Psych emergencies:

Question 1

List the main 4 psychiatric emergencies:

Answer 1

• Lithium toxicity
• Acute dystonic reaction
• Neuroleptic malignant syndrome
• Serotonin syndrome

Question 2

What is the management for lithium toxicity?

Answer 2

1) ABCDE
2) Stop Li, check level, admit
3) Rapid reduction of serum Li required - whole bowel irrigation, forced diuresis, haemodialysis

Question 3

What is acute dystonic reaction?

Answer 3

Abnormal body movements caused by slow and sustained muscle contractions (EPSE).

Question 4

What causes acute dystonic reaction?

Answer 4

Nigrostriatial D2 blockade = excess striatial cholinergic output

Question 5

What is the treatment for acute dystonic reaction?

Answer 5

(may resolve by itself)

1) IM anticholinergic (procyclidine)
2) BZD

Question 6

Give 4 features of neuroleptic malignant syndrome:

Answer 6

• Muscular rigidity
• Pallor
• Sweating
• Changing BP

Question 7

What is the treatment for neuroleptic malignant syndrome?

Answer 7

1) BZD
2) Discontinue any causative agent
3) IV Dantrolene

Question 8

Give 3 features of serotonin syndrome:

Answer 8

• Altered mental state
• Tremor
• Hyperreflexia

Question 9

What is the management of serotonin syndrome?

Answer 9

1) ABCDE
2) Discontinue all serotonergic meds
3) If OD consider gastric lavage/activated charcoal