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Phase 3a - Psychiatry > Addictive Behaviours and Psychiatric Emergencies > Flashcards

Addictive Behaviours and Psychiatric Emergencies Flashcards

1
Q

What are some examples of psychiatric emergencies?

A
  1. Neuroleptic Malignant syndrome
  2. Serotonin syndrome
  3. Acute dystonic syndrome
  4. Alcohol withdrawal
  5. Delirium tremens
  6. Lithium toxicity
  7. Self-harm - overdose, DSM, ligatures

DSM = deliberate self-harm

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2
Q

What is neuroleptic malignant syndrome?

A

Adverse reaction to antipsychotics (dopamine receptor agonists) or abrupt cessation of dopaminergic meds (levodopa)

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3
Q

Sx of neuroleptic malignant syndrome?

Hint - mnemonic FARM

A
  • Fever
  • Autonomic hyperactivity- tachycardic, htn
  • Rigidity (lead pipe) - severe
  • Mental state changes - confused, altered
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4
Q

Ix and Tx of neuroleptic malignant syndrome?

A

Ix:
* Bloods - Inc. WBC + creatine kinase and dec. Fe
* CT/MRI head

Tx:
* Stop causative drug + supportive mx

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5
Q

What is serotonin syndrome and what causes it?

A

Overactivation of serotonergic system (high synaptic conc of serotonin)

Caused by SSRIs, opioids, lithium, TCA (tricyclic antidepressants)

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6
Q

Sx of serotonin syndrome?

Hint - mnemonic MAN

A
  • Mental state changes - confusion, hallucinations
  • Autonomic hyperactivity - hyperthermia (fever), htn, tachycardic, hyperreflexia
  • Neuromuscular abnormalities - clonus, tremor
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7
Q

Tx of serotonin syndrome

A

Stop causative drug + supportive tx

If SSRI overdose - activated charcoal

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8
Q

What is acute dystonic syndrome and what is it caused by?

A

Sustained, painful, involuntary contraction of muscle groups.

Usually caused by typical antipsychotics.

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9
Q

Sx of acute dystonic syndrome?

A

Extremely painful contraction in the :
* Eye - oculogyric crisis
* Neck - antero/latero/retro torticollis
* Jaw
* Arm

Presnts as arm in dystnic posture, neck spasm to side, mouth open, upward eye gaze, pain and distress.

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10
Q

Tx of acute dystonic syndrome?

A

Stop causative drug
IM procyclidine 5-10mg

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11
Q

What is alcohol withdrawal and delirium tremens?

A
  • Alcohol withdrawal = sx that occurs when a person whose been drinking excessively suddenly stops
  • Delirium tremens = life threatening cdtn that develop around 72 hours after alcohol intake cessation and can persist for several days.
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12
Q

What are the different tests used for alcohol abuse?

A

AUDIT
CAGE
FAST

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13
Q

Sx of alcohol withdrawal and delirium tremens

Describe sx:
* 6-12 hrs after last drink
* 12-24 hrs post-drink
* 72 hrs post drink

A

Simple withdrawal (6-12 hrs after last drink):
* Insomnia
* Tremor
* Anxiety
* N+V
* Sweating
* Palpitations

Alcohol hallucinosis (12-24 hrs post):
* Visual, tactile or auditory hallucinations

Delirium tremens (72 hrs post):
* Delusions + hallucinations
* Confusion
* Seizures
* Autonomic hyperactivity - sweating, htn, tachycardic, hyperthermia

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14
Q

Tx of:
* Alcohol withdrawal
* Delirium tremens

A

Alcohol withdrawal:
* Chlordiazepoxide (5-7 days)
* Pabrinex - to prevent Wernicke’s encephalopathy and replenish vitamins
* Fluids and anti-emetics
* Thiamine supplementation (3 mths)

Delirium tremens:
* Oral lorazepam - 1st line
* IV pabrinex

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15
Q

What is Wernicke’s encephalopathy?

A

Syndrome associated with chronic alcohol abuse that occurs due to B1 (thiamine) deficiency - results in mammillary body atrophy. however, it’s reversible.

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16
Q

Sx of Wernicke’s encephalopathy

A

Confusion
Ataxia
Ophthalmoplegia
Nystagmus
Less common - urinary incontinence, hypothermia

Tx = pabrinex and thiamine supps

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17
Q

What is Korsakoff’s psychosis?

A

Irreversible manifestation of untreated Wernicke’s encephalopathy

18
Q

Sx of Korsakoff’s psychosis

A

Retrograde amnesia (inability to remeber past events)
Anterograde amnesia (inability to form new memories)
Confabulation (generating false memories without intention of deceit)

Tx - pabrinex

19
Q

What is lithium used for?

A

Used to primarily tx bipolar and mania but can also be used as a mood stabiliser.

Should be avoided in severe renal impairment.

20
Q

What are the common side effects of lithium?

A

Fine tremor
Dry mouth
GI disturbance
Polydipsia and polyuria
Drowsiness

It’s a teratogenic medication

21
Q

Sx of lithium toxicity

A

Coarse tremor
CNS disturbance - seizures, impaired co-ordination
Cardiac arrhythmias
Visual disturbance
Renal failure

22
Q

Tx of lithium toxicity

A

Supportive mx - electrolyte balance, monitor renal function, IV fluid therapy
If severe - hameodialysis

To treat agitation and seizures - Benzodiazepines

23
Q

What are the features of opiate intoxication?

Opiate = i.e. heroin

They act on opiate receptors

A
  • Drowsiness
  • Confusion
  • Dec. RR
  • Dec. HR
  • Constricted pupils
  • Track marks (needle marks) if the intravenous route has been used; abscesses at injection sites
24
Q

What is opiate withdrawal? When does it occur?

A

Occurs as a result of opiate abuse. Can begin as early as 6 hours after last dose. However, symptoms peak at 36-72 hours.

Note - opiate withdrawal not as dangerous as alcohol withdrawal

25
Q

Describe features of opiate withdrawal?

A

Agitation
Anxiety and irritability
Muscle aches or cramps
Chills
Runny eyes
Runny nose
Sweating
Hypersalivation
Insomnia

26
Q

Tx of opiate withdrawal to help with sx?

A
  • Methadone (detox programme) - may cause prolonged QTc
  • Lofexidine (relieve withdrawals)
  • Neltrexone (prevent relapse) - once detox is complete
  • Naloxone (overdose)
27
Q

Cannabis intoxication sx?

Cannabis = marijuana

They act on cannabinoid receptors

A
  • Drowsiness
  • Impaired memory
  • Slow reflexes + motor skills
  • Increased appetite
  • Paranoia
  • Tachycardia
  • Dry mouth
28
Q

LSD intoxication sx?

LSD = psychedelic drug

They act on dopamine receptors

A
  • Labile mood - emotional instability
  • Hallucinations
  • Inc. HR, BP and temp
  • Sweating
  • Insomnia
  • Dry mouth
29
Q

What are some examples of static risk factors?

A
  • Hx of self-harm/overdose
  • Previous hospitilisation
  • Hx of mental disorder
  • Hx of substance use disorder (overdose)
  • Personality disorder
  • Childhood adversity
  • Family history of suicide
30
Q

What are some examples of dynamic risk factors?

A
  • Suicide ideation and intent
  • Hopelessness
  • Psych symtpoms - hallucinations?
  • Treatment adherence
  • Substance use
  • Psychosocial stress
31
Q

Tx for opiate overdose?

A

Naloxone

32
Q

What is the most common agent for intentional self-harm in the UK?

A

Paracetamol (overdose)

33
Q

Sx of paracetamol overdose?

A

Usually asx, but can have:
N + V
Loin pain
Haematuria and proteinuria
jaundice
Abdo pain
Coma

Think of sx that happens as a result of liver/kidney damage

34
Q

Build up of which toxic substance happens in paracetamol overdose?

A

NAPQI (N-acetyl-p-benzoquinone-imine)

35
Q

Ix for paracetamol overdose?

A

Bloods: FBC, U&E, LFTs, Clotting screen, venous blood gas (severe metabolic acidosis), paracetamol levels

36
Q

What are the main two tx for paracetamol overdose?

Tx of paracetamol overdose:
* If <1hr + dose >150mg/kg
* If <4hrs
* If 4-8hrs + dose >150mg/kg
* If 8-24hrs + dose >150mg/kg
* >24hrs
* Staggered overdose

A

Main two tx: activated charcoal and N-acetylcysteine

    • If <1hr + dose >150mg/kg:
      Activated charcoal
  • If < 4hrs:
    Wait until 4 hrs, take level and tx w/N-acetylcysteine based on level
  • If 4-8hrs + dose >150mg/kg:
    Start N-acetylcysteine immediately
  • If 8-24hrs + dose >150mg/kg:
    Start N-acetylcysteine immediately
  • If >24hrs:
    Start N-acetylcysteine immediately if pt has jaundice, RUQ tenderness, inc, ALT etc
  • Staggered overdose:
    Start N-acetylcysteine immediately
37
Q

Sx of TCA overdose?

A

Drowsiness and confusion
Cardiac arrhythmias
Seizures
Vomiting
Dilated pupils

38
Q

Ix for TCA overdose:

A

Bloods: FBC, U&E, CRP, LFTs, Venous blood gas (metabolic acidosis)

ECG: Prolonged Qt interval (cardiac arrhythmia)

39
Q

Tx of TCA overdose?

A
  1. IV sodium bicarbonate
  2. Activated charcoal within 2-4hrs of overdose
40
Q

Tx of benzodiazapine overdose?

A
  1. Activated charcoal
  2. Flumanezil

Flumazenil is a benzodiazepine receptor antagonist that competitively inhibits the activity of benzodiazepines

Phase 3a - Psychiatry (10 decks)

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