Psych emergencies

Question 1

Neuroleptic malignant syndrome
Patho:
S/s

Answer 1

Caused by blocking of dopamine receptors or decreased systemic dopamine
S/s: Tetrad: AMS, muscular rigidity, FEVER, autonomic instability (unstable BP, tachy)
Usually within 4-14 days of initiation of drug
Tx: ABCs, stop agent, aggressive cooling, fluids, bromocriptine (dopamine agonist), dantrolene (skeletal muscle relaxant)

Question 2

Serotonin syndrome
Eti;
S/s: 
Comp:
Tx:

Answer 2

Eti: Serotonergic medications: MC antidepressants, other psych meds.
S/s: Triad: 2-24 hours after taking meds
- Cognitive: AMS, agitation, insomnia…
- Neuromuscular: myoclonus, muscle rigidity, hyperreflexia, tremor, generalized seizures
- Autonomic dysfunction: hyperthermia, diaphoresis, tachy, HTN…
Comp: rhabdo, metabolic acidosis
Tx; D/c meds, anti-serotonergics

Question 3

Serotonin Discontinuation syndrome

Answer 3

Eti: D/c of Anti D that was taken for a least 6 weeks
s/s: flu like symptoms, insomnia, n, ha,
Tx: restart med and do a slow taper

Question 4

EtoH withdrawl

Answer 4

S/s: can start as early as 2-6 hours after last drink
- hand tremors, HA, anorexia, n/v, diaphoresis…
Comp: Seizures: 90% begin within 48 hours
Delirium tremens DTs:
Tx: Benzos: usually lorazepam, and zofran

Question 5

Alcohol poisoning

Answer 5

S/sx: hypotension, hypothermia, hypoglycemia, lactic acidosis
Comp: Wernickes encephalopathy
Tx: supportive care, D50 if needed

Question 6

Wernicke’s encephalopathy

Answer 6

Neurological symptoms caused by biochemical lesions of the CNS.
Eti: Def in B1 (thiamine)
S/s: Triad: ophthalmoplegia, ataxia, confusion

Question 7

Opioid withdrawl
S/s:
Tx:

Answer 7

Peak at 72 hours
S/s: dialated pupils, n/v/d, abd pain, myalgias
Tx: Benzos for agitation
- Methadone
- Naloxone/buprenorphine (suboxone)

Question 8

Methods of emergency contraception

4 main categories

Answer 8

1. Combined estrogen and progestin
2. Progestin only (plan B)
3. Antiprogestin (Ella)
4. IUDs: Copper

Question 9

Benefits of categories of emergency contraception systems:

Answer 9

IUD: 98% effective, associated with heavier periods
Ella: 67%, but most effective pill form
Plan B: over the counter

All methods good for up to 5 days, plan B best up to 3 days