Ibanez Noel
Dept. of Psychiatry WVU, Morgantown, USA.
W V Med J. 2012 Jul-Aug;108(4):16-7.
This is the case of a 44-year-old man with frontotemporal lobar dementia whose presentation was consistent with bipolar affective disorder with psychosis in addition to ongoing substance abuse. Despite extended periods of sobriety and multiple medications to target Bipolar Disorder, his symptoms remained refractory. With repeated brain imaging and progression of the disease, frontotemporal dementia was diagnosed. The patient went on to develop amyotrophic lateral sclerosis (ALS), which is known to overlap the neuropathological features with frontotemporal lobar dementia. Respiratory compromise ultimately led to this patient's death, which was deemed secondary to ALS. This case demonstrates the need for clinicians to recognize differential diagnoses in manic and psychotic symptoms resistant to polypharmacy.
这是一名44岁患有额颞叶痴呆的男性患者的病例，其临床表现除了持续存在药物滥用外，还符合伴有精神病性症状的双相情感障碍。尽管有较长时间的戒酒期以及使用了多种针对双相情感障碍的药物，但其症状仍难以控制。随着反复的脑部影像学检查以及疾病进展，最终诊断为额颞叶痴呆。该患者随后又患上了肌萎缩侧索硬化症（ALS），已知其与额颞叶痴呆在神经病理学特征上存在重叠。呼吸功能受损最终导致了该患者的死亡，死因被认为是继发于ALS。该病例表明临床医生需要认识到对多种药物治疗耐药的躁狂和精神病性症状的鉴别诊断。
