Please predict possible top 2 disease causes for this patient case, provide brief explanation, limit to <100 words.
Also briefly explain what the prescribed medications are for.
Please suggest the optimal medications for the top predicted disease.
Compared to doctor's prescribed medications, what should the patient ask doctor to optimize treatment plan?
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A 64-year old woman was referred to psychiatric department with the following symptoms: deterioration in general functioning, sluggishness, apathy, and depressed mood.

Three years before, patient's family noticed subtle changes in patient's behaviour: difficulties with decision making, decreased activity, avoidance of social meetings.

Five months before admission to the clinic, patient complained of memory problems, which caused difficulties at work, and recurrent visual and auditory hallucinations. The patient was examined by a psychiatrist in the outpatient clinic and was prescribed 20 mg of citalopram and 50 mg of perazine per day. As a result of implemented treatment, a slight improvement was observed – hallucinations disappeared but at the same time bradykinesia, generalized fatigue, difficulties with initiation of movements, shuffling gait appeared.

In the hospital, the patient complained of depressed mood, lower activity, impairment of short-term memory and concentration. She described her previously experienced visual and auditory hallucinations as pleasant – she was observing non-moving human figures behind her window, and was hearing the sound of opening doors or windows.

The neurological examination revealed the symptoms of Parkinson syndrome, such as monotonous, blurred speech, disturbances in speech prosody, hypomimia, bradykinesia, postural instability, forward-flexed posture. In the examination of extremities there was an increased muscle tone, deterioration in precise movements of the hands and apraxia. The patient also complained of recurrent falls, syncopes, and urinary incontinence. The computer tomography and magnetic resonance imagining showed temporal atrophy bilaterally.

Neuropsychological evaluation including: Mini-Mental State Examination (MMSE), the Clock Drawing Test (CDT), Benton Visual Retention Test (BVRT), Color Trails Test (CTT), California Verbal Learning Test (CVLT), the Wechsler Adult Intelligence Test-Revised [WAIS-R (PL)], Verbal Fluency Test (VFS) revealed severe deficits in cognition functioning, especially in visuospatial functioning, attention maintaining, visuo-motor coordination, learning, short-and long term memory. The MMSE result was confined with mild degree dementia.

During hospitalization the patient was treated with levodopa/benserazide 62,5 mg four times per day, levodopa/benseraside modified release capsule once daily and rivastigimine 1,5 mg twice daily. After three weeks of such medication, significant changes in motor function (reduction in slow motion, improvement of precise movements and walking) and marked improvement in cognition, general activity, and mood were observed.

Based on the patient's symptoms and medical history, I predict the top 2 disease causes as:

1. **Dementia with Lewy Bodies (DLB)**: The patient's symptoms of cognitive decline, hallucinations, fluctuations in cognitive function, and Parkinsonian motor symptoms are consistent with DLB. The presence of temporal atrophy bilaterally on imaging studies also supports this diagnosis.
2. **Parkinson's Disease Dementia (PDD)**: The patient's Parkinsonian motor symptoms, such as bradykinesia, rigidity, and postural instability, along with cognitive decline and hallucinations, are consistent with PDD.

The prescribed medications are:

* Citalopram (20mg/day): an antidepressant, likely prescribed for the patient's depressed mood.
* Perazine (50mg/day): an antipsychotic, likely prescribed for the patient's hallucinations.
* Levodopa/benserazide (62.5mg four times a day and modified release capsule once daily): a dopamine replacement therapy, prescribed for the patient's Parkinsonian motor symptoms.
* Rivastigmine (1.5mg twice daily): a cholinesterase inhibitor, prescribed for the patient's cognitive symptoms.

Optimal medications for the top predicted disease (DLB) would include:

* Cholinesterase inhibitors, such as rivastigmine or donepezil, to manage cognitive symptoms.
* Dopamine replacement therapy, such as levodopa/benserazide, to manage Parkinsonian motor symptoms.
* Antipsychotics, such as quetiapine or clozapine, to manage hallucinations and other psychotic symptoms.

Compared to the doctor's prescribed medications, the patient may want to ask the doctor to consider:

* Increasing the dose of rivastigmine to 3-4mg twice daily, as the current dose may not be sufficient to manage cognitive symptoms.
* Adding a dopamine agonist, such as pramipexole or ropinirole, to manage Parkinsonian motor symptoms.
* Switching to a different antipsychotic, such as quetiapine or clozapine, to better manage hallucinations and other psychotic symptoms.
* Considering memantine, an NMDA receptor antagonist, to manage cognitive symptoms.

It is essential to note that the patient's treatment plan should be individualized and tailored to their specific needs and medical history. The patient should discuss these suggestions with their doctor to determine the best course of treatment.

Please predict possible top 2 disease causes for this patient case, provide brief explanation, limit to <100 words. Also briefly explain what the prescribed medications are for.

A 64-year old woman was referred to psychiatric department with the following symptoms: deterioration in general functioning, sluggishness, apathy, and depressed mood.

Three years before, patient's family noticed subtle changes in patient's behaviour: difficulties with decision making, decreased activity, avoidance of social meetings.

Five months before admission to the clinic, patient complained of memory problems, which caused difficulties at work, and recurrent visual and auditory hallucinations. The patient was examined by a psychiatrist in the outpatient clinic and was prescribed 20 mg of citalopram and 50 mg of perazine per day. As a result of implemented treatment, a slight improvement was observed – hallucinations disappeared but at the same time bradykinesia, generalized fatigue, difficulties with initiation of movements, shuffling gait appeared.

Based on the patient's symptoms, I predict the top 2 disease causes to be:

1. **Parkinson's disease**: The patient's symptoms of bradykinesia, generalized fatigue, difficulties with initiation of movements, and shuffling gait are characteristic of Parkinson's disease. The fact that these symptoms appeared after the patient started taking citalopram and perazine, which can sometimes worsen Parkinson's symptoms, further supports this diagnosis.
2. **Dementia with Lewy bodies**: The patient's history of memory problems, visual and auditory hallucinations, and fluctuations in cognitive function are consistent with dementia with Lewy bodies. The fact that the hallucinations disappeared with treatment but other symptoms worsened also suggests this diagnosis.

The prescribed medications are:

* **Citalopram**: an antidepressant, likely prescribed to treat the patient's depressed mood and apathy.
* **Perazine**: an antipsychotic, likely prescribed to treat the patient's hallucinations.

Note: A thorough evaluation, including physical examination, laboratory tests, and imaging studies, would be necessary to confirm the diagnosis.