Psychiatry Flashcards
Key clinical features of serotonin syndrome
- Autonomic Dysfunction: Diaphoresis, tachycardia, hypertension, mydriasis
- Neuromuscular excitability: hyperreflexia, myoclonus, clonus, ocular clonus (horizontal), increased tone, hyperthermia
- Altered mental status
What drugs other than antidepressants can cause serotonin syndrome?
Tramadol, Ondansetron, Linezolid, Ritonavir, St John’s Wort, Ginseng, Cocaine, Valproate
Indication for intubation in Serotonin Syndrome?
Temperature >41.1
When might a patient with serotonin syndrome have hypotension?
MAOI can cause hypotension
Key Features of Neuroleptic Malignant Syndrome
- Insidious onset over weeks
- Early cognitive changes progressing through delirium to catatonia
- Parkinsonism
- High grade fevers
- Autonomic instability
- High CK, abnormal LFTs
(no clonus or hyperreflexia)
Key medication for severe Neuroleptic Malignant Syndrome? (inc. details of medication)
Dantrolene:
Direct acting skeletal muscle relaxant by interfering with calcium release from sarcoplasmic reticulum.
Usual side effects but also N/V, pericarditis, eosinophilia + pleural effusion
What medications can make lithium toxicity more likely?
Medications that increase renal absorption: thiazides, NSAIDs, ACEi, ARB
Others: Tetracyclines, Cyclosporines, Metronidazole
How does timeline of Lithium Toxicity alter presentation?
Acute: early GI symptoms then neurological symptoms later
Acute on chronic: Simultaneous
Chronic: Neurological symptoms alone
Features of Lithium Toxicity
GI: N/V, DIarrhoea
Neurological: altered mental state, delirium, psychomotor impairment, tremor, seizures, myoclonus, EPSEs, Hyperreflexia, arrhythmia (prolonged QT, T wave changes)
Indications for Dialysis in Lithium Toxicity
Absolute:
- Lithium >4 with kidney impairment, altered mental state, seizure, life threatening arrhythmia
Also consider
- Lithium level >5, confusion, not expecting concentration to decrease to <1 within 36hr
