Một người đàn ông 82 tuổi mà không có tiền sử thần kinh quan trọng được nhập viện vì viêm phổi. Vào tối ngày bệnh viện thứ hai, ông phát triển kích động và sự nhầm lẫn nghiêm trọng. | 93 1. An 82-year-old man without previous significant neurological history is hospitalized for pneumonia. On the second hospital evening he develops severe agitation and confusion. His symptoms wax and wane over the next several days and resolve with improvement of his pneumonia. Which of the following options represents the current model of neurotransmitter deficiency excess in the pathophysiology of this patient s neuropsychiatric symptoms A. Acetylcholine deficit and dopamine excess B. Dopamine deficit and serotonin excess C. gamma -Aminobutyric acid GABA deficit and glutamine excess D. Serotonin deficit and acetylcholine excess E. Glutamine deficit and GABA excess Correct Answer The correct answer is A. This patient s symptoms and signs are most consistent with delirium. The current pathophysiological model of delirium suggests the pathophysiological role of a simultaneous cholinergic deficit and dopamine excess although these alterations probably exist within a more global derangement of multiple neurotransmitter systems. 2. A 35-year-old woman has presented to her physician with three different acutely distressing symptoms in the past 2 years. Shortly after the holidays 2 years ago she complained of dysphagia. No abnormalities were found on a barium swallow or upper endoscopy. She experienced no weight loss and the dysphagia gradually improved with reassurance. She returned to the physician the next spring with complaints of intermittent shortness of breath. A fairly detailed cardiopulmonary evaluation failed to demonstrate any abnormalities. She was placed in a graded exercise program and experienced a gradual amelioration of this problem. However this year she returned with complaints of diffuse myalgias and weakness. Evaluation failed to show any objective signs of weakness or laboratory evidence of muscle disease. This woman s constellation of somatic symptoms meets the diagnostic criteria for which of the following disorders A. Conversion disorder B. .
