A 46 yo male is brought to your office by his wife for the evaluation of his symptoms. She reports that for the last 8 months, the patient has lost all ‘norms of decency’. He is touching his private parts in public places. He is undressing and exposing his genitals to strangers. He has difficulty remembering things. A few months ago, on a flight from Los Angeles to New York, he allegedly touched a fellow passenger inappropriately and was arrested by the federal aviation authorities. He pleaded guilty to a misdemeanor and was sentenced to a federal prison for 3 months. Prison health records show that he has had a tendency to explore objects by placing them in the mouth together with the indiscriminate eating or chewing of objects and all kinds of food. He reports that he has no other way to recognize objects as he cannot see them properly. His past medical history is significant for herpes simplex encephalitis and a head injury a year ago. In the physical examination, you notice a very passive individual with a flat affect and reduced response to your greetings,but he follows your commands well. He exhibits excessive attentiveness to visual stimuli with a tendency to touch every object. The MRI of his brain showed bilateral damage to the amygdala and the neighboring temporal cortex. What is the most likely diagnosis in this patient?

Thomas is a 22 year-old college student who sustained a head injury 3 weeks ago while playing golf. He did not suffer loss of consciousness but later that day developed headache, dizziness, insomnia, blurred vision, restlessness and inability to concentrate. He has a prior history of anxiety and depression. His neurological examination is normal and the MRI scan of his head done a week ago is unremarkable. Thomas reports that his symptoms ‘somewhat improved’ but not completely. Which of the following have a role in the management of his disorder?

A 42 year-old caucasian male presents to your office for the evaluation of his loss of fine manual skills, diminished work performance, inability to manage household responsibilities and disturbances of sleep. For the last 10 months, he has been experiencing repeated, irregular movements of his eyebrows and the muscles in his forehead. His hands and legs feel rigid. He has developed uncontrolled jerking movements of face, arms, and trunk, which he cannot control. He has trouble speaking. He developed loss of balance and had trouble walking. He hears, sees, smells and feels things that others do not. He is having problems with his memory. He is becoming increasingly suspicious of others, even his wife. He is having difficulty figuring out where he is, what time, date or day it is. He is no more interested in doing things he used to enjoy. He reports some of his relatives in his extended family also developed similar symptoms around his age. You ordered some laboratory work up and genetic testing. His head CT showed cerebral and caudate nucleus atrophy. Genetic testing revealed CAG trinucleotides with defective genes localized on chromosome 4. Of the following, what is the most likely diagnosis in this patient?