Psych Emergencies

Question 1

• Delirium
• Agitation
• Fever
• Autonomic hyperactivity
• Auditory and Visual hallucinations
• 2 - 4 days after cessation, but may occur later

Answer 1

Delirium Tremens (DTs)

Question 2

Rx for Delirium Tremens (DTs)?

Answer 2

Benzodiazepines and Hydration

Question 3

• Fever
• Rigidity
• Autonomic instability
• Clouding of consciousness
• Elevated WBC / CPK

Answer 3

Neuroleptic Malignant Syndrome (NMS)

Question 4

Tx and Rx for Neuroleptic Malignant Syndrome (NMS)?

Answer 4

• Withhold neuroleptics
• Hydrate
• Rx: Consider Dantrolene and/or Bromocriptine

Question 5

• Altered mental status / Confusion
• Fever
• Agitation
• Tremor
• Myoclonic jerks
• Hyerreflexia / Hypertonicity / Rhabdomyolysis
• Ataxia
• Incoordination
• Diaphoresis / Flushing / Shivering
• Renal failure
• Diarrhea
• Death

Answer 5

Serotonin Syndrome

Question 6

Tx and Rx for Serotonin Syndrome?

Answer 6

• Discontinue offending agents
• Rx:
  
  • Benzodiazepines
  • Cyproheptadine

Question 7

• HTN
• HA
• Neck stiffness
• Sweating
• Nausea
• Vomiting
• Visual problems
• Possible Stroke and Death
• Buildup of catecholamines
• Tyramine-rich foods (red wine, cheese, chicken liver, cured meats) + MAOIs or w/ Sympathomimetics

Answer 7

Tyramine Reaction / Hypertensive Crisis

Question 8

Rx for Tyramine Reaction / Hypertensive Crisis?

Answer 8

Nitroprusside

or

Phentolamine

Question 9

• Early sudden onset of muscle spasms:
  
  • Eyes
  • Tongue
  • Jaw
  • Neck
  • Laryngospasm requires intubation

Answer 9

Acute Dystonia

Question 10

Rx for Acute Dystonia?

Answer 10

Benzotropine (Cogentin)

or

Diphenhydramine (Benadryl)

Question 11

• Nausea / Vomiting
• Slurred speech
• Ataxia
• Incoordination
• Myoclonus
• Hyperreflexia
• Seizures
• Nephrogenic diabetes insipidus
• Delirium coma

Answer 11

Lithium Toxicity

Question 12

Tx for Lithium Toxicity?

Answer 12

• Discontinue Li
• Hydrate aggressively
• Consider Hemodialysis

Question 13

• Anticholinergic effects:
  
  • Cardiac conduction disturbances
  • Hypotension
  • Respiratory depression
  • Agitation
  • Hallucinations
• CNS stimulation, Depression, Seizures

Answer 13

Tricyclic Antidepressant (TCA) toxicity

Question 14

Tx for Tricyclic Antidepressant (TCA) Toxicity?

Answer 14

• Monitor ECG
• Activated charcoal
• Cathartics
• Supportive Treatment

Question 15

• Parkinsonism - masklike face, cogwheel rigidity, bardykinesia, pill-rolling tremor
• Akathisia - restlessness, need to move, and agitation
• Dystonia - sustained, painful contraction of muscles of neck, tongue, eyes, diaphragm

Answer 15

Extrapyramidal Side Effects (EPS)

a/w 1st Gen. Antipsychotics

Question 16

• Occurs with High-potency, Typical (1st Gen.) Antispychotics and Risperidone

Answer 16

Hyperprolactinemia

Question 17

• Choreoathetoid muscle movements, mouth and tongue
• Grimacing
• Tongue protrusion
• Irreversible

Answer 17

Tadrive dyskinesia (TD)

a/w High Potency 1st Gen. Antispychotics

Question 18

• Mental status change
• Fever
• Tachycardia
• HTN
• Tremor
• Elevated Creatine Phosphokinase (CPK)
• “Lead-pipe” rigidity
• 20% Mortality Rate

Answer 18

Neuroleptic Malignant Syndrome

a/w High-pentency 1st Gen. Antipsychotics

Question 19

Rx for Extrapyramidal Symptoms?

Answer 19

Benztropine

Question 20

CYP450 Inducers (4)

Answer 20

• Tobacco (1A2)
• Carbamazepine (1A2, 2C9, 3A4)
• Barbiturates (2C9)
• St. John’s Wart (2C19, 3A4)

Question 21

CYP450 inhibitors (5)

Answer 21

• Fluvoxamine (1A2, 2C19, 3A4)
• Fluoxetine (2C19)
• Paroxetine (2D6)
• Duloxetine (2D6)
• Sertraline (2D6)