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  #1  
Old 03-07-2011
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Drug 25 yo schizophrenic with somnolence

A 25 year old construction worker comes in to your clinic complaining of daytime somnolence. Upon questioning he has also a recently reduced ability to perform tasks with controlling machines in his work. He reports that his sleep is disrupted by urges to move his legs and sometimes he needs to get up and walk to soothe himself. Upon questioning he reveals that he has a hx of recent onset schizophrenia for which he has been recently started depot IM fluphenazine. What is the most likely cause of his somnolence?

a) Akathisia
b) Acute dystonia
c) Drug induced insomnia
d) Drug induced Parkinsonism
e) Drug induced restless legs syndrome
f) Hereditary restless leg syndrome
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  #2  
Old 03-07-2011
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a) akathisia
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its Akathisia
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  #4  
Old 03-07-2011
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Default hey

a) Akathisia
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Old 03-07-2011
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Default explanation please

would u explain please ?
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drug induced insomnia
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Old 03-07-2011
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it is typical presentation of akathisia it is side effect of antipyschotics nd also consider time period it is seen within weeks after taking this. fluphenazine is high potency antipyschotics so more eps than anticholernigcs..
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would u explain please ?
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Old 03-07-2011
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Quote:
Originally Posted by hardik221186 View Post
it is typical presentation of akathisia it is side effect of antipyschotics nd also consider time period it is seen within weeks after taking this. fluphenazine is high potency antipyschotics so more eps than anticholernigcs..
can you explain please what AKATHISIA is?
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Old 03-07-2011
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maybe it's
e) Drug induced restless legs syndrome
but I am confused between A and E :sorry:
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Quote:
Originally Posted by tinhi View Post
can you explain please what akathisia is?
sense of motor restlessness = anxiety
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  #11  
Old 03-07-2011
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Don't shoot me if I am wrong because I made up this question!

The correct answer is (F) Hereditary Restless leg syndrome.

Restless legs syndrome (RLS) is characterized by an urge to move the lower limbs especially during rest which occurs during night-time hours when the patient goes to bed. A characteristic finding is that this discomfort can awaken the patient who needs to move his legs and sometimes to stand up and walk in order to alleviate his symptoms. Restless legs syndrome can be most commonly familial (hereditary) in 50-60% of cases however it can be also secondary to certain medications like antipsychotics, however this is least likely. The patient's visit may coincide with his recent fluphenazine administration however the question fails to describe the onset of restless legs symptoms, which could be prior to the onset of schizophrenia.

(A) Akathisia is a feeling of restlessness which unlike RLS doesn't occur at rest only, and it is not alleviated by leg movement - Actually patients may pace for hours due to a feeling of inner restlessness, and they sit down due to fatigue. It is a classic antipsychotic induced movement disorder classically treated by lowering the dose.

(B) Acute dystonia doesn't present by leg restlessness

(C) Drug induced insomnia can happen with many medications however antipsychotics usually have a rather sedating effect by blocking the histaminic receptors a fact that could worsen the patient's already fatigued state by the RLS.

(D) Drug induced parkinsonism presents as bradykinesia, rigidity, instability and resting-"pill rolling"(7 Hz) tremor.

(E) Drug induced RLS could be a very good explanation however the question doesn't describe the onset of symptoms (tricky point) making statistically the hereditary restless leg syndrome most common.

A question that someone may have is, why didn't the pt report his somnolence earlier? The answer is a bit complicated however, a possible answer is that symptoms tend to worsen with age, and also the recent antipsychotic administration will tend to exacerbate any fatigue that this patient tolerated before starting the medication.

Restless leg syndrome can have a 10% prevalence and physicians should be aware of it's distinguishing features and management.
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  #12  
Old 03-07-2011
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Quote:
Originally Posted by tkourkou View Post
Don't shoot me if I am wrong because I made up this question!

The correct answer is (F) Hereditary Restless leg syndrome.


Restless leg syndrome can have a 10% prevalence and physicians should be aware of it's distinguishing features and management.

What do you mean by 10% prevalence? 10% of adult population or old age population? Thanks
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What do you mean by 10% prevalence? 10% of adult population or old age population? Thanks
10% of adult population
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Old 03-08-2011
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@tk:
i wonder what'd happen to all of us if you were the paper setter!!!!
Really good question!
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