Risks Associated with Pyschotrophic Medications

Question 1

Possible fatal risks

Answer 1

Neuroleptic malignant syndrome
Agranulocytosis
Serotonin syndrome
Lithium toxicity

Question 2

Neuroleptic malignant syndrome

Answer 2

Incidence of mortality estimated at 5-11% in those who have neuroleptic malignant syndrome

Question 3

NMS

Answer 3

More common in men then women 2:1
Can occur in any age/ under 40 more at risk
Onset is usually 4-14 days of commencing neuroleptics
Symptoms usually evolve gradually over 72 hours

Question 4

NMS

Answer 4

Abrupt withdrawal of Parkinson drugs can cause NMS

Question 5

Clinical neuroleptic malignant syndrome

Answer 5

Clinical features
Muscular rigidity
Hyperthermia
Tremor
dehydration
Auntonomic instability including tachycardia ,alterations in blood pressure and rapid respirations
Mental status changes including coma,delirium or catatonia
Incontinence
Excessive sweating

Question 6

Treatment of NMS

Answer 6

Stop all neuroleptics
A dopamine antagonist can be given to increase dopamine such as bromocriptine
A muscle relaxant such as dantrolene could also be given.
Push fluids to reduced dehydration ,usually iv fluids
Brings temp down with the use of anti pyretics

Question 7

Complications of NMS

Answer 7

Renal failure
Cardiac arrest
Seizures
Respiratory failure

Question 8

Prevention of NMS

Answer 8

People with history of nms should not be prescribed antipsychotics but other drugs such as lithium ,carbamazepine or benzodiazepines

Question 9

Agranulocytosis

Answer 9

Potentially life threatening adverse effect of clozapine
This is why clozapine is restricted for use in those with treatment resistant schizophrenia.
3-4% of patients get neutropenia and must stop clozapine ,1% get agranulocytosis
Agranulocytosis is a severe decrease or lack of granulocytes in the blood .
Blood monitoring essential
Bloods carried out for four weeks after clozapine therapy
Clinical features lethargy,sore throat ,fever,weakness
Antibiotics may be necessary if infection is present

Question 10

Serotonin syndrome

Answer 10

Rare life threatening drug reaction caused by an excess of serotonin in the system

Question 11

How does it occur ?

Answer 11

It can occur as part of normal therapeutic drug use e.g when combined with drugs that increase serotonin levels such as SSRIs,Tricyclics ,MAOIs,some pain medications for example tramadol

Question 12

Symptoms

Answer 12

Euphoria
Jerks
Twitches
Tremors
Confusion
Agitation
Restlessness
Shivering
Hyperthermia
Sweating
Diarrhoea

Question 13

Serotonin syndrome

Answer 13

Is distinguished by its rapid onset ,presence of diarrhoea ,twitches and absence of lead rigidity.

Question 14

Treatment of serotonin syndrome

Answer 14

Stopping medication should be discontinued and symptom should be managed for example temp
IV fluids maybe required,vital signs and urine output should be monitored
Condition will often resolve on its own within a 24 hour period