Psychiatric Emergency

Question 1

How many team members should be on a restraint team?

Answer 1

5

Question 2

If the patient is female, how many team members from the restraint team must be female?

Answer 2

1

Question 3

Preferred when sedating patients when agitated from unknown cause. Can cause respiratory depression. Can be used with first gen antipsychotics

Answer 3

benzos (lorazepam/midazolam)

Question 4

What is an adverse effect of 1st gen antipyschotic haloperidal and droperidol (black box warning for the latter)?

Answer 4

QT prolongation that can cause Torsades

Question 5

Less sedation & fewer extrapyramidal side effects. Less experience using them so benzodiazepines and first generation antipsychotics first choice

Answer 5

2nd gen antipsychotics

Question 6

Name the 2nd gen antipsychotics

Answer 6

Olanzapine (Zyprexa)‏
Risperidone (Risperdal)‏
Ziprasidone (Geodon)‏

Question 7

If a patient has a paradoxical reaction to a drug, how should you adjust treatment?

Answer 7

swtich to an agent from a different class

Question 8

AIDs patient presents with change in mental status and abnormal neuro exam. What is the most likely diagnosis?

Answer 8

Acute AIDS Encephalopathy

Question 9

What CD4 cell counts predispose patient to opportunitistic infections?

Answer 9

< 200/microL

Question 10

First test ordered to investigate a suspected AIDS encephalopathy

Answer 10

CT/MRI

Question 11

disturbance in the perception of reality, evidenced by hallucinations, delusions, or thought disorganization. Psychotic states are periods of high risk for agitation, aggression, impulsivity and other forms of behavioral dysfunction

Answer 11

psychosis

Question 12

What are potential complications of meth?

Answer 12

hypovolemia, metabolic acidosis hyperthermia and rhadomyalysis

Question 13

Anesthetic agent that is CI with treatment of meth

Answer 13

succinylcholine

Question 14

What is used to treat HTN of meth overdose?

Answer 14

nitroprusside or phetolamine. Avoid beta-blockers

Question 15

Life threatening neurologic emergency associated with the use of neuroleptic agents. Most often seen w/ the first generation high potency agents.

Answer 15

Neuroleptic Malignant Syndrome (NMS)‏

Question 16

Patient presents with mental status change, muscle ridigity, hyperthermia, autonomic instability within the first 2 weeks of therapy

Answer 16

Neuroleptic Malignant Syndrome (NMS)‏

Question 17

What is the only positive diagnostic test of NMS?

Answer 17

elevated creatinine kinase (>1000 IU/L)

Question 18

Usually occur 12-48 hours after last drink. More common in patients w/ long history of chronic alcoholism. Usually singular or several over short period. Treat w/ benzodiazepines and phenobarbital

Answer 18

withdrawal seizures

Question 19

Develop within 12-24 hours after last drink and resolve within 24-48 hours. Usually visual, but auditory and tactile can occur. NO clouding of the sensorium and VS normal

Answer 19

Alcoholic Hallucinosis

Question 20

Begins between 48-95 hours after last drink and can last 1-5 days. Present w/hallucinations, disorientation, agitation, tachycardia, HTN, fever

Answer 20

delirium tremens

Question 21

Why do you administer thiamine before glucose when treating a potential alcoholic patient?

Answer 21

prevent Wernicke’s

Question 22

characterized by the sudden onset of intense fear and by the abrupt development of specific somatic, cognitive and affective symptoms

Answer 22

panic attacks

Question 23

It is a behavioral syndrome inability to move normally DESPITE the physical capacity to do so

Answer 23

catatonia

Question 24

Medication that can help bring person out of catatonic state

Answer 24

lorazepam

Question 25

Only definitive treatment for catatonia

Answer 25

electroconvulsive therapy

Question 26

Neurologic symptoms that are inconsistent with a neurologic disease, but cause distress, and/or impairment

Answer 26

conversion disorder

Question 27

Syndrome of nonspecific physical symptoms that are distressing. May not be fully explained by a known medical condition after appropriate investigation. May be influenced by a desire for the sick role or for personal gain

Answer 27

somatization

Question 28

Increased serotonergic activity in the CNS. spontaneous clonus, hyperreflexia, hyperthermia, tremor

Answer 28

serotonin syndrome

Question 29

What serotonin antagonist can be used for severe serotonin syndrome?

Answer 29

Cyproheptadine (Periactin)

Question 30

Criteria for involuntary psych admission

Answer 30

presence of pysch illness with dangerous behavior toward self or others or inability to adequately care for self

Question 31

Can be initiated by: another adult, the police, a physician

Generally brief: ranges from 24 hours, 1-3 days Limited paperwork

Answer 31

emergency detention

Question 32

Usually limited to physicians/hospital personnel,

Many states require court approval

Answer 32

observational committment

Question 33

Formal application/sometimes 2 physicians. Involves a hearing

Answer 33

extended committment