Psychiatric emergencies

Question 1

Which medications are known to induce a manic episode?

Answer 1

Steroids
levodopa
Antidepressants

Question 2

What’s the presentation of neuroleptic malignant syndrome?

Answer 2

Mental status changes, fever, muscle rigidity, and autonomic instability (fever)

Question 3

What’s the pathophysiology of malignant neuroleptic syndrome?

Answer 3

Sudden decrease in dopaminergic activity

Caused by sudden stopping or starting of meds, or taking multiple dopamine drugs

Eg. risperidone

Question 4

How is malignant neuroleptic syndrome managed?

Answer 4

Mostly supportive

• Stop the causative agent
• Consider dopamine agonist

Question 5

What’s the presentation of serotonin syndrome?

Answer 5

Fever
Diarrhoea
Vomiting
Agitation
Hyperreflexia

Question 6

When is serotonin syndrome most likely?

Answer 6

When taking multiple SSRI’s

Question 7

What are the complications of clozapine?

Answer 7

Constipation
Myocarditis
Agranulocytosis
Seizures, DVT, toxicity

Question 8

What is the pathophysiology of serotonin syndrome?

Answer 8

Excess serotonin in the body

Question 9

What is post-partum psychosis?

Answer 9

AKA puerperal psychosis
Happens in first 8 weeks post partum

Strong risk of relapse is history of mental health

Question 10

If IM lorazepam hasn’t worked to calm a patient, what else can be prescribed?

Answer 10

Olanzapine on top of that
(Not in dementia)