Psychiatric Emergencies - Neuroleptic malignant syndrome, Seretonin syndrome Flashcards

1
Q

Neuroleptic malignant syndrome
-what is it
-risk factors

A

Dopamine blockade triggers massive glutamate release => neurotoxicity and muscle damage

Antipsychotic meds
Suddenly stopping/reducing levodopa

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2
Q

NMS
-presentation
-diagnosis

A

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

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3
Q

NMS
-management

A

Stop antipsychotic
TRANSFER TO MEDICAL WARD/ICU
IV fluids - prevent renal failure
BZ

Can use
-dantrolene
-D agonist - bromocriptine

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4
Q

Seretonin syndrome
-what is it
-risk factors

A

Seretonin levels are too high

Combination of
-SSRI
-SNRI
-TCA
-MAOI
-triptan
-tramadol
-MDMA/ecstacy, amphetamine

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5
Q

Seretonin syndrome
-presentation

A

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

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6
Q

Seretonin syndrome
-management

A

IV fluids + BZ

Severe - seretonin ant (chlorpromazine/cyproheptadine)

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