psychiatric emergencies Flashcards
What is serotonin syndrome
high synaptic concentration of serotonin
What causes serotonin syndrome
caused by multiple drugs, mc co-administration of antidepressants
* SSRI/ SNRI
* TCA
* MAOi
* Lithium
Describe the classic triad of serotonin syndrome
- neuromuscular abnormalities - hyperreflexia, tremor
- altered mental state - agitation, confusion
- autonomic dysfunction - HTN, hyperthermia, tachycardia
How is serotonin syndrome managed
Medical emergency if severe
* stop causative drugs
* supportive treatment (sedation)
* 5HT2 antagonist - cyproheptadine
Give 4 symptoms of lithium toxicity
- nephrotoxicity - polyuria, nausea, diarrhoea
- confusion, drowsiness
- fine tremor progressing to coarse tremor
- weight gain
- increased reflexes
Give 4 signs of lithium toxicity
- nephrogenic diabetes insipidus
- CKD
- Hypothyroidism
- hyperparathyroidism and hypercalcaemia
How is lithium toxicity managed
- stop lithium
- high fluid and IV NaCl
- haemodialysis if severe
How are patients on lithium monitored
- Initiation: sample should be taken 12h post-dose
- after starting, levels should be checked weekly
- once established, check every 3m
- after a change in dose, Li levels should be taken a week later and weekly until levels are stable
- thyroid and renal function - every 6m
What causes acute dystonic syndrom
typical antipsychotics
Give 4 symptoms of acute dystonic syndrome
sustained muscle contraction
* eyes - oculogyric crisis
* neck - torticollis (twisted)
* jaw - mouth open
* pain and distress
How is acute dystonic syndrome managed
IM procyclidine 5-10mg
