LACK OF CONCENTRATION AND
ACADEMIC DELAY IN A FEMALE UNIVERSITY STUDENT WITH PECULIAR NEUROPSYCHIATRIC
FEATURES.
Renato COCCHI, a neurologist and a medical
psychologist
(Other research on this topic)
Summary.
A university student woman of 37 years,
with a manic type cyclic psychosis under therapy with lithium, destructive and
aggressive fits against her family (An EEG positive for previous brain
suffering) and lack of concentration by intrusive thinking, with imposing delay
in the studies, had a drug therapy with more suitable lithium dosing, but with
low dosing antiepileptic, antidepressant and antistress drugs.
Besides the general improvement and the
impressive reduction of the destructive and aggressive episodes, the intrusive
thought decreased and the concentration improved.
In 17 months she sustained 10
examinations with better notes than previously and she graduated. The stress,
primarily of intern origin, seems be the common element that sustained this
tangled neuropsychiatric syndrome.
Key words: Stop studying, concentration,
memory, stress, epilepsy, cyclic psychosis, depression, drug therapy.
Attention and concentration troubles.
Drug modulation of stress reactions
Home Page
/ / / Pagina
iniziale
After I reported seven cases with stop
studying with resumption following drug therapy, and four dropouts with
psychotic evolution, a person, already in therapy but then never seen after the
first checkup, communicated by telephone information of her degree, after about
20 months since the first consultation.
Since she was a person with peculiar
neuropsychiatric features, I wanted here to report her case history because it
allows a better refinement of the preceding case histories within the reactions
of stress.
The case.
17 May 2001. F, 37 years Old to the first
examination, she is a Pharmacy student, in a little university of the middle of
Italy. She is taking lithium since some years, as her sister does. She suffered
from a maniacal episode, but now she thinks that the lithium is helping to
study. Now, she has the feeling of being persecuted. Often she becomes very
reactive with aggression episodes against things. During similar episodes,
which happens frequently, she attacked even her boyfriend. She inclines to
spend money without a true reason to do it.
She affirms to think too and of don't
control the flux of her thoughts (intrusive thinking), and so she cannot have
good concentration and cannot study. Some years ago she interrupted the
university for four years then she restarted it. Ten examinations miss to the
degree. In her family doesn't believe that she succeeds to finish their
studies.
She is suffering from the heat, has low
blood tension, likes very much the sweet foods, and in past she had a period of
anorexia. Habitually she sleeps well. There are some depressive cues, even as
reaction to the difficulty of studying. To the test "Which is the opposite
of the colour Red?" she answers: White. Often she has opposite behaviour.
She affirms she did not suffer from
embryonic or fatal problems, neither then during her birth, with a term
spontaneous delivery, and birthweight in the normal range (more than 3000 g).
During junior and high schools she did better humanities. She remembers that
when she was 4-5 inclined to keep to and she did not play with her peers.
To the current therapy with lithium
carbonate 450mg daily, were added (daily doses, by the oral via): Carbamazepine
200mg; amitriptyline 6mg and oxazepam 15mg.
19 October 2001. The first checkup. In the
last summer she did fairly well. She spent the summer in her family, in
southern Italy, but he succeeded to quarrel with her sister and her mother. Fits
of aggression against objects and persons were fewer, although the fits were
more violent. The intrusive thinking decreased after the first month of
therapy. The concentration improved and she has sustained two heavy
examinations, one of which was physiology, with good notes. Resumption of the
ability of studying has been clear after about two months of therapy. She did
not lead it to try first, because the summer vacation period.
Now, she sleeps better. Sometimes she has
some sharp pains to her head that appear signals of stress. She has hypomanic
moments in the premenstrual days. Always suffering from the heat did not change
and she always inclines to the blood low tension. She goes on to eat sweet
things. Now she succeeds to do physical activity. I asked an EEG because I
suspected that the aggression fits are epileptic equivalents.
Perhaps less opposite behaviour occurs.
Finally, she says that she feels as if in her were two persons, a positive one
and a negative one.
Therapeutic variation (daily doses, by the
oral via ): Lithium carbonate 600mg, carbamazepine 400mg (following the EEG
report), amitriptyline 10mg.
09 January 2004 (By the telephone): She has
always taken the therapy. In last October she graduated with 90/110 final note,
at 39 years and eight months. In 17 months she sustained 10 examinations and
the graduation thesis, with average notes higher then she had in the preceding
examinations. A university professor of his faculty, who knew her well, was
amazed of her brilliant resumption of the studies. She wants to do the work she
studied for it. The destructive and aggressive fits became very unusual. Her
mood improved a lot. She bears better the heat. The blood tension became
regular. Now she affirms that of his two personalities the positive one
prevails. She has fewer intrusive thoughts, and, if they appear, she succeeds
to redirect the thought on a chosen content.
Finally, she says that persecuting ideas are
missing. Now she is doing the apprentice in a public pharmacy.
Discussion.
The peculiar aspects of this case are at
least three:
- A manic type cyclical psychosis, with a
frank episode in the past and a tendency to the euphoria in the premenstrual
days;
- A brain bioelectric trouble from previous
brain suffering, with EEGraphic positiveness and fits of considerable
aggressiveness as epileptic equivalents.
- a half-brain dominance at least unstable.
To that it has to add a deficit of
concentration with studying difficulties, dropping out from the university for
four years, and its resumption with the same difficulties.
The cyclic psychosis was the only drug
treated (lithium) feature when she had the first consultation. Nearly certainly
there is a familiarity for this illness, because even her sister takes lithium
and the father had cyclical mood variations of this type. The persecuting ideas
did not appear worthy of specific treatment.
The EEGraphic positiveness of the brain
bioelectric trouble was the confirmation of the suspect that the aggression
fits found in it their real base. The carbamazepine, even an antimanic drug,
besides being an antiepileptic drug, permitted to lower much the frequency of
these episodes.
The trouble of the half-brain dominance is
supported by the answer: White (the contrary of black, as the usual response of
depressed persons), by the opposite behaviour and by the confession of the
double personality, negative and positive. It is even possible that the
persecuting ideas reflect an emotional prevalence of the right half-brain.
Now, the trouble of the concentration seems
be in close relationship with the intrusive thinking, which bars the pathway
from the short-term memory to the working memory first and to long term memory
then. In students this difficulty of studying becomes its evident symptom,
while in other persons with intrusive thinking, the related trouble is the
forgetfulness of recent things. The memory disturbing mechanism is however the
same.
The intrusive thinking is a trouble of the
mobility of the thought. It may be fluctuating, or focusing on a thematic
detail, often related his/her own health or that of a beloved person.
When the persons are questioned about it,
they affirm of having "His/her head full of thoughts " and that their
brain "is like a mill that grinds without stopping". Some of them maintain
that the brain doesn't stop to think even during the sleep.
It is hard to give an explanation of this
phenomenon. It is possible that it works as a compensatory mechanism, with the
aim to consume a district excess of energy (creditable to excitatory
neurotransmitters?).
It remembers a much similar phenomenon - the
need of numbering objects without any pointless reason -, even if this last
related, with high probability, to a different brain area.
The common datum of all these phenomena
could be reactions to the stress or stresses, mainly of internal type: A cyclic
psychosis, the bioelectric brain's disturb, the unstable half-brain dominance,
the premenstrual syndrome, and the basic depression. We should not exclude
external stresses that can add to the first ones.
For eliciting stress reactions it needs to
overcome the individual tolerance threshold that has constitutional ground, but
it is even varying during the age. The elderly persons become more sensitive to
the stress.
This suggests that the antistress therapies
should be always individualized and adapted after a first trial period.
The prescribed regimen, which acted as
antimaniac ( with lithium and carbamazepine), antepileptic ( with carbamazpine
and oxazepam) antidepressant ( with amitriptyline and oxazepam), and antistress
therapy (with oxazepam, amitriptyline and carbamazepine) had on the one hand
reduced the stress of internal origin and on the other hand, raised the
threshold of reactions to stress.
Twenty months after its starting, the
results can be considered as remarkable and worthy of being known.
(Four other research on this topic)
References.
Cocchi R. Problems of attention and concentration
leading to interruption of studying by high school and University students: A
report of 4 cases. It. J. Intellect. Impair. 1994, 7: 29-38.
Cocchi R. Scientific college dropouts and
the risk for psychotic outcome: Four male cases. It. J. Intellect. Impair.
1995:, 8: 37-43.
Cocchi R. The trouble of the concentration,
and stop studying in three university students. Relief after antistress drug
therapy. Posted on Internet on July
2003.<www.stress-cocchi.net/Droping3.htm>
Posted on Internet on January 2004. Copyright by Renato Cocchi, 2004.
Author's address: dr Renato COCCHI, via
Rabbeno, 3
42100 Reggio Emilia (Italy)
renatococchi@libero.it
Attention and concentration troubles.
Drug modulation of stress reactions
Home Page
/ / / Pagina
iniziale