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Old 08-26-2012
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Default psychiatry question

A medicine consult is requested on a 32-year-old woman with paranoid schizophrenia who is a patient in a closed psychiatric unit. Several days after the patient's admission, she developed polyuria, vomiting, stupor, diarrhea, and restlessness. She is currently taking risperidone, 10 mg given at bedtime, but no other medications. Which of the following is the most likely diagnosis?

A. Anticholinergic crisis
B. Acute dystonic reaction
C. Serotonin syndrome
D. Tardive dyskinesia
E. Water intoxication

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Old 08-26-2012
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Originally Posted by K06100 View Post
A medicine consult is requested on a 32-year-old woman with paranoid schizophrenia who is a patient in a closed psychiatric unit. Several days after the patient's admission, she developed polyuria, vomiting, stupor, diarrhea, and restlessness. She is currently taking risperidone, 10 mg given at bedtime, but no other medications. Which of the following is the most likely diagnosis?

A. Anticholinergic crisis
B. Acute dystonic reaction
C. Serotonin syndrome
D. Tardive dyskinesia
E. Water intoxication

answer with reason

E. Water intoxication
because of polyuria, mental status changes (due to hyponatremia). Also she has access to water but not to any medication being in a closed psychiatric unit. Also, Water intoxication is more common in schizophrenia.


Cannot be A since she is not dry or hot.
cannot be B since it doesn't have the features of Acute dystonic reaction like muscle contractures etc. & is too early for D to occur.
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Old 08-26-2012
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i agree with water intoxication. you'd see a dilute urine being produced. i want to also add this lady couldnt have serotonin syndrome as she's not taking something like sertraline with an antibiotic.
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