Suicidal Husband-Buzz Group 1 Flashcards
History: A 32 year old man was brought to a psychiatrist by his wife because he took about 10-15 tablets of Benadryl (diphenhydramine) in an attempt to end his life a few days ago. He had slept almost 48 hours, and then wife only noticed the empty bottle of pills after he woke up. thoughts?
Age –> young
no occupation given
suicidal attempt with Antihistamime (diphenhydramine)
what are some symptoms associated with an overdose of Benadryl (diphenhydramin)?
Hallucinations, low blood pressure, tachycardia
what common mental disorder illicits similar symptoms as that of a benadryl overdose?
schizophrenia
remember rule everything else out before you dx someone with schizophrenia
His wife complains that he developed emotional instability over the past 2 years, with periods of depression and lethargy. Lesion in which part of the nervous system can cause depression and lethargy?
frontal lobe is the best answer (could also be insular lobe)
Wife also stated that during the last few months, he has developed occasional jerking movements of his head, limbs and trunk. The husband was confronted by his wife regarding these abnormal movements but he denied being aware of the jerking movements or any change in mood. Lesion in what part of the nervous system is likely to cause hyperkinesia?
Basal Ganglia
Patient did admit that he sometimes stumbles and recently almost fell down a staircase. The wife is very distressed about both the recent violent outbursts in the home and numerous arguments about known extramarital affairs within the last year. what type of lesion does this describe?
genetic
The wife further adds that her husband’s grandmother died 50 years ago in a psychiatric hospital, and his aunt told her that the grandmother experienced abnormal movements of the arms and legs. Is this a positive family history?
No (unsure if it was caused by meds)
Patients autonomic function was fine. Patient was only able to remember two of the three objects after 5 minutes, but had good calculation skills, and reduced visual spatial skills. what are some examples of ways to test visual spatial skills?
Solving a jigsaw puzzle
navigating with a map in a foreign city
Patient grimaced and pursed his lips, moved his eyebrows frequently. CN II-XII intact. Saccadic eye movements were moderately slowed. what does that indicate?
Indicated that one the brainstem is intact and two that the lesion may be in the frontal lobe
patient had a normal flexor plantar responses bilaterally. what does this tell you?
not an UMN lesion
Bilateral palmomental, glabellar, and snout reflexes were present. Tandem gait slightly unsteady. Sensory testing showed no deficits. what do those three test test for?
Palmomental reflex–> twitch of the chin
Glabellar –> tapping of the forehead to stop blinking
Snout –> pouting or pursing of the lips elicted by light tapping of the closed lips
In this patient, based on the information given, where is the lesion?
cerebral lesion that is central and bilateral with basal ganglia and cerebral hemispheres involved.
what are the key points in the case to lead one to dx the patient with Huntingtons Disease?
Psychiatric and cognitive abnormalities
chorea
chronic progressive course
possible positive family history
In huntingtons disease there are a reduced number of D2 receptors where?
Bilateral degeneration of Strial Neurons (with D2 receptors)
causes a loss of any and all control between the striatum and the GPe.
what is the influence of the dopaminergic projection to the indirect pathway?
facilitates movement by inhibition of striatal cells
