approximately 2.5 cases every 10,000 in 1960-1970s to 1 every 1,000 children in 1990s, with a male to female ratio of 4:1.
Aetiology :
• genetic predisposition^ref to autism is evident from family (frequency of autism among siblings of probands with autism = 2-4% (RR = 20-60)) and monozygotic twin (high concordance) studies, and heritability in idiopathic autism is estimated at over 90%. Family studies and several genome-wide linkage analyses support the hypothesis of complex inheritance with involvement of as many as 5-10 genes of moderate effect. All chromosomes except 14 have at least 1 patient with autism associted with them : mendelian, double hit, trinucleotide repeats, mtDNA, or polygenic inheritance has been proposed. There is an autism susceptibility gene on chromosome 1 and further on chromosomes 6 and 19. 33% of autistic individuals experience seizures. A susceptibility locus for autism was mapped near a cluster of voltage-gated sodium channel genes on chromosome 2. Mutations in 2 of these genes, SCN1A and SCN2A, result in the seizure disorder GEFS+. The variant R1902C in SCN2A is located in the calmodulin binding site and was found to reduce binding affinity for calcium-bound calmodulin. R542Q in SCN1A was observed in one autism family and had previously been identified in a patient with juvenile myoclonic epilepsy
• endocrine
• infectious
• some cases of late-onset (regressive) autism may involve abnormal flora because oral vancomycin, which is poorly absorbed, may lead to significant improvement in these children. Fecal flora of children with regressive autism was compared with that of control children, and clostridial counts were higher. The number of clostridial species found in the stools of children with autism was greater than in the stools of control children. Children with autism had 9 Clostridium spp. not found in controls, whereas controls yielded only 3 species not found in children with autism. In all, there were 25 different clostridial species found. In gastric and duodenal specimens, the most striking finding was total absence of non-spore-forming anaerobes and microaerophilic bacteria from control children and significant numbers of such bacteria from children with autism. These studies demonstrate significant alterations in the upper and lower intestinal flora of children with late-onset autism and may provide insights into the nature of this disorder^ref
• subacute, chronic Clostridium tetani infection of the intestinal tract as the underlying cause for symptoms of autism observed in some individuals. A significant percentage of individuals with autism have a history of extensive antibiotic use. Oral antibiotics significantly disrupt protective intestinal microbiota, creating a favorable environment for colonization by opportunistic pathogens. C. tetani is an ubiquitous anaerobic bacillus that produces a potent neurotoxin. Intestinal colonization by C. tetani, and subsequent neurotoxin release, have been demonstrated in laboratory animals which were fed vegetative cells. The vagus nerve is capable of transporting tetanus neurotoxin (TeNT) and provides a route of ascent from the intestinal tract to the CNS. This route bypasses TeNT's normal preferential binding sites in the spinal cord, and therefore the symptoms of a typical tetanus infection are not evident. Once in the brain, TeNT disrupts the release of neurotransmitters by the proteolytic cleavage of synaptobrevin, a synaptic vesicle membrane protein. This inhibition of neurotransmitter release would explain a wide variety of behavioral deficits apparent in autism. Lab animals injected in the brain with TeNT have exhibited many of these behaviors. Some children with autism have also shown a significant reduction in stereotyped behaviors when treated with antimicrobials effective against intestinal clostridia. When viewed as sequelae to a subacute, chronic tetanus infection, many of the puzzling abnormalities of autism have a logical basis^ref.
• toxic :
• attenuated measles vaccine (expecially in measles-mumps-rubella (MMR) vaccine). The UK government has been accused of blocking imports of measles and mumps vaccines, sending prices soaring to force parents into using the controversial measles, mumps, rubella (MMR) triple jab. Doctors in Edinburgh, Glasgow and London are now charging more than £100 for a single measles or mumps vaccine because it is increasingly difficult to get them in the UK. In recent months, the government has cut supplies further, restricting them to only 25 doses per day.
• diphtheria, tetanus and pertussis (DTwP) vaccine : it deposits 25 mg of ethyl mercury into a child.
Pathogenesis : mirror neurons are brain cells in the premotor cortex. First identified in macaque monkeys in the early 1990s, the neurons -- also known as "monkey-see, monkey-do cells" -- fire both when a monkey performs an action itself and when it observes another living creature perform that same action. Though it has been impossible to directly study the analogue of these neurons in people (since human subjects cannot be implanted with electrodes), several indirect brain-imaging measures, including EEG, have confirmed the presence of a mirror neuron system in humans. The human mirror neuron system is now thought to be involved not only in the execution and observation of movement, but also in higher cognitive processes -- language, for instance, or being able to imitate and learn from others' actions, or decode their intentions and empathize with their pain. Suppression of m rhythm (8–13 Hz) over sensorimotor cortex correlates with mirror neuron activity and is defective in subjects with autism spectrum disorders : one therapeutic possibility suggested by the study's findings is biofeedback. Another possible therapy would involve ordinary mirrors^ref
Symptoms & signs : affected individuals look normal at birth, and the symptoms manifest at the first 2-3 years of life (median : 13.8 months), with medical diagnosis at median 2.7-6.8 years (differential diagnosis with mental retardation or language disorders is stable if done before age 2, sure since month 18). The spectrum of clinical symptoms and the severity of the disorder are variable even among siblings. Qualitative impairment in reciprocal social interaction (e.g., lack of awareness of the existence of feelings of others, failure to seek comfort at times of distress, lack of imitation), in verbal and nonverbal communication, and in capacity for symbolic play, and by restricted and unusual repertoire of activities and interests. Other characteristics sometimes include cognitive impairment (> 66% have some degree of mental retardation), hyper- or hyporeactivity to certain stimuli, stereotypic behaviors, neurological abnormalities such as seizures or altered muscle tone, sleeping or eating pattern abnormalities, and severe behavioral problems. As adults they develop OCD and mental retardation (higher functioning PDD : high IQ in adulthood).
Laboratory examinations : several screening instruments have been developed to quickly gather information about a child's social and communicative development within medical settings. Among them are
• Checklist of Autism in Toddlers (CHAT)^ref
• modified Checklist for Autism in Toddlers (M-CHAT)
• Screening Tool for Autism in Two-Year-Olds (STAT)^ref
• Social Communication Questionnaire (SCQ)^ref (for children 4 years of age and older).
Some screening instruments rely solely on parent responses to a questionnaire, and some rely on a combination of parent report and observation. Key items on these instruments that appear to differentiate children with autism from other groups before the age of 2 include pointing and pretend play. Screening instruments do not provide individual diagnosis but serve to assess the need for referral for possible diagnosis of ASD. These screening methods may not identify children with mild ASD, such as those with high-functioning autism or Asperger syndrome.
Differential diagnosis :
• Rett syndrome
• childhood disintegrative disorder
• Asperger's syndrome
• schizophrenia
• selective mutism
• expressive language disorder
• mixed receptive-expressive language disorder
• mental retardation
Therapy :
• educational approaches (Treatment and Education of Autistic and Related Communication Handicapped CHildren (TEACCH))
• psychosocial
• drugs (risperidone)
• probiotics
Web resources : Autism at CDC
• Rett syndrome (RTT / RTS) / cerebroatrophic hyperammonemia : a PDD affecting the gray matter of the brain

Epidemiology : 1:10,000 individuals, occurring exclusively in females and present from birth
Aetiology : dominant mutations in the MECP2 gene, a X-linked transcriptional repressor. A severe early-onset Rett phenotype that often includes seizures or infantile spasms can be caused by mutation in the CDKL5 gene
Pathogenesis : the timing of the period of regression in RTT--during ages 1 to 2 years--parallels the period of intense synaptic development. The effects of the MECP2 mutation also increases concomitantly with peak synaptogenesis. Neuropathological findings in Rett include the selective reduction of dendritric spines in the pyramidal cells of RTT brains; this feature has also been reported in autism. Studies have observed that MECP influences the expression of brain-derived neurotrophic factor and thus may influence synaptic plasticity. Abnormalities in synapse maintenance and modulation may contribute to regression in RTT and autism. A recent study observed abnormal expression of MeCP2 in RTT and other neurodevelopmental disorders such as autism. Although the genetic background and certain clinical features differ in RTT and autism, a similar mechanism involving MeCP2 regulation and expression may contribute to regression^ref.
Symptoms & signs : progressive and is characterized by autistic behavior (but a preserved speech variant exists), ataxia, dementia, seizures, and loss of purposeful use of the hands, with cerebral atrophy, mild hyperammonemia, and decreased levels of biogenic amines. During the regression stage, RTT girls display many autistic features, such as loss of communication and social skills, poor eye contact, and lack of interest, and initially may be given the diagnosis of autism.
Differential diagnosis :
• autistic disorder
• childhood disintegrative disorder
• Asperger's syndrome
Experimental animal models : the phenotype of one mouse model includes features such as regression and abnormal behavioral and social interactions.
• childhood disintegrative disorder : pervasive developmental disorder characterized by marked regression in a variety of skills, including language, social skills or adaptive behavior, play, bowel or bladder control, and motor skills, after at least 2, but less than 10, years of apparently normal development.

Differential diagnosis :
• autistic disorder
• Rett syndrome
• Asperger's syndrome
• dementia
• Asperger's syndrome : a pervasive developmental disorder resembling autistic disorder, being characterized by severe impairment of social interactions and by restricted interests and behaviors, but lacking the delays in development of language, cognitive function, and self-help skills that additionally define autistic disorder. It may be equivalent to a high-functioning form of autistic disorder.

Laboratory examinations : during the last few years, screening instruments have been devised to screen for Asperger syndrome and higher functioning autism. The Autism Spectrum Screening Questionnaire (ASSQ)^ref, the Australian Scale for Asperger's Syndrome^ref, and the most recent, the Childhood Asperger Syndrome Test (CAST)^ref, are some of the instruments that are reliable for identification of school-age children with Asperger syndrome or higher functioning autism. These tools concentrate on social and behavioral impairments in children without significant language delay.
Differential diagnosis :
• autistic disorder
• Rett syndrome
• childhood disintegrative disorder
• obsessive-compulsive disorder (OCD)
• schizoid personality disorder
• pervasive developmental disorder-not otherwise specified (PDD-NOS)
• silent-treatment : a temporary act of teenage rebellion, usually the result of being confronted by a parent; extended silence used to avoid discussion about a drug or drinking problem
• attention-deficit/hyperactivity disorder and disruptive behavior disorders
• attention-deficit / hyperactivity disorder (ADHD) / hyperkinetic disorder (HKD) or syndrome : a childhood mental disorder

Epidemiology : prevalence = 3% to 10% of the pediatric population. Datamonitor estimates that 23 million children and adolescents across the 7 major pharmaceutical markets suffer from ADHD, a physician perceived prevalence rate of about 15%. However currently only 12% of those, or only 1.8% of children in the total population, are actually correctly diagnosed with ADHD. Despite the availability of numerous longer-acting therapies, currently only 20% of newly diagnosed patients receive such drugs as a first-line treatment, falling to 3% at second-line.
Pathogenesis : the number and density of DATs and DAT binding sites are increased by up to 70 %
Symptoms & signs : inattention (such as distractibility, forgetfulness, not finishing tasks, and not appearing to listen), by hyperactivity and impulsivity (such as fidgeting and squirming, difficulty in remaining seated, excessive running or climbing, feelings of restlessness, difficulty awaiting one's turn, interrupting others, and excessive talking) or by both types of behavior. The disorder is subtyped as
• combined type
• predominantly inattentive type (attention-deficit disorder (ADD))
• predominantly hyperactive-impulsive type
Behavior must interfere with academic, social, or work functioning, with impairment existing in at least two settings. Onset is before age 7 but it can persist into adulthood.
Differential diagnosis :
• behaviour adequate to gorgeous babies
• mental retardation
• poorly stimulating environments
• oppositional defiant disorder
• other mental disorders
• pervasive developmental disorders
• psychotic disorder
• substance-related disorders-NOS
• bronchodilators
• isoniazid
• neuroleptic-induced acute akathisia
Chemotherapy :
• stimulants, which, because of their addictive properties and potential for abuse, are controlled substances. The 14-month, controlled Multimodal Treatment Study of Children with Attention Deficit–Hyperactivity Disorder (MTA study), sponsored by the National Institute of Mental Health, revealed a high rate of response to stimulants (> 70%) and large effect sizes (0.6 to 1.2 standard deviations), with significantly lower rates of improvement for subjects who underwent psychotherapy^{ref1, ref2, ref3}. Although these drugs are the mainstay of treatment for ADHD, nearly one third of patients may not respond to or be able to tolerate them. The FDA advisory committee heard testimony indicating that 2.5 million children now take stimulants for ADHD, including nearly 10% of all 10-year-old boys in the USA^ref. The committee also learned that the use of these agents is much less prevalent in European countries, where the diagnosis of ADHD is relatively uncommon. Even more strikingly, 1.5 million adults now take such stimulants on a daily basis, with 10% of users older than 50 years of age. The diagnosis of "adult" ADHD is a relatively recent phenomenon and has resulted in the most rapid growth in the use of such agents^ref. The vast increase in the diagnosis of ADHD and the frequency of treatment for the condition in children is, unfortunately, no longer a phenomenon specific to the United States. According to the latest Drug Prescription Report (Schwabe U, Paffrath D. Arzneiverordnungsreport 2005. Berlin: Springer-Verlag, 2005), the number of daily doses of methylphenidate that are prescribed in Germany has reached 26 million per year. Although the population-adjusted volume in the USA is still 8 to 10 times that amount, the number of prescriptions for the drug for German children rose by a factor of 20 during the past 10 years, with no signs of abating. The use of methylphenidate by adults is similarly on the rise.
• amphetamines :
• d-threo-methylphenidate (d-MPH) (a dopamine agonist that blocks DAT, significantly increasing extra cellular dopamine, so correcting the dopamine deficiency in the frontal lobes and basal ganglia (expecially the striatum) structures, regions associated with attention and behaviouri. This is strikingly similar to the mechanism of action of cocaine, a primary stimulant drug of abuse. When administered intravenously, MPH like cocaine has reinforcing effects (euphoria) at doses that exceed a DAT blockade threshold of 60% (therapeutic doses of MPH block > 50% of DAT). When administered orally at clinical doses, the pharmacological effects of MPH also exceed this threshold, but reinforcing effects rarely occur). ADHD is a controversial problem in sport since participants with this disorder often require banned stimulant medication while competing.
• mixed salts
• NRI (atomoxetine), a nonstimulant approved by the US Food and Drug Administration
Web resources : Attention-deficit / hyperactivity disorder (ADHD) at CDC
• attention-deficit / hyperactivity disorder (ADHD)-not otherwise specified (NOS)
• disruptive behavior disorders : a group of mental disorders of children and adolescents consisting of behavior that violates social norms, is disruptive, and may be illegal, often distressing others more than it does the person with the disorder. It includes :
• conduct disorder : a type of disruptive behavior disorder of childhood and adolescence characterized by a persistent pattern of conduct in which rights of others or age-appropriate societal norms or rules are violated, with misconduct including aggression to people or animals, destruction of property, deceitfulness or theft, and serious violations of rules; depending on whether the behavior begins before or after the age of 10, it is classified as
• childhood-onset
• adolescent-onset
Differential diagnosis :
• oppositional defiant disorder
• attention-deficit/hyperactivity disorder (ADHD)
• mania
• adjustement disorders
• antisocial behaviour of child or adolescent
• antisocial personality (disorder)
• oppositional defiant disorder : a type of disruptive behavior disorder characterized by a recurrent pattern of defiant, hostile, disobedient, and negativistic behavior directed toward those in authority, including such actions as defying the requests or rules of adults, deliberately annoying others, arguing, spitefulness, and vindictiveness that occur much more frequently than would be expected on the basis of age and developmental stage

Differential diagnosis :
• conduct disorder
• mood disorders
• psychotic disorder
• attention-deficit/hyperactivity disorder (ADHD)
• mental retardation
• compromised language comprehension
• deafness
• mixed receptive-expressive language disorder
• typical characteristic of certain developmental stages (early childhood, adolescence, ...)
• disruptive behavior disorder-not otherwise specified (NOS)
• feeding and eating disorders of infancy or early childhood : any of several disorders in which abnormal feeding habits are associated with psychological factors
• bradyphagia : abnormal slowness in eating.
• monophagia : desire for one kind of food only
• pica : compulsive eating of nonnutritive substances, such as
• ice (pagophagia)
• dirt (geophagia)
• gravel
• flaking paint or plaster
• clay
• hair (trichophagia) => trichobezoar
• laundry starch (amylophagia)
• bone (osteophagia) due to a craving for phosphorus.
• dung, or feces (coprophagy)
In children this syndrome, classified with the eating disorders in DSM-IV, is a rare mental disorder with onset typically in the second year of life; it usually remits in childhood but may persist into adolescence.
Aetiology :
• pica and unusual food cravings (citta) are sometimes seen in pregnant women
• iron deficiency or zinc deficiency
Differential diagnosis :
• pervasive developmental disorders
• Kleine-Levin syndrome : episodic periods of excessive sleep and overeating lasting for several weeks, with amnesia for the attacks; it usually occurs in adolescent boys.
• schizophrenia
• rumination disorder
• anorexia nervosa
• bulimia nervosa
• feeding disorder of infancy or early childhood
• rumination disorder : an eating disorder seen in infants under 1 year of age; after a period of normal eating habits, the child begins excessive regurgitation and rechewing of food, which is then ejected from the mouth or reswallowed

Prognosis : if untreated, death from malnutrition may occur.
Differential diagnosis :
• congenital anomalies
• hypertrophic pyloric stenosis
• gastroesophageal reflux disease (GERD)
• normal involuntary vomiting of early childhood
• anorexia nervosa
• bulimia nervosa
• feeding disorder of infancy or early childhood : loss of weight increase for > 1 month in absence of gastrointestinal or other general medical condition (e.g. gastroesophageal reflux disease (GERD)) severe enough to explain the feeding anomaly and not attributable to other mental disorder (e.g. rumination disorder) or lack of available food.

Differential diagnosis :
• gastrointestinal condition
• endocrinological condition
• neurological condition
• tic disorders
• Gilles de la Tourette's syndrome (lasting > 12 months)
• chronic motor or vocal tic disorder (lasting > 12 months)
• transient tic disorder (lasting 1 < x < 12 months)
• single episode
• relapsing
• tic disorder-not otherwise specified (NOS) : lasting < 1 month, onset > 18 years, or single motor or vocal tic)
Differential diagnosis :
• general medical conditions
• Huntington's disease
• Lesch-Nyhan syndrome
• Wilson's disease / hepatolenticular degeneration
• Sydenham's chorea
• multiple sclerosis (MS)
• acute disseminated encephalomyelitis (ADEM)
• head injuries
• direct effect of a substance (e.g. neuroleptic drug)
• chorea
• athetosis
• myoclonus
• hemiballismus
• spasms
• hemifacial spasms
• synkinesis
• drug-induced movement disorder-not otherwise specified (NOS)
• pervasive developmental disorders
• compulsions
• schizophrenia
• evacuation disorders
• encopresis (for babies with a mental age > 4 years)
• with constipation and overfilling incontinence
• withouth constipation and overfilling incontince
Differential diagnosis :
• fecal incontinence associated with other medical conditions (e.g. chronic diarrhea)
• enuresis (not due to a general medical condition)
• only during bedtime
• only during daytime
• bedtime and daytime
Differential diagnosis :
• neurological bladder
• general medical condition causing polyuria or imperious micturition (e.g. untreated diabetes mellitus or diabetes insipidus
• acute urinary tract infection (UTI)
• other infancy, childhood, or adolescence disorders
• separation anxiety disorder
• selective mutism : a mental disorder of childhood characterized by continuous refusal to speak in social situations by a child who is able and willing to speak to selected persons.
• nyctaphonia : elective mutism with loss of voice during the night.
Differential diagnosis :
• communication disorders
• pervasive developmental disorders
• lack of knowledge of language in immigrants
• psychotic disorder
• severe mental retardation
• reactive attachment disorder : a mental disorder of infancy or early childhood, characterized by notably unusual and developmentally inappropriate social relatedness, usually associated with grossly pathological care. It may be :
• inhibited type, with failure to initiate or respond to social interactions
• disinhibited type, with indiscriminate sociability or attachment.
Differential diagnosis :
• pervasive developmental disorders
• mental retardation
• attention-deficit/hyperactivity disorder (ADHD)
• stereotypic movement disorder : a mental disorder characterized by repetitive nonfunctional motor behavior, such as hand waving, rocking, head-banging, or self-biting, which often appears to be driven and can result in serious self-inflicted injuries

Differential diagnosis :
• pervasive developmental disorders
• mental retardation
• obsessive-compulsive disorder (OCD)
• complex motor tic disorders
• trichotillomania
• factitious disorder with main physical signs and symptoms
• automutilation associated with certain psychotic disorder and personality disorders
• involuntary movements associated with neurological conditions
• behaviours of self-stimulation appropriated to little babies developmental stage (e.g. thumb suction, head hurting, ...)
• behaviours of self-stimulation in subjects with sensory deficiencies (e.g. blindness)
• infancy, childhood, or adolescence disorder-not otherwise specified (NOS)

• delirium / acute (organic) brain syndrome : an acute, transient disturbance of consciousness accompanied by a change in cognition and having a fluctuating course. Characteristics include reduced ability to maintain attention to external stimuli and disorganized thinking as manifested by rambling, irrelevant, or incoherent speech; there may also be a reduced level of consciousness, sensory misperceptions, disturbance of the sleep-wake cycle and level of psychomotor activity, disorientation to time, place, or person, and memory impairment.

Aetiology : conditions that result in derangement of cerebral metabolism, including
• delirium due to general medical condition
• systemic infection
• cerebral tumor
• seizures or head trauma
• metabolic disturbances such as fluid, electrolyte, or acid-base imbalance, hypoxia, hypoglycemia, or hepatic or renal failure
• febrile delirium : the delirium of fever.
• postcardiotomy delirium / postcardiotomy psychosis syndrome : anxiety, confusion, and perceptual disturbances occurring > 3 days after open heart surgery.
• senile delirium : a form of senile dementia, usually of acute onset and characterized by disorientation, restlessness, insomnia, hallucinations, and aimless wandering.
• traumatic delirium : that which follows severe head injury; superficially the patient is alert, but there is marked disorientation, memory defect, and confabulation.
• substance-induced delirium
• delirium due to multiple aetiologies
• delirium-not otherwise specified (NOS)
Grading :
• acute delirium : a suddenly appearing and severe delirium lasting only a short time.
• low delirium : delirium marked by confusion of ideas and slowness of mental action rather than by excitement.
Differential diagnosis :
• dementia
• susbtance intoxication
• substance withdrawal
• psychotic disorder
• mood disorders with psychotic features
• malingering
• factitious disorder
• dementia : literally out of mind, loss of self, i.e. a general acquired loss of intellectual and cognitive abilities, including impairment of memory as well as one or more of other abilities in subjects that have reached normality (on the contrary of mental retardation).

Epidemiology : 24.3 million people have dementia today, with 4.6 million new cases of dementia every year (one new case every 7 seconds). The number of people affected will double every 20 years to 81.1 million by 2040. Most people with dementia live in developing countries (60% in 2001, rising to 71% by 2040). Rates of increase are not uniform; numbers in developed countries are forecast to increase by 100% between 2001 and 2040, but by more than 300% in India, China, and their south Asian and western Pacific neighbours^ref.
Aetiology :
• primary or degenerative dementias
• cortical dementias
• dementia of the Alzheimer type / Alzheimer-type dementia (ATD) (43.6-60% of all dementias) : that occurring in Alzheimer's disease, being of insidious onset and gradually progressive course, with histopathological changes characteristic of Alzheimer's disease and not due to other CNS, systemic, or substance-induced conditions known to cause dementia. It is subcategorized on the basis of accompanying features, including
• delirium
• delusion
• depression
• behavioral disturbances
• none (uncomplicated)
Patients lose their ability to encode new memories, first of trivial and then of important details of life => both declarative and nondeclarative memory become profoundly impaired, and the capacities for reasoning, abstraction, and language slip away.
• presenile dementia / dementia of the Alzheimer type, early onset : occurring before age 65
• senile dementia / dementia of the Alzheimer type, late onset : occurring after age 65
• frontotemporal dementias (FTD) (10%; higher in presenile cases, i.e. < 65 years) : due to atrophy of frontal and eventually also temporal lobes
• frontotemporal dementia (FTD) with parkinsonism / frontotemporal lobar degeneration (FTLD) / multiple system tauopathy with presenile dementia (MSTD) / Wilhelmsen-Lynch disease (WLD) / disinhibition-dementia-parkinsonism-amyotrophy complex (DDPAC)

Aetiology : mutations in microtubule-associated protein (MAP) tau or presenilin 1 (PS1)
• Pick disease / circumscribed cerebral atrophy : a rare progressive degenerative disease of the brain very similar in clinical manifestations and course to Alzheimer's disease but having a distinctive histopathology; cortical atrophy is symmetric > asymmetric and is confined to the frontal and/or temporal lobes and sometimes may involve the basal nuclei

Epidemiology : onset at age 40-60
Laboratory examinations : balloon degenerating neurons contain Pick bodies
• autosomal dominant frontotemporal dementia (FTD) linked to chromosome 3 (FTD3)

Aetiology : a mutation in CHMP2B, encoding a component of the endosomal ESCRTIII complex, that results in aberrant mRNA splicing^ref
Symptoms & signs : behavioural and appetite disinhibition, emotive flattening, irritability, bulimia, weight gain, preserved memory, copying, calculation, memory, socially inadequate behaviours or isolation => rigidity and mutism