Psychiatric Emergencies

Question 1

what is neuroleptic malignant syndrome caused by

Answer 1

Antipsychotics (usually first gen)

Question 2

Features

Answer 2

Rigidity (more than serotonin syndrome)
dysphagia, tremor
incontinence
altered LOC

Question 3

Tx of neuroleptic malignant syndrome

Answer 3

Stop antipsychotics
Bromocriptine +- dantrolene
Lorazepam
Hydration
Cooling measures

Question 4

What is serotonin syndrome caused by

Answer 4

Two antidepressants

usually MAOI + fluoxetine

Question 5

Features of serotonin syndrome

Answer 5

Less rigidity than neuroleptic malignant syndrome

SHIVERS
- shivering
- hyperreflexia + myoclonus
- increased temp (>41deg)
- vital signs instability
- Encephalopathy
- restlessness
- sweating

Question 6

Mx of serotonin syndrome

Answer 6

Stop antidepressants
lorazepam
hydration
cooling measures

Question 7

___ is elevated in both neuroleptic malignant syndrome and serotonin syndrome

Answer 7

CK

Question 8

What is the interaction between St John’s Wort and SSRIs?

Answer 8

Causes serotonin syndrome

Serotonin syndrome is a potentially life-threatening condition resulting from increased levels of serotonin in the brain.

Question 9

What is the effect of Fluvoxamine when taken with warfarin?

Answer 9

Inhibits metabolism of warfarin - increased bleeding risk

Warfarin is an anticoagulant, and its metabolism is critical to manage bleeding risks.

Question 10

What is the consequence of combining ACE inhibitors with lithium?

Answer 10

Increased risk of lithium toxicity - reduced lithium clearance

Lithium is used to treat bipolar disorder, and its levels must be carefully monitored.

Question 11

What is the risk associated with NSAIDs and lithium?

Answer 11

Increased risk of lithium toxicity

NSAIDs can affect kidney function, which is crucial for lithium excretion.