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I am a psych provider with my own practice. Have a patient

will all sx of prodromal...
I am a psych provider with my own practice. Have a patient will all sx of prodromal schizophrenia, but yet some sx that baffle me. Binge eating to the point of sickness and not worried about weight( she is very thin,not bulemic), more cognitive dysfunx than would normally be seen with early schizophrenia (trouble understanding and speaking, memory loss, no concentration, language problems), personality changes that could be contributed to schizophrenia, no empathy, no desire to be around people. More. that are your htoughts? I'm going to refer her to a neurologist but still treat her schizo sx. These sx began 2 months ago and are worsening.  I hope an MD with experience in Picks Disease my review this.
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Answered in 13 minutes by:
7/27/2011
Dr. K
Dr. K, Psychiatrist
Category: Mental Health
Satisfied Customers: 358
Experience: 15 years clinical experience in all areas of psychiatry. Holistic and practical approach.
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Look for horses, not zebra's. Although, Occam's razor has its limitations, it's often a good paradigm for medicine. Anorexia is much more common than Pick's Disease. You must read The Golden Cage by Hilde Bruch, MD.
This book is one of the best around for eating disorders. What it helps you realize is that the 1st step in anorexia is getting the patient back to a normal weight. Starvation affects cognition in a very significant way and can often lead to symptoms which seem like delusions or other schizophrenia symptoms.
It doesn't hurt to refer to a neurologist to officially rule out Pick's disease, but I'm not hearing you mention any of the typical frontal lobe symptoms seen with such (impulsive, and almost manic-like behaviors). Review these links:
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001752/
http://www.mayoclinic.com/health/frontotemporal-dementia/DS00874/DSECTION=causes
I hope this helps. Let me know if you need more feedback. Good luck.
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Dr. K
Dr. K, Psychiatrist
Category: Mental Health
Satisfied Customers: 358
Experience: 15 years clinical experience in all areas of psychiatry. Holistic and practical approach.
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Customer reply replied 6 years ago

Thanks for your input. She doesn't have anorexia though, she eats compusively until she feels sick many times a day. She compusively thinks of food, but is not at all overweight. This came on quickly over just a few months. This is a sx I read about many times for picks disease. No manic symptoms. the cognitive dysfunction could be several things but is always present with schizophrenia. She is forgetting how to drive, can't understand what she reads, forgets word-use in speech. Most of her sx are related to schizophrenia. I started her on invega sustena and will see how things improve. If not, then I'll send her to a neurologist. Thanks for your input, again. and have a great day!

Jessica

What is her weight & what percentage of her ideal BMI is it? I'm wondering if the cognitive symptoms are multi-factorial. If her BMI is low, the starvation component can still effect her mental status.
What is her body image? Does she feel fat despite thinness? Also, it doesn't sound like she currently has any positive symptoms of schizophrenia. I would be curious to know more about any family history of mental illness...and also, what were the family dynamics growing up (e.g. high pressure, mid to upper class family typical of eating disorders).
Btw, thanks for "acceping" the question and giving a bonus...I was not expecting either but just giving advice as a professional courtesy.
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Dr. K
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