Which one of the following would be the most effective monotherapy for alcohol withdrawal syndrome?
Correct Answer E:
Alcohol withdrawal syndrome encompasses a wide range of symptoms involving primarily the central nervous, cardiovascular, and gastrointestinal systems, and is mediated by the abrupt removal of alcohol-enhanced GABA inhibition of excitatory glutamate receptors in the central nervous system. It generally is divided into three stages, based on severity and timeline; seizures may occur during any of these stages and may be the first sign of withdrawal.
The ideal pharmacologic agent should provide not only safe sedation but also protection from seizures. Long-acting benzodiazepines such as chlordiazepoxide have been shown to be superior to the other choices in numerous studies. Clonidine and atenolol have been found to be useful in symptom reduction but not in seizure prevention. Phenytoin would seem to offer protection from seizures, but studies have not consistently shown this to be the case. Phenobarbital, while effective, has a very narrow therapeutic window, making its use problematic.
Two middle aged brothers moved back into their parent’s house, in order to take care of the family business. The eldest brother was diagnosed with paranoid schizophrenia, and was not compliant with his medication. He would constantly tell his younger brother that the neighbors were plotting against their family, and would be contaminating the water supply with arsenic. He would also stress the importance of not trusting anyone in the community, and because harm would come to them. The younger brother did believe these things that his elder brother would tell him. When the elder brother left the home, the younger brother started to let go of these beliefs.
What is the younger brother’s diagnosis?
Correct Answer A:
Folie a deux is where symptoms of a delusional belief is transmitted from one individual to another individual. This syndrome is most commonly diagnosed when the two or more individuals concerned live in proximity and may be socially or physically isolated and have little interaction with other people.
Capgras syndrome is where a person holds a delusion that a friend, spouse, parent or other close family member has been replaced by an identical-looking impostor.
Fregoli delusion is a delusional belief that different people are in fact a single person who changes appearance or is in disguise. May be related to a brain lesion, and is often of a paranoid nature with the delusional person believing themselves persecuted by the person they believe is in disguise.
Mirrored self-misidentification is the delusional belief that one's reflection in a mirror is some other person (often believed to be someone who is following them around). Often people who suffer from this delusion are not delusional about anything else.
A 21 year old college student complains that the dean of her school is secretly taping her conversations with her roommate “I’m sure of it!” she states emphatically. When probed further she says that she didn’t always feel that way but ever since her roommate (who also happens to be her sister) told her about how she is “being watched” she started to feel paranoid.
The next best step is to:
This interesting pathology (shared delusional disorder or Folie à deux) occurs when two people in close contact have the same delusional belief. It is most common in mother-daughter or sister-sister relationships. There is usually a dominant and submissive relationship in which the dominant individual has an established psychotic disorder and the submissive or dependent individual is desperately anxious to be cared for and accepted by the dominant person. Treatment involves separating the affected individuals and helping the submissive partner develop other/healthier means of support. Sometimes antipsychotics medications are beneficial.
When treating shared delusional disorder your first step is to separate those involved.
A patient presents with a case of drug overdose. He has fever, tachycardia, dilated pupils a blood pressure of 220/110.
The most likely cause is:
Because cocaine is a very short-acting drug, heavy users may inject it or smoke it q 10 to 15 min. This repetition produces toxic effects, such as tachycardia, hypertension, mydriasis, muscle twitching, sleeplessness, and extreme nervousness.
→ Heroin, barbiturate, benzodiazepine intoxications and alcohol abuse may cause hypotension, sedation or coma and not hypertension.
Which one of the following signs is consistent with an overdose of morphine?
Correct Answer C:
Respiratory depression is the chief hazard of all morphine preparations. Respiratory depression occurs more frequently in elderly or debilitated patients and in those suffering from conditions accompanied by hypoxia, hypercapnia, or upper airway obstruction, in whom even moderate therapeutic doses may significantly decrease pulmonary ventilation. Acute overdosage with morphine is manifested by respiratory depression, somnolence progressing to stupor or coma, skeletal muscle flaccidity, cold and clammy skin and constricted pupils.
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