A 75-year-old man worried that he has recently developed quite a marked tremor and nothing helps him control it. He has a long-established diagnosis of bipolar disorder, which has been well controlled with lithium. His medication was recently changed. Mental state examination The man is cooperative and communicative with good eye contact. His speech is normal. His mood is objectively and subjectively stable. He does not express any ideas of self-harm.
There is no evidence of psychosis. He is orientated in time, place and person, and there is no cognitive impairment. Physical examination The man looks well and there is nothing of note except a marked coarse tremor. The tremor is not rhythmic and is present at rest and when he attempts a task. There is no indication of any cogwheel rigidity or lack of facial expressions. What is the probable diagnosis? Source : 100 Cases in Psychiatry…
