anatomy
Forum Guru
Topics: 101
Posts: 423
|
A 52-year-old white male who had been found wandering the streets
is brought into the hospital by the police. On initial physical exam
, his motor behavior is notable for bradykinesia and a 4-6 Hz
hand tremor at rest. He is kept under observation in the
psychiatric ward, but is not medicated. Over the next
few days, his motor symptoms start to abate, but he becomes
increasingly paranoid and confused, and he insists that he
is the President of the United States. Which of the following
conditions best describes the patient at the time of admission?
A. Alcoholic suffering from acute symptoms of withdrawal
B. Chronic amphetamine user suffering from drug-induced psychosis
C. Chronic schizophrenic suffering from tardive dyskinesia
D. Parkinsonian patient overmedicated with L-dopa
E. Schizophrenic overmedicated with haloperidol
|
| phuluong2k
Forum Fanatic
Topics: 714
Posts: 2,008
|
I think it is E ( C make me confused )
|
| Moctopod
Forum Elite
Topics: 14
Posts: 422
|
I think it's Parkinson's, but please correct me if I'm wrong.
Even with L-dopa therapy I remember learning that you can have 'on-off' episodes of Parkinsonian symptoms (bradykinesia, 4-6Hz resting tremor, rigidity, etc). The age and ethnicity of the patient correlate. Paranoid ideation is a recognised side effect of levodopa.
|
| anatomy
Forum Guru
Topics: 101
Posts: 423
|
answer is "e"
The patient is a schizophrenic overmedicated with haloperidol. When the patient is first brought into the hospital, he is suffering from Parkinsonian motor symptoms that are a significant side effect of many neuroleptics (particularly haloperidol). Over the next few days, he remains unmedicated, and the effects of haloperidol begin to wear off, which relieves his motor symptoms, but leads to the reappearance of his psychotic symptoms.
While alcohol withdrawal (choice A) can produce delirium tremens, it would not explain the initial presentation with Parkinsonian symptoms.
Chronic amphetamine use (choice B) can result in an amphetamine-induced psychosis that resembles an acute schizophrenic attack. However, these attacks abate within a few days after drug use ceases. This patient's psychosis surfaced after a few days without medication.
Chronic schizophrenics (choice C) with an extensive history of neuroleptic use can develop tardive dyskinesia, which is characterized by involuntary jaw and tongue movements.
A Parkinsonian patient overmedicated with L-dopa (choice D) may suffer from visual and auditory hallucinations as well as involuntary movements. These symptoms are the result of increased activity in the dopamine system, and would be expected to abate after several days without treatment. Parkinsonian motor symptoms repressed by L-dopa would be expected to re-emerge as the drug is cleared from the system.
|
| Moctopod
Forum Elite
Topics: 14
Posts: 422
|
Thanks Anatomy for a nice question
|
|
| |
| | | | | |
