Psych

Question 1

Neuromuscular hyperreactivity (tremor, hyperreflexia, myoclonus) NMS or serotonin syndrome?

Answer 1

Serotonin syndrome

Note: NMS develops over days to weeks, whereas serotonin syndrome develops over 24 hours. Also, resolution of NMS typically requires an average of nine days, compared with less than 24 hours (usually) for resolution of serotonin syndrome

Question 2

Sluggish neuromuscular responses (rigidity, bradyreflexia) NMS or serotonin syndrome?

Answer 2

NMS

Note: Hyperreflexia and myoclonus are rare in NMS

Question 3

Therapeutic range for Li and when should it be tested related to dosing?

Answer 3

0.4 -1

12 hours post dose

Question 4

Lithium should be prescribed by brand name T/F

Answer 4

T - as different preparations vary in salt type and bioavailability

Question 5

SSRIs can increase the risk of Li toxicity T/F

Answer 5

T

As can typical antipsychotics; carbamazepine; diuretics (esp thiazide); NSAIDs; ACEi and calcium channel blockers (less commonly)

Question 6

Features of Li toxicity?

Answer 6

GI: anorexia, nausea, diarrhoea

CNS: muscle weakness and twitching, drowsiness, ataxia, coarse tremor, tinnitus. At high levels coma and seizures

CV: ventricular tachyarythmia; can see T wave inversion or signs of SA node dysfunction on ECG

Question 7

In the absence of symptoms of toxicity Li levels < 2.5 can be managed in the community

Answer 7

F - less than 1.5 for community mgmt in absence of toxicity symptoms

Question 8

Indications for haemodialysis in Li toxicity?

Answer 8

Level of greater than 4 mmol/L or features of central nervous system toxicity or cardiac instability

Note:Whole bowel irrigation should be considered in adults who have ingested a slow release preparation of lithium of greater than 4 g

Question 9

What region of brain is implicated in panic disorder?

Answer 9

Locus caeruleus