DIAGNOSIS: Medical Conundrum
Grand Rounds Scenario
Out of the Blue
Is it Tourette's Syndrome (TS) ?
Tourette's Syndrome is a psychological disorder characterized by 'tics', twitching, and verbal or physical outbursts. These may be harmful to the patient in question, but may just be harmless spasms. However, in most cases the disorder is detected in childhood. It may be possible for Carl to have not displayed signs of TS, as his symptoms match the prognosis generalized with the disease. To help keep these outbursts at the very lowest number possibly, Carl's doctor may reccomend starting him on a medicinal regimen to control the symptoms, while the disease is not curable. Neuroleptics such as haloperidol and pimozide are often used in such cases as Carl's.
....Intermittent Explosive Disorder (Rage Disorder)?
A more vague diagnosis for Carl's condition would be intermittent explosive disorder, or, more commonly: rage disorder. This disease is characterized by repeated episodes of impulsive, aggressive, violent behavior or angry verbal outbursts towards others. Domestic abuse, road rage, throwing and breaking things and acting out in general are all symptoms, and is as elusive as it is explosive, hence 'explosive' in the title. Carl may have something as 'simple' as this and not a deeper psychological problem. Psychotherapy and medication are used to control his aggresive impulses.
Possible Treatment
Abilify, Zyprexa, Geodon and Seroquel are all possible forms of prescription drugs used to treat the symptoms of psychosis in many patients diagnosed with TS or IED. More than likely, Carl will be given a supplement of one of these medications. However medication is not the only treatment that Carl could receive, as in most cases medicine is not enough. Therapy will be instated to further supplement his care in controlling his disorder.