Page 1 of 1: psychiatry-deviation of neck

drprasu · Credits: 5755 My Scrapbook

Vasanti, 45 yrs, was brought to casualty with abnormal movements which induced persistent deviation of neck to rt. side. 1 day before, she was prescribed haloperidol 5 mg 3 times daily from psy. OPD. she also had an altercation with her husband recently. DX is:
1) conversion reaction
2) Ac. psychosis
3) Ac. drug dystonia
4) CVA

bhavu · Credits: 9491 My Scrapbook

answer is c only see kdt 4th edi page 411
bizarre muscle spasm involving linguo-facial muscles-grimacing, torticollis,locked jaw; occurs within few hours of a single dose or at the most first week of therapy.

bhavu · Credits: 9491 My Scrapbook

it is acute dystonia.ya it is more common in children but it is not that it can not occur in adults.

drprasu · Credits: 5755 My Scrapbook

u cud b rite but look at this

features of conversion rt. as given on p101 ahuja 5/e

1)motor or sensory symptoms = +nt in this pt.
2)sudden onset = +nt in this pt.
3)presence of significant psychosocial stressor = +nt in this pt.
4)clear temporal rel. b/w stressor and symptom = +nt in this pt.
5)F>M

i can't exclude conversion reaction in this pt. everything seems to favour it.
yes nowhere it is written that drug dystonia cannot occur in adult. it is just more common in children less than 10 yrs.

but when we can't exclude conversion, we can use this(cud b significant) point against drug dystonia
what do u think???

bhavu · Credits: 9491 My Scrapbook

i too though so but here classical torticollis which is one of the muscle gruop classically involved in acute dystonia. oof kash ye log apni answer keys declare karte.

manpreet108 · Credits: 30702 My Scrapbook

i also agree with bhavu--the specific group of muscles involved in this case is more hinting towards drug induced dystonia.

plus i find one more peculiarity in this lady--may be this is justa biased view--as i ve been convinced its dystonia----

motor symptoms in conversion disorder--classically symptom distribution in pt,is according to her knowledge of nervous system-weather its paralysis or abn movements]].[pg103].this lady is already having abnormal movements--probably huntingtons chorea for which she was strated with haloperidol--
so i think if stressor had anything to bring about conversion disorder in this lady---it wd manifest as exacerbation of the kind of abnormal movements she is already having.....

confused · Credits: 3695 My Scrapbook

guys, there is nothing to break ur head.
the answer is acute dystonia.

dystonia occurs in early in the course of treatment( 4 hours to 4 days), with high potency (haloperidol etc) and high doses ( here - yes, definitely considering 15 mg on day one).

incidence is high in men and more common below 30 years, but not that it wont occur in women and above 30 years.

btw someone mentioned about conversion disorder. i wont discuss details of why it wont be the answer. still if u want to consider it as a strong possiblity, u always go for organic causes first and then the others. u got to follow this heirarcyy.

drprasu · Credits: 5755 My Scrapbook

ya of course that's right confused
DX of psyc. dis. are made after excluding organic causes
thanx!!

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