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- Aug 2, 2013
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A 52-year-old female patient is brought to the psychiatric emergency service with marked motor abnormalities. On examination, she displays mutism, staring, grimacing, echolalia, and echopraxia. The patient is on high doses of diazepam, and previous laboratory findings revealed elevated levels of glutamic acid decarboxylase (GAD) antibodies. Her past medical history includes epilepsy and diabetes mellitus.
The patient's sister, who is her legal guardian and resides overseas, has instructed the medical team to avoid any "aggressive" interventions, in line with their cultural beliefs. There is also an ongoing legal dispute concerning medical power of attorney.
What are the most appropriate courses of action, considering the psychiatric, neurological, medical, ethical, cultural, legal, and psychopharmacological complexities?
A) Facilitate a video conference with the sister.
B) Increase diazepam, initiate lorazepam.
C) Start ECT.
D) Engage a medical ethicist.
E) Consult hospital legal counsel.
F) Start amantadine, maintain the current diazepam regimen.
G) Initiate memantine, increase the dose of diazepam.
H) Provide physical therapy.
I) Notify local law enforcement regarding the legal dispute.
J) Pursue a court order for treatment against the sister's wishes.
K) A, E, F and H
L) F, H, D, E, and A
M) G, B, C, and I
The patient's sister, who is her legal guardian and resides overseas, has instructed the medical team to avoid any "aggressive" interventions, in line with their cultural beliefs. There is also an ongoing legal dispute concerning medical power of attorney.
What are the most appropriate courses of action, considering the psychiatric, neurological, medical, ethical, cultural, legal, and psychopharmacological complexities?
A) Facilitate a video conference with the sister.
B) Increase diazepam, initiate lorazepam.
C) Start ECT.
D) Engage a medical ethicist.
E) Consult hospital legal counsel.
F) Start amantadine, maintain the current diazepam regimen.
G) Initiate memantine, increase the dose of diazepam.
H) Provide physical therapy.
I) Notify local law enforcement regarding the legal dispute.
J) Pursue a court order for treatment against the sister's wishes.
K) A, E, F and H
L) F, H, D, E, and A
M) G, B, C, and I