Metallic Psychosis

Topic: Adult

Created on Tuesday, October 28 2008 by rednucleus

Last modified on Tuesday, October 28 2008.

A 17-year-old high school girl has been referred from the psychiatry department as a difficult-to-manage case of affective psychosis. She is on chlorpromazine for the past 3 months. Examination reveals resting tremor, rigidity, and dysarthria. Her work-up shows ALT 61 iu/L, total serum bilirubin 2.3 mg/dl, serum bicarbonate 14 mEq/L, blood urea nitrogen 15 mg/dl, and positive urine glucose testing. What does the girl have?

A) Juvenile Huntington's disease (HD)

B) Wilson's disease

C) Chlorpromazine-induced cholestatic hepatitis

D) Occult drug abuse

E) Chlorpromazine-induced Parkinsonism

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This question was created on October 28, 2008 by rednucleus.
This question was last modified on October 28, 2008.

ANSWERS AND EXPLANATIONS

A) Juvenile Huntington's disease (HD)

This answer is incorrect.

Juvenile variants of HD may have Parkinsonism, and may present with predominant psychiatric manifestations, but the lab tests are not consistent with this diagnosis. (See References)


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B) Wilson's disease

This answer is correct.

Up to 20% of Wilson's disease patients may have predominant psychiatric manifestations and psychiatrists might be the first who see those patients. Note the profound acidosis with normal renal function and urine sugar (normal anion gap metabolic acidosis of proximal renal tubular acidosis). You may assume her liver function abnormalities to be due to chlorpromazine therapy, but the latter would not explain other tests. (See References)


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C) Chlorpromazine-induced cholestatic hepatitis

This answer is incorrect.

This would not explain her other abnormal tests. (See References)


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D) Occult drug abuse

This answer is incorrect.

Occult drug abuse should always be searched for in cases of refractory psychiatric manifestations, but this would not explain her lab tests. (See References)


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E) Chlorpromazine-induced Parkinsonism

This answer is incorrect.

This would not affect her liver and renal tubular function. (See References)


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References:

1. Victor, M., and Ropper, A.H. (2001). Adams and Victor's Principles of Neurology, 7th Edition. McGraw-Hill, New York. (ISBN:0070674973)

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adult
Metallic Psychosis
Question ID: 102708236
Question written by rednucleus. (C) FrontalCortex.com 2006-2009, all rights reserved. Created: 10/28/2008
Modified: 10/28/2008
Estimated Permutations: 120