Psy to know

Question 1

Describe: Neuroleptic Malignant Syndrome (5)

Answer 1

• psychiatric emergency
  
  • due to strong DA blockade; increased incidence with high potency and depot antipsychotics
• risk factors
  
  • medication factors: sudden increase in dosage, starting a new drug
  • patient factors: medical illness, dehydration, exhaustion, poor nutrition, external heat load, male, young adults
• clinical feature
  
  • tetrad:
    
    • mental status changes (usually occur first)
    • fever
    • rigidity
    • autonomic instability
  • develops over 24-72 h
  • labs: increased creatine phosphokinase, leukocytosis, myoglobinuria
• treatment: supportive - discontinue antipsychotic drug, hydration, cooling blankets, dantrolene (hydrantoin derivative, used as a muscle relaxant), bromocriptine (DA agonist)
• mortality: 5%

Question 2

Name tetrad: Neuroleptic Malignant Syndrome (5)

Answer 2

• mental status changes (usually occur first)
• fever
• rigidity
• autonomic instability

Question 3

Name symptoms: Serotonin Syndrome (3)

Answer 3

• état mental: irritabilité, anxiété confusion, désorientation, coma
• autonomique: fièvre, diaphorèse, tachycardie HTA, mydriase
• neuromusculaire: tremblement, rigidité, ataxie

Question 4

Describe: Discontinuation Syndrome (2)

Answer 4

• caused by the abrupt cessation of some antidepressants
• symptoms usually begin within 1-3 d

Question 5

Discontinuation Syndrome most common with what? (4)

Answer 5

• paroxetine
• fluvoxamine
• venlafaxine
• (drugs with shortest half-lives)

Question 6

Name: Symptoms of Antidepressant Discontinuation (6)

Answer 6

FINISH

• Flu-like symptoms
• Insomnia
• Nausea
• Imbalance
• Sensory disturbances
• Hyperarousal (anxiety/agitation)

Question 7

Describe tx: Discontinuation Syndrome (1)

Answer 7

• symptoms may last between 1-3 wk, but can be relieved within 24 h by restarting antidepressant at the same dosage the patient was taking and initiating a slower taper over several weeks

Question 8

Name clinical features: Lithium Toxicity (12)

Answer 8

• GI:
  
  • severe no/vo
  • diarrhea
• cerebellar:
  
  • ataxia
  • slurred speech
  • lack of coordination
• cerebral:
  
  • drowsiness
  • myoclonus
  • tremor
  • upper motor neuron signs
  • seizures
  • delirium
  • coma

Question 9

Describe management: Lithium toxicity (4)

Answer 9

• discontinue lithium for several days and begin again at a lower dose when lithium level has fallen to a non-toxic range
• monitor serum lithium levels, BUN, electrolytes
• IV saline
• hemodialysis if lithium >2 mmol/L, coma, shock, severe dehydration, failure to respond to treatment after 24 h, or deterioration