A girl with normal milestones spend her time seeing her own hand, do not interact with others, what is the diagnosis ?
Autism Prevasive developmental disorder includes the following condition :- Autism - Rett's disorder - Asperger's disorder - Childhood disintegrative disorder - Pervasive disorders not otherwise specified Pervasive development disorders are characterized by three symptom clusters? i) Impairment in social reciprocity marked by poor eye contact, lack of interest in other people and failure to interact appropriately with others. ii) Communicative impairment, it is characterized by either no language at all or by dent speech with errors in tone, prosody, pitch, grammar, or pragmatics. iii) Restricted and repetitive behaviours include using the same words and phrases repeatedly out of context, performing the same action in routine ways or insisting that others do so, or exhibiting other vocal or visual self stimulatory behaviours.Stereotype movements are seen. Stereotype movements are apparently purposeless movements such as hand flapping, head rolling or body rocking.) Now, the salient feature of each pervasive disorder: Autistic disorder It gives all the classical features of pervasive developmental disorder. The patient presents with problems in social interaction, communication and repetitive sterotype behaviour. In most of these patients there is subnormal intelligence. Example A 3 year old boy shows no interest in or connection to his parents, other adults or children. He does not speak voluntarily and is fascinated with watching rotating objects. He screams fiercely when his environment is altered in any way such as when his mother tries to dress him. Rett's disorder It is seen exclusively in females. The characteristic feature of these patients is that they begin to lose their acquired skills. Example After 4 months of normal development, an infant begins to lose her acquired skills. By 18 months of age, she shows little social interaction with her parents, other adults or children and she uses strange hand gestures. Asperger's disorder The impoant point in differential diagnosis of these patients is that they have normal intelligence. These are the only pervasive development disorders in which the intelligence is unimpaired. These patients often have some exceptional ability. They have little or no developmental language delay and relatively normal cognitive development. In the question the lack of social interaction and communication along with stereotypic behaviour (watching her own hard) suggests Autistic disorder. The patient does not give any symptoms of attention deficit disorder i.e. there are no symptoms indicating lack of concentration and hyperactivity. The patients of ADHD can also present with symptoms similar to pervasive developmental disorder but the main complaint will always be that of attention deficit and hyperactivity. Patients with depression should give other features of depression. 200. Ans is (I)) i.e. Serotonin Suicide is caused by diminished serotonin level Serotonin is a hormone that acts as neurotransmitter. Serotonin levels in our body affects a wide range of mental and physical responses and plays a significant role in activities such as temperature regulation, longer sensations, ,sexual behaviour and sleep patterns. Serotonin receptors also help to regulate emotions, cognition, pain and sensory motor function. Serotonin deficiencies can give rise to wide range of illnesses depending on the pa of the brain that is affected. Other neurotransmitters may send the message that we are full but serotonin level determines if we are satisfied. Low serotonin levels in the brain are linked to clinical depression, suicidal tendencies, anxiety disorders, obsessive compulsive behaviours (such as builimia), schizophrenia sleep problems, migraine, headaches, autism, drug and alcohol addiction, Alzhiemer's diseases and patterns of violent behaviour. "Diminished central serotonin plays a role in suicidal behaviour. A group at the karolinska institute was the first to note that low concentrations of the serotonin metabolite 5 Hydroxy indoleacetic acid (5HIAA) in the lumbar cerebro spinal fluid (CSF) were associated with suicidal behaviour." This finding has been replicated many times and in different diagnostic groups. Postmoem neurochemical studies have repoed modest decrease in serotonin itself or 5HIAA, in either the brain stem or frontal coex of suicide victims. Post moem receptor studies have repoed significant changes in presynaptic and postsynaptic serotonin binding sites in suicide victims.
ADHD
Autism
Schizophrenia
Depression