Psychiatric emergencies Flashcards
What is Neuroleptic malignant syndrome
Recognise/treat
Side effect of too many anti-psychotics FEVER (D2 blockage @hypothalamus ^temp) Rigidity/stiffness altered mental state autonomic dysfunction (pale, ^HR, sweating, tremor etc)
Gradual (1-3day) onset within 4weeks of starting antipsychotic drugs
Delirium tremens
What is it - name symptoms
Change in mental state 24-72 hours after stopping alcohol Hallucinations Confusion Delusions Severe agitation Seizures
Delirium tremens
How do you manage it
ABC
Diazepam
Thiamine
?Magnesium to protect from seizures/arrthymias
Wernicke’s encephalopathy
Name some causes
Chronic alcohol consumption
= reduced thiamine intake and reduced absorption in GI tract
Brain tumour
Malabsorption / prolonged vomiting
Chemotherapy
Wernicke’s encephalopathy
Name the triad of symptoms
1) confusion
2) wide based gait ataxia
3) opthalmoplegia (nystagmus, conjugate gaze, bilateral lateral recrus palsies)
Also bad memory, low bp, cold, ptôsis etc
Wernicke’s encephalopathy
Treatment
Before or after glucose if required?
Thiamine
To be given BEFORE glucose if this is required
Wernicke’s encephalopathy
can lead to what if untreated
Korsakoff syndrome
Thiamine deficiency causes damage to hypothalamus and cerebral atrophy
Cant make new memories - confabulates
no insight and apathy
Symptoms of lithium toxicity
- Anorexia, diarrhoea and vomiting.
- Drowsiness, apathy, restlessness.
- Dysarthria.
- Dizziness, ataxia, uncoordinated, muscle twitching, coarse tremor
If severe: •Hyperreflexia, convulsions. •Collapse, coma, death •Renal failure •Hypokalaemia
Treatment of lithium toxicity
Stop lithium, check level
encourage fluids
stop diuretics
monitor electrolytes renal function
Lithium side effects
Polyuria/dipsia - lithium competes with ADH receptors
Hypothyroidism
Weight gain
Muscles twitching
What is an acute dystonic reaction - what does it look like
Extrapyramidal side effect - sustained muscle contractions, twitching, repetitive movements or abnormal postures
rarely life threatening
because the dopamine blockade causes excessive striatal ACh output
How long does an acute dystonic reaction last for?
a few days untreated
usually manifests a few hours after taking a causative drug
What causes an acute dystonic reaction?
Anti-psychotics most importantly
but also: SSRIs, recreational drugs and other things
First line treatment of an acute dystonic reaction
Benztropine
What is Neuroleptic malignant syndrome, what causes it
Potentially life threatening reaction to neuroleptic/antipsychotic drugs
Neuroleptic malignant syndrome - symptoms
Fever
Muscular rigidity (lead pipe)
Altered mental state
Autonomic dysfunction (pale, HR^, BP change, sweaty, tremor, incontinence)
Because D2 block in hypothalamus messes with temperature regulation
occurs within 10 days in 90%
Gradual onset over 1-3 days
Serotonin syndrome - what is it - drugs which cause it
Serotonin excess - excessive stimulation of the CNS - usually from SSRIs, SNRIs etc - other drugs can cause it too
Serotonin syndrome - triad of symptoms
1 Autonomic hyperactivity (HTN, HR^, hyperthermia, ^bowel sounds, sweating)
2 Neuromuscular abnormality (tremor, clonus, ocular clonus, hypertonicity, hyperreflexia)
3 Mental state changes (anxious, agitated, confused, coma)
Usually appear within 6 hours of taking the provoking drug
Paracetamol overdose - treatment
N-acetylcysteine
What is Catatonia
3 Classic features
abnormality of movement and behaviour arising from a disturbed mental state
- Motoric immobility - catalepsy, waxy flexibility, stupor
- Mutism - verbally minimally responsive.
- Negativism - involuntary resistance to passive movement, or involuntary oppositional behaviour
What is stupor
extreme hypoactivity, minimal response to stimuli, including painful ones
What is Catalepsy
Catalepsy is a state characterised by a patient keeping an uncomfortable, rigid and fixed posture despite external stimulus or resistance. There may also be decreased sensitivity to pain. It is a feature seen in catatonia
Catatonia - management
treat underlying cause
psychiatric causes:
NMS, severe depression, psychosis,drugs etc
Define delirium
an acute, transient and reversible state of confusion, usually the result of other organic processes (infection, drugs, dehydration etc.), the onset is acute and the cognition of the patient can be highly fluctuant over a short period of time.
acute confusional state
Hyperactive delirium symptoms
Agitation Delusions Hallucination Wandering Aggression
Hypoactive delirium symptoms
Lethargy
Slowness with everyday tasks
Excessive sleeping
Inattention
looks like depression
Causes of delirium
CHIMPS PHONED
Constipation Hypoxia Infection Metabolic disturbance (inc endocrine) Pain Sleeplessness/surgery Prescriptions Hypothermia/pyrexia Organ dysfunction (hepatic or renal impairment) Nutrition Environmental changes Drugs (over the counter, illicit, recreational, their partner/neighbour/pets’, alcohol and smoking)
Delirium management
Supportive - have a clock, consistent staff etc, relax, TV, pleasant environment, allow wandering as much as possible
haloperidol/olanzapine only if necessary
