psychiatric emergencies Flashcards
How does age relate to likelihood of suicide death?
- suicide is one of the leading causes of death in adolescents
- but, suicide rates are higher in the elderly- they are more frail and more likely to use lethal methods
What are the most commonly diagnosed psychiatric disorders in people who die by suicide?
- chronic psychotic disorders- schizophrenia and schizoaffective
- substance-use disorders (esp. EtOH)
- mood disorders, esp. MDD
Among elderly, mood disorders clearly predominate
What kinds of emotions are usually expressed in a suicide attempt?
despair, rage, help seeking
What are psychiatric diagnoses predictive of violence in inpatient/acute settings?
- mania
- psychosis
- substance related states- either intoxication or withdrawal
- Cognitive impairment states
- Personality disorders- esp those with chronic impulse control issues (borderline, antisocial)
- depression, if comorbid with risks listed above
What are psychiatric diagnoses predictive of violence in inpatient/acute settings?
- mania
- psychosis
- substance related states- either intoxication or withdrawal
- Cognitive impairment states
- Personality disorders- esp those with chronic impulse control issues (borderline, antisocial)
- depression, if comorbid with risks listed above
What is catatonia?
Syndrome with:
- severe psychomotor abnormality, which may include purposeless, self-directed incr. motor activity, severe slowing or immpobility (or may include catalepsy- limb position may be molded by examiner and patient will maintain that position), or weird voluntary movements (bizarre postures, sterotypes)
- mutism
- negativism (resistance to all instruction/attempts at being moved)
- echolalia or echopraxia
DDx for catatonia
- primary neuro disease (encephalitis, stroke Parkinson’s)
- metabolic conditions (hepatic/electrolyte abnormalities)
- meds
- idopathic mood disorder
- schizophrenia
- schizoaffective
- In new presentation of catatonia, you must first treat as a medical emergency until proven otherwise
If pt has idiopathic catatonia, what is the usual underlying dx?
usually due to mood disorder with psychotic features
If pt has idiopathic catatonia, what is the usual underlying dx?
usually due to mood disorder with psychotic features
tx for catatonia
- feeding tube for nutrition
- bowel/bladder care
- prevention of deconditioning
- vitals
- lorezapam/ativan may be given to attempt to lyse catatonia vs. ECT
tx for catatonia
- feeding tube for nutrition
- bowel/bladder care
- prevention of deconditioning
- vitals
- lorezapam/ativan may be given to attempt to lyse catatonia vs. ECT
Acute dystonia- what are some unusual drugs that cause it
obviously the antispychotics
but also can be seen with prochlroperazine (compazine) and metoclopramide (reglan)
What are the most serious/dangerous manifestations of acute dystonia?
- torticollis
- opisthotonos (severe extension of the entire spine)
- oculogyric crisis (fixed upward gaze)
- laryngeal dystonia (can cause airway obstruction)
Tx of acute dystonia
IM anticholinergics like benztropin (cogentin) and/or benadryl
tx of NMS
dantrolene and bromocriptine (central DA agonist, may help neuro components of NMS)
What symptoms point more toward serotonin syndrome than NMS?
shivering, diarrhea, tremor, hyperreflexia, and myoclonus
When would a pt begin to feel sx of SSRI discontinuation syndrome? How long might those sx last?
onset- 2-4 days after last dose
duration: may be as long as 3 wks
What are some pharmacologic treatments for serotonin syndrome?
methysergide, cyproheptatidine, propanolol
Which SSRI(s) is LEAST likely to cause SSRI discontinuation syndrome? Which SSRI(s) are MOST likely to cause it if improperly tapered?
least likely- fluoxetine, due to long half life (self taper)
most- paroxetine
Which SSRI(s) is LEAST likely to cause SSRI discontinuation syndrome? Which SSRI(s) are MOST likely to cause it if improperly tapered?
least likely- fluoxetine, due to long half life (self taper)
most- paroxetine
What are the tx for tyramine-induced hypertensive crisis?
- nifedipine
- may add alpha adrenergic blockade (phentolamine, possibly chlorpromazine)
