Psychiatric emergencies Flashcards
Serotonin syndrome
rare but life threatening of increased serotonin activity - rapidly occurring within minutes of taking medication
Serotonin syndrome cause
SSRI, TCA and lithium
Cognitive effects serotonin syndrome
Headache
Agitation
hypomania
confusion
hallucinations
coma
Autonomic effects serotonin syndrome
shiverying
sweating
hyperthermia
hypertension
tachycardia
Somatic effects serotonin syndrome
myoclonus
hyperreflexia
tremor
Management serotonin syndrome
stopping offending drug and supportive measures
Lithium toxicity symptoms
4 Ds
Dehydration
Drugs (ACE inhibitors, NSAIDS)
Diuretics
Depletion of sodium
Lithium toxicity treatment
High intake of fluid, including iv sodium chloride therapy to stimulate osmotic diuresis
Renal dialysis may be needed
Neuroleptic malignant syndrome
occurs with dopaminergic drugs (such as levodopa) for Parkinson’s disease, when it is suddenly stopped or the dose is reduced.
- More common in young male patients
- Onset usually in first 10 days of treatment or after increasing dose.
NMS symptoms
- Presents with pyrexia, muscular rigidity, confusion, fluctuating consciousness and autonomic instability. May have delirium
NMS signs
- Creatinine Kinase increased, FBC leukocytosis and deranged LFT
NMS treatment
- Stop the antipsychotic, monitor vital signs, IV fluids to prevent renal failure and cooling . Dantolene may be useful in select cases. Bromocriptine can also be used as a dopamine agonist.
Complications NMS
- Complications are pulmonary embolism, renal failure and shock.
Overdose Benzos
ataxia, dysarthria, nystagmus, coma, resp depression
ABCDE approach
IV flumazenil
Benzo withdrawal
up to 3 weeks after stopping
Insomnia
Anxiety
loss of appetite
tremor
muscle twitching
sweating
tinnitus
perceptual disturbances
seizures
