Psychiatric Emergencies - Neuroleptic malignant syndrome, Seretonin syndrome

Question 1

Neuroleptic malignant syndrome
-what is it
-risk factors

Answer 1

Dopamine blockade triggers massive glutamate release => neurotoxicity and muscle damage

Antipsychotic meds
Suddenly stopping/reducing levodopa

Question 2

NMS
-presentation
-diagnosis

Answer 2

Within hours-days of starting neuroleptics
Muscle rigidity
-reduced reflexes, rigidity, leadpiping

Autonomic derangements
-HR, RR, BP abnormal
-fever, sweating
-agitated delirium with confusion
-normal pupils

High CK, WCC
AKI from rhabdomyolysis

Question 3

NMS
-management

Answer 3

Stop antipsychotic
TRANSFER TO MEDICAL WARD/ICU
IV fluids - prevent renal failure
BZ

Can use
-dantrolene
-D agonist - bromocriptine

Question 4

Seretonin syndrome
-what is it
-risk factors

Answer 4

Seretonin levels are too high

Combination of
-SSRI
-SNRI
-TCA
-MAOI
-triptan
-tramadol
-MDMA/ecstacy, amphetamine

Question 5

Seretonin syndrome
-presentation

Answer 5

Within hours, faster onset than NMJ
Neuromuscular excitation
-rigidity, hyperreflexia, myoclonus

Autonomic derangements
-HR, RR, BP abnormal
-fever, sweating
-agitated delirium with confusion
-dilated pupils

Question 6

Seretonin syndrome
-management

Answer 6

IV fluids + BZ

Severe - seretonin ant (chlorpromazine/cyproheptadine)