new_n_lost
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A 73-year-old man with advanced Parkinson’s disease is being treated on the ward for a urinary tract infection. His regular medication includes co-careldopa, entacapone, cabergoline, and prn subcutaneous apomorphine injections. His wife tells you that for the last month his behaviour has changed and he has become agitated, disinhibited and he keeps asking her for money. His dyskinesia has also become more pronounced over this period. On examination, he is distractable. He denies having hallucinations and, after probing questioning, you can find no evidence of delusional thought. Mood assessment shows him to be cheerful and there are no cognitive or biological features of depression.
What is the likely physiological cause of the behavioural change?
A. Reduced breakdown of dopamine
B. Change in sensitivity to dopamine
C. Confusional state due to urosepsis
D. Direct dopamine agonism
E. Coexisting dementia
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| Parachute
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is it A?
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| me007
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he was treated for UTI, usually it is TMP-SMX, which is inhibits cytochrome P450, so can be A
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| usmle4me
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Sure hard one...
Not sure about the answer.But in case of reduced breakdown there should be delusion and depression.Here that is absent!!
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| me007
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symptoms are behavioral - agitated, distractable, cheerful, no cognitive disfuctions
there are only 3 choices in this Q due to what it could be - dopamine, dementia, sepsis.
If not dopamine - dementia? does not looks like dementia.
his diskinesia is more pronounced - this one can be in advanced Parkinson's due to weaking off fenomenon
what for apomorphine? and what means prn?
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| usmle4me
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Confused between A and D
Agitated,Disinhibited,Keeps asking for money!!!This looks like Psychosis.And in ans.A there should be Depression for sure.
But not sure what D means
Other don't fit in atall.
NNL please .....Answer
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| mytime
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  C ????????
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| new_n_lost
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D. Direct dopamine agonism
Neuropsychiatric complications of Parkinson’s disease (PD) are common ��" experienced by some 70% of all patients.
Hedonistic dysregulation is being increasingly recognised; here patients typically take increasing amounts of a dopamine agonist even though it worsens their dyskinesia (usually apomorphine is abused in this way). This results in euphoria, hypersexuality and gambling. There is an extensive body of research literature on dopamine reward pathways (from the ventral tegmental area to the nucleus accumbens) as the mediator of motivation and possibly drug addiction.
The commonest psychiatric complication, however, is depression (50%, associated with a younger onset, female gender), anxiety (40%), psychosis (40%, visual hallucinations and persecutory delusions, often drug related) and dementia (20��"40% associated with an older onset PD, severe extrapyramidal features).
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| epica
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Interesting Q
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| mytime
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| usmle4me
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Wow I was so close...though I had no clue about overdose
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