Psych Flashcards
A 32-year-old man presents to the Emergency Department with confusion, drowsiness and an unstable gait. He was treated with amoxicillin for an upper respiratory-tract infection 3 days ago. He has a history of schizophrenia and is taking clozapine. He never smokes and does not drink alcohol.
His observations are as follows:
Temperature 37 °C
Heart rate 120 bpm
Respiratory rate 16 breaths/min
Blood pressure 106/72 mmHg
SpO2 97%
Chest examination is normal. Neurological examination reveals no focal neurological deficits.
Which is the most appropriate investigation to confirm the diagnosis?
Clozipine levels:
his man has symptoms of clozapine toxicity – confusion, drowsiness, ataxia and tachycardia. Clozapine toxicity in this man is likely to be precipitated by an acute infection, ie. pneumonia. As clozapine is metabolised by CYP450 enzymes, it is postulated that downregulation of these enzymes by cytokines in an infection/inflammation decreases the metabolism of clozapine, leading to a raised clozapine level. It is recommended to measure a clozapine level in the presence of an infection in anticipation of toxicity.
A 24-year-old female presents to her GP 10 days after the birth of her first child, accompanied by her partner. She has a past medical history of bipolar disorder, but her partner reports this has been well managed for years. The partner expresses concerns that she has been behaving strangely for the past few days, crying often, and becoming increasingly anxious and paranoid. More recently, the patient has expressed doubts about the identity of her baby. She repeatedly queries whether it is really their child or has been exchanged with an identical ‘changeling’.
Given the presentation and likely diagnosis, what type of eponymous syndrome is described here?
Capgras
