jean robert
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A 54-year-old woman presents to her primary care physician for her routine yearly health maintenance examination. She denies any new problems. Her only significant medical history includes a 25-year history of schizophrenia, which has been well-controlled with antipsychotic agents, and a 5-year history of hypertension for which she takes a diuretic. Vital signs and physical examination are within normal limits. However, the patient is noted to have occasional irregular puckering and lip-smacking movements. She denies having noticed the abnormal movements, and her speech is normal. Which of the following is the most likely diagnosis?
A. Acute dystonia
B. Akathisia
C. Pseudoparkinsonism
D. Tardive dyskinesia
E. Tardive dystonia
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| drduck
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D
Tardative dyskinesia.
It wasnt that difficult. Or is there something I missed in the question?
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| brainstem
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D
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| UsmleUSA
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D
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| GoodGirl
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D
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| jean robert
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The correct answer is D.
Tardive dyskinesia (TD) is a syndrome characterized by abnormal choreiform and athetoid movements occurring late in onset in relation to initiation of antipsychotic treatment. TD usually develops after months to years of treatment with antipsychotic agents, and is presumably much less likely to occur with the use of atypical antipsychotics. Risk factors for TD include older age, longer duration of antipsychotic treatment, and presence of an affective disorder. The abnormal involuntary movements usually involve orofacial muscles but may include the trunk and extremities. Regular examinations should be done to ensure that patients treated with these medications do not develop signs of TD.
Acute dystonia (choice A) is an abrupt reaction consisting of abnormal positioning or spasm of the muscles of the head, neck, limbs, or trunk. This form of extrapyramidal side effect (EPS) associated with antipsychotic medications can be terminated with administration of an anticholinergic agent.
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Le découragement, c’est du temps perdu.Ce qui est fait n’est plus à faire. Vouloir ce que l’on veut ; le vouloir constamment est le secret des forts.Great works are performed not by strength but PERSEVERANCE.
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| jean robert
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Akathisia (choice B) occurs in approximately 50% of patients taking conventional antipsychotic agents. This form of EPS consists of the experience of a subjective feeling of restlessness. Patients may rock, pace, tap, or move restlessly while sitting. This side effect may be confused with anxiety, agitation, tardive dyskinesia, or worsening of psychosis. Treatment includes reducing the antipsychotic dose, switching to another agent, and the use of beta-blockers or benzodiazepines.
Pseudoparkinsonism (choice C) is a form of EPS consisting of some or all of the following: bradykinesia, masklike facial expression, slow speech, tremor, cogwheel rigidity, stooped posture, and shuffling gait.
Tardive dystonia (choice E) is a late-occurring dystonia that is a rare adverse event associated with antipsychotic treatment.
___________________
Le découragement, c’est du temps perdu.Ce qui est fait n’est plus à faire. Vouloir ce que l’on veut ; le vouloir constamment est le secret des forts.Great works are performed not by strength but PERSEVERANCE.
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