Psychiatric Emergencies

Question 1

What causes an acute dystonic reaction?

Answer 1

Starting new antipsychotic medication (occurs within 1 week), sharply increasing dose or decreasing dose.

Question 2

What happens in an acute dystonic reaction?

Answer 2

Sustained, painful muscle spasm producing twisting movements and abnormal posture. Torticollis of head and neck muscles, grimacing, occulogyric spasm. Fluctuates and lasts minutes to hours untreated.

Question 3

How do you treat an acute dystonic reaction?

Answer 3

Discontinue medication and give IM anticholinergic Procyclidine

Question 4

What is the main cause of Lithium toxicity?

Answer 4

Dehydration while taking Lithium

Question 5

How does Lithium toxicity present?

Answer 5

Ataxia, myoclonic jerks, hyperreflexia, agitation, confusion and stupor.
Complications include liver toxicity and cardiac arrhythmias,

Question 6

How do you treat Lithium toxicity?

Answer 6

Stop Lithium
IV fluids
Haemodialysis

Question 7

What is Neuroleptic Malignant Syndrome?

Answer 7

Life threatening idiosyncratic reaction to antipsychotics/antidepressants/lithium.

Question 8

What is seen on bloods in NMS?

Answer 8

Raised CK above 2000 units due to rhabdomyolysis

Question 9

What are the symptoms of Neuroleptic Malignant Syndrome?

Answer 9

Autonomic dysfunction:
High BP
Hyperthermia
Altered Consciousness and mental state
Muscle Rigidity/Clonus
Tachycardia
Tachypnoea
Tremor
Incontinence/ Retention
Metabolic Acidosis

Question 10

What are the risk factors for Neuroleptic Malignant Syndrome?

Answer 10

Increase in ambient temperature
Dehydration
Change in antipsychotic dosing (rapid)
Withdrawal of antipsychotic medication
Organic brain disease

Question 11

What is the cause of death of Neuroleptic Malignant Syndrome?

Answer 11

Respiratory failure
CV collapse
Arrhythmias
DIC

Question 12

How do you treat Neuroleptic Malignant Syndrome?

Answer 12

ABCD
Fluid and Electrolytes
Stop new medication
IV DANTROLENE or BENZOS or Muscle Relaxants
Antipyretics 
Bromocriptine

Question 13

What investigations should be done in suspected Neuroleptic Malignant Syndrome?

Answer 13

FBC
LFT
U and E
Ca
Phosphate
Serum CK
Coagulation studies
Toxicology
CXR
LP
CT head

Question 14

How long does Neuroleptic Malignant syndrome last for?

Answer 14

7- 10 days, or up to 21 days if depot antipsychotic.

Question 15

What causes serotonin syndrome?

Answer 15

Excess SSRIs, or amphetamine, MAOIs, MDMA and Lithium

Question 16

How common is serotonin syndrome?

Answer 16

Very common in a mild form that is very unreported, but rarely severe

Question 17

What are the symptoms of serotonin syndrome?

Answer 17

Anxiety 
Agitation
Disorientation
Lethargy
Seizures
Hypomania
Hallucinations
Myoclonus
Rigidity
Hyperreflexia
Hyperpyrexia
Dilated pupil
Hyperthermia
GI Upset
Coma

Question 18

What is the differential for Serotonin Syndrome?

Answer 18

NMS

Question 19

What is the treatment for severe Serotonin Syndrome?

Answer 19

Gastric Lavage or Activated Charcoal

Question 20

What is the standard treatment for Serotonin Syndrome?

Answer 20

ABCD
Stop Serotonin
Benzos
SSRI antagonist (Trazodone)

Question 21

What does the NICE Depression screen include?

Answer 21

1. Felt hopeless, depressed or down in the last month?
2. During last month have you felt bothered by experiencing little pleasure or interest in things you used to enjoy?

IF YES

1. Feelings of worthlessness?
2. Poor concentration?
3. Thoughts of suicide or death?

Question 22

State some components of a Suicide Risk Assessment

Answer 22

Cause of emotions- reason for suicide
Preventative/Protective factors
Perceived hope for the future
Coping Strategies
Chronic Patterns
Will/ Notes
On the day- who was around, what did they do, where were they?
Plans- detailed or unplanned?
Did they seek help?
Social hx- older males, unemployed and social isolation
Risk of taking drugs/ alcohol
Previous self harm history