psychiatric emergencies

Question 1

What is the treatment for paracetamol OD?

Answer 1

N acetylcysteine- use if high paracetamol levels, is a staggered dose, INR low

Question 2

How do you deal with an aggressive psychotic patient?

Answer 2

Ask patient to take tablets before attempting a IM

use lorezepam first line and haloperidol with promethiazine second line

Question 3

What is acute dystonia?

Answer 3

involuntary contraction of muscles which then causes abnormal face (more common) and body movements
-Affects a specific muscle or group of muscles

Causes abnormal posture or muscle spasm

Contorts part of the body

Causes pain (sometimes debilitating)

Question 4

What is tardive dyskinesia?

Answer 4

RHYTMIC AND SMOOTH, ROLLING MOTION,

involuntary movements of trunk, arms, tongue, face, and jaw

eg smack lips

Not typically painful

Question 5

How do you treat acute dystonia or tardive dyskinesia?

Answer 5

They are exrapyrimidal SE.

treat with procyclidine

Question 6

What are the symptoms of lithium toxicity?

Answer 6

D+V, shaky, thirst, increased urination, weakness, seizure

Question 7

What do you treat lithium toxicity?

Answer 7

Supportive management, haemodialysis if severe

Question 8

What is neuroleptic malignant syndrome (NMS) and what are symptoms?

Answer 8

It is a side effect of anti-psychotics.
pyrexia, sweaty, autonomic lability: typical features include hypertension, tachycardia and tachypnoea gradual onset, STIFF AND RIGID MUSCLES, delirium

Question 9

What will you find on blood tests for NMS?

Answer 9

Leucocytosis, increased CK

Question 10

How long after antipsychotics could NMS take effect?

Answer 10

Starts 7-10 days post tablets or 3 weeks post depo

Question 11

What is the management for NMS?

Answer 11

admit, stop meds, treat rhabdomyolysis

Question 12

When is Disseminated intravascular coagulation (DIC) a concern?

Answer 12

Can occur with NMS- so can pre-eclampsia

Acute kidney injury (secondary to rhabdomyolysis) may develop in severe cases

Question 13

What is the management for NMS?

Answer 13

dantrolene, (pyrexia) paracetamol, sodium bicarbonate (AKI), Stop meds, fluids and oxygen

Question 14

What is serotonin syndrome?

Answer 14

It happens secondary to SSRIs, usually if on multiple

Question 15

What are the symptoms of serotonin syndrome?

Answer 15

similar to NMS, but more acute
plus get diarrhoea, hyperreflexia and clonus NOT rigidity
remember the SS ship - flow of diarrhoea from it

Question 16

What is the management for serotonin syndome?

Answer 16

stop meds, supportive, benzos for agitation,

more severe cases are managed using serotonin antagonists such as cyproheptadine and chlorpromazine

Question 17

What are the potential complications of giving clozapine?

Answer 17

Agranulocytosis

Volvulus due to constipation

Myocarditis

Question 18

Describe agranulocytosis

Answer 18

lowered WCC –> may clinically present with sudden fever, rigors and sore throat. Infection of any organ may be rapidly progressive