RT Book, Section
A1 Jobst, Erin E.
A1 Panus, Peter C.
A1 Kruidering-Hall, Marieke
SR Print(0)
ID 1192816090
T1 Antipsychotic Agents and Lithium
T2 Pharmacology for the Physical Therapist, 2e
YR 2020
FD 2020
PB McGraw-Hill Education
PP New York, NY
SN 9781259862229
LK accessphysiotherapy.mhmedical.com/content.aspx?aid=1192816090
RD 2024/04/20
AB CASE  STUDYM.M.  is  a  56-year-old  man  who  was  referred  to  rehabilitation  by  his  physician  after  several  falls  and  increasing  balance  problems  as  per  his  wife’s  observation.  The  patient  has  a  history  of  schizophrenia  that  has  been  well  controlled  with  medication.  Recent  imaging  and  clinical  diagnostic  tests  have  ruled  out  any  neurological  or  structural  central  nervous  system  (CNS)  pathology.  M.M.  is  currently  taking  pantoprazole  (a  proton  pump  inhibitor)  and  quetiapine.  During  the  patient  interview,  M.M.  reported  that  his  prescribing  practitioner  increased  his  dose  of  quetiapine  after  a  psychotic  episode  2  months  ago.  Hesitantly,  M.M.  also  reported  several  recent  episodes  of  lightheadedness.  M.M.  states  that  he  has  begun  to  feel  extremely  stiff  at  times  and  has  had  a  hard  time  moving.  During  the  physical  therapy  examination,  M.M.  appeared  to  be  in  no  acute  physical  distress.  When  moving  from  sitting  to  standing,  M.M.  stated  that  he  became  slightly  lightheaded  with  the  edges  of  his  vision  blurring.  The  therapist  confirmed  orthostatic  hypotension  during  a  sit-to-stand  transfer  with  a  fall  in  systolic  and  diastolic  blood  pressure  of  24  and  18  mm  Hg,  respectively.  Although  M.M.  had  normal  range  of  motion  and  strength  in  all  extremities,  he  displayed  some  postural  rigidity  evident  by  resistance  to  passive  stretch  that  was  more  severe  in  the  lower  extremities.  The  patient  did  not  demonstrate  a  resting  tremor.  M.M.’s  performance  on  the  Mini-BESTest  revealed  moderate  impairments  in  dynamic  balance.