Mental Health

Question 1

symptoms of serotonin syndrome and medications that increase the risk of this

Answer 1

symptoms suggestive of serotonin syndrome pyrexia, rigidity, hyperreflexia, confusion, and altered mental state.

Serotonin syndrome is a condition in which there is excess serotonin in the body.

Medications that increase the risk of serotonin syndrome i (SSRIs) and monoamine oxidase inhibitors. Other drugs can also interact with these medications, further increasing the risk of serotonin syndrome - these include St John’s wort and tramadol.

Question 2

Antipsychotics in the elderly: increase risk of…

Answer 2

Antipsychotics in the elderly - increased risk of stroke and VTE

Question 3

classic picture of aspirin overdose

Answer 3

Initial respiratory alkalosis due to stimulation of the central respiratory centre causing increased respiratory effort. Following this, a metabolic acidosis develops along side the respiratory alkalosis. This is due to the direct effect of the metabolite salicylic acid.

Question 4

features of salicylate overdose

Answer 4

Features
* hyperventilation (centrally stimulates respiration)
* tinnitus
* lethargy
* sweating, pyrexia
* nausea/vomiting
* hyperglycaemia and hypoglycaemia
* seizures
* coma

Question 5

treatment of salicylate overdose

Answer 5

Treatment
* general (ABC, charcoal)
* urinary alkalinization with intravenous sodium bicarbonate - enhances elimination of aspirin in the urine
* haemodialysis

Question 6

Indications for haemodialysis in salicylate overdose

Answer 6

• serum concentration > 700mg/L
• metabolic acidosis resistant to treatment
• acute renal failure
• pulmonary oedema
• seizures
• coma

Question 7

management of severe alcoholic hepatitis

Answer 7

Corticosteroids-prednisolone

Question 8

features of lithium toxicity

Answer 8

coarse tremor (a fine tremor is seen in therapeutic levels)
hyperreflexia
acute confusion
polyuria
seizure
coma

Question 9

Lithium toxicity may be precipitated by:

Answer 9

• dehydration
• renal failure
• drugs: diuretics (especially thiazides), ACE inhibitors/angiotensin II receptor blockers, NSAIDs and metronidazole.

Question 10

Lithium toxicity management

Answer 10

• mild-moderate toxicity may respond to volume resuscitation with normal saline
• haemodialysis may be needed in severe toxicity
  sodium bicarbonate is sometimes used but there is limited evidence to support this. By increasing the alkalinity of the urine it promotes lithium excretion

Question 11

Lithium toxicity generally occurs following concentrations >

Answer 11

1.5

Question 12

Features of lithium toxicity

Answer 12

Features of toxicity
coarse tremor (a fine tremor is seen in therapeutic levels)
hyperreflexia
acute confusion
polyuria
seizure
coma

Question 13

the single most important prognostic factor in paracetamol overdose

Answer 13

The arterial pH is the single most important prognostic factor in paracetamol overdose

Question 14

type 1 vs type 2 bipolar disorder

Answer 14

Type I bipolar is associated with mania and type 2 is associated with hypomania

Question 15

drugs that can cause serotonin syndrome

Answer 15

monoamine oxidase inhibitors
SSRIs
* St John’s Wort, often taken over the counter for depression, can interact with SSRIs to cause serotonin syndrome
* tramadol may also interact with SSRIs

ecstasy
amphetamines