Acute Psychotic presentation

Question 1

Rapid tranquilisation is used for controlling disturbed behaviour - what drugs can be used?

Answer 1

Haloperidol/olanzapine/aripiprazole

Sedatives e.g. Lorazepam

Question 2

What is the mechanism of antipsychotic medications?

Answer 2

Reduce the amount of dopamine in the Mesolimbic pathway (motivation, emotion and reward areas of the brain)

Question 3

How would you examine a patient to see if they have EPSEs?

Answer 3

Gait assessment
Upper and Lower limb tone assessment

Question 4

Which medications are given for ACUTE EPSEs and why?

Answer 4

Procyclidine - anti-cholinergic medications

Question 5

Why is Procyclidine not used in tardive dyskinesia?

Answer 5

It often makes the symptoms worse

Question 6

What drug is given to treat Tardive Dyskinesia?

Answer 6

Tetrabenazine

Question 7

What is Neuroleptic Malignant Syndrome?

Answer 7

Rare but serious complications of anti-psychotic medication

Question 8

Presentation of Neuroleptic Malignant Syndrome

Answer 8

Stiffness
Impaired consciousness
Hyperpyrexia
Elevated Creatine Kinase
Unstable blood pressure

Question 9

How to differentiate between NMS and Serotonin sydrome

Answer 9

NMS - slower onset, hours to days
SS - quicker, more rapid onset.

NMS is characterised by ‘lead-pipe’ rigidity, whilst serotonin syndrome is characterised by hyperreflexia and clonus.

Question 10

How might myocarditis present (in clozapine therapy)?

Answer 10

Chest pain.
Fatigue.
Swelling of the legs, ankles and feet.
Rapid or irregular heartbeat (arrhythmias)
Shortness of breath, at rest or during activity.