Psychiatric emergencies Flashcards
Define acute dystonia
abnormal involuntary muscle contraction with slow sustained, repetitive movement and posturing
What causes acute dystonia?
dopamine-receptor blockade disrupting dopaminergic-cholinergic balance in basal ganglia (substantia nigra) –> excess cholinergic output
Acute dystonia management
confirm antidopaminergic exposure
diphenydramine or benzatropine
urgent treatment and supportive measures
How is catatonia diagnosed?
DSM-5 at least 3 of:
waxy flexibility
catalepsy
posturing
stupor
agitation
negativism
mutism
grimacing
mannerisms
stereotypies
echolalia
echopraxia
Catatonia causes
psychiatric causes:
- bipolar disorder + schizophrenia
- depression, OCD, PTSD, ASD
non-psychiatric causes:
- infections, autoimmune disorders affecting CNS
- side effect or withdrawal effect from benzos or antipsychotics
- substance use or withdrawal from substances (eg. alcohol or cocaine)
What is catatonia?
neuropsychiatric condition where individual becomes unreactive to environment
Signs/symptoms of catatonia
sitting or standing in same position for hours - hold odd positions, resist movement of extremities
severe (malignant catatonia) = fever, psychomotor agitation, autonomic dysfunction
Catatonia treatment
benzodiazepines eg. lorazepam
electroconvulsive therapy
Key difference between NMS and SS
(caused by different medications)
NMS = lead pipe rigidity
SS = hyperreflexia + clonus
Serotonin syndrome presentation
more acute (hours)
caused by SSRIs, SNRIs, MAOIs, tricyclic antidepressants, synthetic opioids, illicit drugs
tachycardia
raised BP
hyperthermia
diaphoresis
rigidity
altered mental state
hyperreflexia
clonus
tremor
dilated pupils
diarrhoea
CK can be raised but not as common as NMS
Serotonin syndrome management
stop serotonergic drugs
IV fluids and cooling
benzodiazepines
cyproheptadine
Neuroleptic malignant syndrome presentation
more gradual (days-weeks)
caused by anti-psychotics, sudden cessation of dopaminergic agents eg. levodopa
tachycardia
raised BP
hyperthermia
diaphoresis
rigidity
altered mental status
delirium
hyporeflexia
lead pipe rigidity
normal pupils
normal GI exam
raised CK - can cause AKI
Neuroleptic malignant syndrome management
stop antipsychotics
IV fluids
dantrolene
bromocriptine
