What is the diagnosis you would give for this patient

Reference no: EM133309368

Case Study: A 78-year-old man presents to your office with his daughter for an urgent appointment as his eyes have been rolling upwards uncontrollably since this morning. He lives on his own following the death of his wife last year and has been very low since then. His daughter is very concerned about him. His self-care has suffered, and he often burns his food, though, at other times "he seems completely fine." Three months ago, he suffered a fall and bruised his face. His daughter has noticed other bruises on his body. He has developed a tremor and seems to stumble a lot. His sleep and appetite have been poor, and he has lost about 2 kg in weight over the past year. Two days ago, he went to the GP surgery complaining of seeing a whole orchestra playing in his kitchen and was prescribed haloperidol 0.5 mg twice daily. However, since yesterday, he has been suffering uncontrollable twisting movements of his neck and face. Last night, he could not keep his balance and suffered a fall in his living room.

Mental State Examination

He is pleasant but seems a little confused and bewildered. He does not have any formal thought disorder. He describes, in great detail, the musicians in the orchestra that he can see in his kitchen. He acknowledges that they are not real and says he finds them disconcerting but not particularly unpleasant. His mood is low, and he gets tearful during the interview.

The Abbreviated Mental Test is abnormal, with a score of 5 out of 10. He has reasonable insight into his symptoms and wants treatment to get better. Physical examination reveals a resting tremor in his hands with cogwheel rigidity in his forearms. The rest of the physical examination is unremarkable.

Question 1: What is the differential diagnosis?
Question 2: What is the diagnosis you would give for this patient?
Question 3: What is the pharmacological management?

Reference no: EM133309368

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