Under certain circumstances, it may be legitimate to detain individuals in an institution against their wishes, for their own good and to protect others.
This situation may arise when:
Correct Answer D:
Involuntary admission to a hospital is allowed when a person:
You see a 25 year old woman with a history of paranoid schizophrenia maintained on haloperidol shots. She is stiff, cannot swallow or talk, and appears tremulous. On examination, her temperature is 38.7 C (101.7 F), blood pressure is 157/104 mm Hg, pulse is 122/min, and respirations are 24/min. She has increased tone in her neck and extremities, and appears tremulous, diaphoretic, and confused. Her leukocyte count is 19,600/mm3 and the serum creatine phosphokinase is markedly elevated.
Which of the following is the most likely diagnosis?
Neuroleptic malignant syndrome (NMS) is a rare complication of neuroleptic therapy that confers high mortality if not recognized and treated promptly. It is defined by the development of severe muscle rigidity and elevated temperature in association with at least two or more of the following: dysphagia, tremor, diaphoresis, tachycardia, change in level of consciousness, leucocytosis, elevated or labile blood pressure, and elevated creatine phosphokinase as an indicator of muscle injury. The predisposing factors include high neuroleptic doses, intramuscular injections, and lithium treatment.
Which of the following is not considered a potential treatment for Neuroleptic Malignant Syndrome?
Correct Answer E:
Valproic acid has no particular use in the treatment of Neuroleptic Malignant Syndrome (NMS). Dantrolene blocks the release of calcium from the sarcoplasmic reticulum, producing muscle relaxation. Of course, the offending antipsychotic should be stopped. Bromocriptine acts as a dopamine receptor agonist, and amantadine enhances the synthesis, release and reuptake of dopamine. Symptomatic treatment of fever, correcting electrolyte imbalance, and managing any cardiovascular instability are necessary as well. Some studies indicate a mortality rate of nearly 12% for NMS.
A 43-year-old male patient presenting with hallucinations and delusions was prescribed chlorpromazine. He woke up early in the morning with acute hyperpyrexia, rigidity and confusion. Three hours later he became unconscious and did not respond to painful stimuli.
What is the most likely diagnosis?
Neuroleptic malignant syndrome (NMS) refers to the combination of hyperthermia, rigidity, and autonomic dysregulation that can occur as a serious complication of the use of antipsychotic drugs. Criteria for the diagnosis of neuroleptic malignant syndrome are based on clinical features. Cardinal features are the development of severe muscular rigidity, hyperthermia, autonomic instability, and changes in the level of consciousness associated with the use of an antipsychotic medication.
A 31-year-old man is shy, socially withdrawn, low in self-esteem, yet eager to please when called on by persons in authority.
Which one of the following personality disorders is most likely to be associated with this clinical description?
Avoidant personality disorder is marked by hypersensitivity to rejection and fear of starting relationships or anything new because of the risk of failure or disappointment. Because affected people have a strong conscious desire for affection and acceptance, they are openly distressed by their isolation and inability to relate comfortably to other people. They respond to even small hints of rejection by withdrawing.
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