DSSSB 12 August 2024
Mental Health Nursing
Medium
A patient on chlorpromazine develops a subjective sensation of muscle discomfort, agitation, and restlessness. What is the condition?
Appeared in: DSSSB 12 August 2024
Explanation
- Akathisia is a medication-induced movement disorder characterized by a subjective feeling of inner restlessness and a compelling urge to move.
- The patient's symptoms of muscle discomfort, agitation, and restlessness are the hallmark signs of akathisia.
- Chlorpromazine, a first-generation (typical) antipsychotic, has a high risk of causing extrapyramidal side effects, including akathisia.
- It is crucial to differentiate akathisia from worsening psychosis, as increasing the antipsychotic dose would exacerbate the akathisia.
Why Other Options Were Wrong
- Option A: Acute dystonia involves involuntary, sustained muscle contractions and spasms, not a subjective feeling of restlessness.
- Option C: Tardive dyskinesia is a late-onset disorder characterized by involuntary, repetitive movements like lip-smacking or writhing of the limbs, not the acute restlessness described.
- Option D: Akinesia is the absence or poverty of movement, which is the opposite of the agitation and restlessness seen in akathisia.
Related Visual
Clinical Relevance
- Nursing practice connection: Use the key finding related to Extrapyramidal side effects of antipsychotic medications to guide bedside assessment, documentation, and the next nursing action.
- Nurses must be vigilant in assessing for EPS in patients taking antipsychotics. Akathisia is highly distressing and can be mistaken for anxiety or worsening psychosis, leading to inappropriate treatment.
- Prompt identification and reporting of akathisia are critical for patient safety and comfort. It is a significant cause of non-adherence to medication and is associated with an increased risk of suicidal ideation.
- Management involves notifying the prescriber, who may reduce the dose, switch to a different antipsychotic (often an atypical one with a lower EPS profile), or prescribe medications like propranolol or benzodiazepines.
How to Approach the Question
- First, identify the drug mentioned (chlorpromazine) and its class (typical antipsychotic).
- Recall the major side effect profile of this drug class, which prominently includes Extrapyramidal Symptoms (EPS).
- Analyze the specific symptoms presented in the clinical scenario: 'subjective sensation of muscle discomfort, agitation, and restlessness'.
- Systematically compare these symptoms to the definitions of the different types of EPS provided in the options.
- Eliminate options that do not match. Acute dystonia involves spasms, tardive dyskinesia involves late-onset repetitive movements, and akinesia is a lack of movement.
- Conclude that the symptoms perfectly match the description of akathisia, the state of motor restlessness.
Concept Tested & Keywords
- Concept Tested: Extrapyramidal side effects of antipsychotic medications
- Stem keywords: chlorpromazine, muscle discomfort, agitation, restlessness
- Lead-in keywords: What is the condition?
- Clinical cues: The patient is on chlorpromazine, a typical antipsychotic known to cause extrapyramidal symptoms (EPS).
Question ID
QLsEve1ra6-Oktgy7LyZ9J
Reference Book
E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) pp. 10037-10039, 5076-5078, 10051-10053
Practise the full DSSSB 12 August 2024
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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