A 59-Year-Old Woman with Schizoaffective Disorder Is Brought to the Emergency

question 35

Multiple Choice

A 59-year-old woman with schizoaffective disorder is brought to the emergency department by her daughter due to restlessness, sweating, diarrhea, and agitation over the last 24 hours.  She was seen 3 days ago in an urgent care clinic for acute lower back pain.  Physical examination showed no significant abnormalities and no further testing was ordered.  The patient was given renewal prescriptions for haloperidol and benztropine and a new prescription for tramadol, and sent home.  She is known to have osteoarthritis, chronic kidney disease, hypertension, and type 2 diabetes mellitus.  Her other medications include acetaminophen, glipizide, sitagliptin, sertraline, and hydrochlorothiazide.
Temperature is 38.9 C (102 F) , blood pressure is 146/94 mm Hg, pulse is 110/min and regular, and respirations are 16/min.  Oxygen saturation on room air is 97%.  The patient appears restless and startles easily.  She has slow, continuous horizontal eye movements.  Her neck is supple.  Cardiopulmonary and abdominal examinations are within normal limits.  She has a tremor and is hyperreflexic in her arms and legs.  She has sustained bilateral patellar and ankle clonus, and Babinski sign is present bilaterally.  Muscle tone is increased diffusely.
Which of the following is the most likely diagnosis in this patient?

• A)Anticholinergic toxicity
• B)Haloperidol overdose
• C)Malignant hyperthermia
• D)Neuroleptic malignant syndrome
• E)Serotonin syndrome

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Definitions:

Westernized Cultures

Societies influenced by Western European and North American norms, values, and practices, often characterized by individualism and materialism.

Asian Cultures

Asian cultures refer to the diverse set of customs, traditions, beliefs, and social norms originating from countries within the Asian continent.

Insecure Attachment

A type of attachment characterized by fear, anxiety, or avoidance in relationships, often stemming from inconsistent caregiving.

Family Self

A concept in psychology that refers to the part of an individual's self-identity that is formed through relationships and roles within the family unit.