A 38-year-old woman is brought to the emergency department after causing a disturbance in a department store. The patient says that the government was releasing poisonous gas through the air vents of the store and that red-colored clothing items were a signal to evacuate. She was arrested a year ago for a similar incident. The patient dropped out of college at age 20. She lives with her parents and has never worked. She smokes a pack of cigarettes a day but does not use alcohol or drugs. Physical examination is unremarkable. On mental status examination the patient appears distracted and fearful. She reports hearing the voices of two men who criticize her actions continuously and have done so for years. Which of the following abnormalities is most likely associated with this patient's symptoms?

Question

A 38-year-old woman is brought to the emergency department after causing a disturbance in a department store.  The patient says that the government was releasing poisonous gas through the air vents of the store and that red-colored clothing items were a signal to evacuate.  She was arrested a year ago for a similar incident.  The patient dropped out of college at age 20.  She lives with her parents and has never worked.  She smokes a pack of cigarettes a day but does not use alcohol or drugs.  Physical examination is unremarkable.  On mental status examination the patient appears distracted and fearful.  She reports hearing the voices of two men who criticize her actions continuously and have done so for years.  Which of the following abnormalities is most likely associated with this patient's symptoms?

Quizplus · Accepted Answer

11ec160b_3644_74bb_9249_4ffb939c7277_MD0001_00 This patient likely has schizophrenia, a psychotic disorder with a prevalence of 1 percent worldwide. Her auditory hallucinations and delusions of being poisoned and receiving signals are characteristic positive symptoms of the disorder. Positive psychotic symptoms are thought to be caused by an excess of dopamine in the mesolimbic dopamine pathway. The mesolimbic pathway projects from the ventral tegmental area to various regions throughout the limbic system. The treatment of choice for schizophrenia is antipsychotic medication. Most antipsychotics are dopamine antagonists that produce their therapeutic effects (ie, decreased intensity of delusions and hallucinations) by decreasing dopamine activity in the mesolimbic pathway (Choice A). Dopamine antagonism in the nigrostriatal and tuberoinfundibular pathways accounts for some of the common side effects of antipsychotics. (Choices B and E) The nigrostriatal pathway extends from the substantia nigra to the basal ganglia and is involved in the coordination of movement. Decreased dopamine activity in the nigrostriatal pathway causes the extrapyramidal side effects of antipsychotics (eg, acute dystonic reactions, akathisia, drug-induced parkinsonism). Increased dopamine activity in the nigrostriatal pathway is thought to be involved in some movement disorders such as chorea and tics. (Choices C and F) The tuberoinfundibular dopamine pathway projects from the hypothalamus to the pituitary gland. Normally, neurons in the tuberoinfundibular pathway secrete dopamine, which inhibits prolactin release from the anterior pituitary gland. Antipsychotics can cause hyperprolactinemia by blocking the inhibition of dopamine activity in the tuberoinfundibular pathway, resulting in amenorrhea, galactorrhea, gynecomastia, and sexual dysfunction. Educational objective: Positive symptoms of schizophrenia (eg, delusions, hallucinations) are associated with increased activity of dopamine in the mesolimbic pathway. Antipsychotics work by antagonizing dopamine receptors in this pathway. __________ References: Does the dopamine hypothesis explain schizophrenia? (http://www.ncbi.nlm.nih.gov/pubmed/23843581)

A 38-Year-Old Woman Is Brought to the Emergency Department After