55 yr female with involuntary movements
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January 21,2022
55 YR OLD FEMALE WITH DEPRESSION AND INVOLUNTARY MOVEMENTS
A 55 years old female came to the GM OPD with chief complaints of
- sudden onset of tremors in right arm since yesterday which stopped during sleep and started again in the morning.
History of present illness:
She was apparently asymptomatic 1year ago. Then as she developed abnormal behaviour with suspicion over that they are harming her and fearfulness towards others 1yr back after her sister's husband died due to excessive alcohol intake daily.
Later past 6 months visited psychiatry op with complaints of self smiling,self talking,decreased response,decrease speech output, difficulty to speak with decreased self care and hygiene,not doing any household work, not interacting with others,decreased eye contact,visual and auditory hallucinations diagnosed as psychosis and medication risperidone.
She didn't follow up and went to nalgonda 3months back CT and MRI scans were taken and were normal. Medication was given which she used for 2days and stopped themselves as she was not improving.
3days back again went to nalgonda were she was given T.olanzapine and T.quetiapine. Yesterday sudden onset of involuntary movements in right arm while eating stopped during sleep and continued next day morning.
Past history: She is suffering from asthma since childhood.
No DM, HTN, TB, Epilepsy, CAD.
Family h/o: her relative experienced same symptoms in the past.
Personal h/o:
Diet -mixed
Appetite - normal
Bowel habits - regular
Bladder habits - regular
Sleep - adequate
No addictions
She is married and have 2daughters and 1son .she had disputes in her family.
General examination: Patient is conscious, coherent,noncooperative ,well built and well nourished.
No pallor,icterus, cyanosis, clubbing, lymphadenopathy, Edema.
Vitals:
Pulse rate - 94 bpm
Temperature- 98.2 degree Fahrenheit
RR - 15 cpm
BP - 130/90 mmHg
Systemic examination :
CVS : S1 S2 + , no added murmurs
RS :BAE + ,NVBS heard
P/A :soft , non tender
No organomegaly
No distension
Bowel sounds heard
CNS:
Pupils- B/L dilated, reacting to light
Tone- Rt. Lt.
UL N N
LL N N
Power-
UL 5/5 5/5
LL 5/5 5/5
Reflexes-
B- + +
T- + +
S- + +
K- + +
A- + +
P- Flexor Flexor
Hand grip 100%. 100%
Provisional diagnosis
Psychosis? Depression?anxiety disorder?
Treatment:
1. Stop T.olanzapine T.quetiapine
2.Tab.tri hexi phenidyl (THP) 2mg
3.Tab mirtazepine
4. Tab. Clonazepam if patient is anxious or restless
Summary
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