Psychiatric Emergencies - Neuroleptic malignant syndrome, Seretonin syndrome Flashcards
Neuroleptic malignant syndrome
-what is it
-risk factors
Dopamine blockade triggers massive glutamate release => neurotoxicity and muscle damage
Antipsychotic meds
Suddenly stopping/reducing levodopa
NMS
-presentation
-diagnosis
Within hours-days of starting neuroleptics
Muscle rigidity
-reduced reflexes, rigidity, leadpiping
Autonomic derangements
-HR, RR, BP abnormal
-fever, sweating
-agitated delirium with confusion
-normal pupils
High CK, WCC
AKI from rhabdomyolysis
NMS
-management
Stop antipsychotic
TRANSFER TO MEDICAL WARD/ICU
IV fluids - prevent renal failure
BZ
Can use
-dantrolene
-D agonist - bromocriptine
Seretonin syndrome
-what is it
-risk factors
Seretonin levels are too high
Combination of
-SSRI
-SNRI
-TCA
-MAOI
-triptan
-tramadol
-MDMA/ecstacy, amphetamine
Seretonin syndrome
-presentation
Within hours, faster onset than NMJ
Neuromuscular excitation
-rigidity, hyperreflexia, myoclonus
Autonomic derangements
-HR, RR, BP abnormal
-fever, sweating
-agitated delirium with confusion
-dilated pupils
Seretonin syndrome
-management
IV fluids + BZ
Severe - seretonin ant (chlorpromazine/cyproheptadine)