Questions

Question 1

What are the 4 signs of neuroleptic malignant syndrome?

Answer 1

Rigidity (lead pipe type)
Hyperthermia >38 degrees
Reduced consciousness
Autonomic instability - labile BP, tachycardia, tremor, excessive sweating

Question 2

What is the mechanism behind neuroleptic malignant syndrome?

Answer 2

It is loss blockage of dopaminergic receptors in the hypothalamus

Question 3

What are some of the risk factors for developing neuroleptic malignant syndrome?

Answer 3

High dose or rapid initiation of neuroleptics
Abruptly stopping neuroleptics
Previous episode of NMS
Dehydration

Question 4

What investigations would suggest Neuroleptic malignant syndrome?

Answer 4

Leucocytosis on FBC
Increased creatine kinase and metabolic disturbance from AKI
Hypocalcaemia
LFTs - elevated ALT

Question 5

What is the treatment of neuroleptic malignant syndrome?

Answer 5

Antipsychotic must be withdrawn immediately
IV fluids and antipyretics
Bromocriptine (dopamine agonist)
Dantrolene can be used to reduce muscle spasm
ECT activates dopaminergic system

Question 6

What are the complications of neuroleptic malignant syndrome?

Answer 6

Cardiac arrest
Seizures
AKI

Question 7

What is serotonin syndrome?

Answer 7

This is symptoms caused by increased 5-HT activity in the brain, usually caused by interactions between drugs e.g. SSRI and MAOI

Question 8

What are the symptoms of serotonin syndrome?

Answer 8

Confusion
Myolonic jerks
Hyperreflexia
Mania

Question 9

What is the treatment of serotonin syndrome?

Answer 9

Stop offending drug

Supportive treatment

Question 10

What drugs cause serotonin syndrome?

Answer 10

SSRI
MAOI
SNRI
St johns wort

Question 11

What is an acute dystonia?

Answer 11

This is a sudden muscle contraction that is sustained and results in abnormal positioning, often painful

Question 12

What are some examples of acute dystonias?

Answer 12

Oculogyric crisis
Torticollis (neck)
Facial grimacing

Question 13

What is the cause of acute dystonias?

Answer 13

usually caused by antipsychotics

Question 14

What is the treatment of an acute dystonic reaction?

Answer 14

Immediately discontinue the antipsychotic and consider using a different one
use anticholinergic (Procyclidine) with massage of muscle
Prescribe procyclide on a PRN basis
Monitor over 24 hours

Question 15

How often do you need to measure lithium levels?

Answer 15

Every 5 days until stable and then 3 monthly

Question 16

What are the main tests that need monitoring on lithium?

Answer 16

TFTs and U and E

Question 17

What are the common lithium side effects?

Answer 17

Polydipsia
Polyuria
Weakness
Lack of coordination
Dry mouth
Weight gain

Question 18

What is the level of lithium that is toxic?

Answer 18

Above 1.3mmol/L

Question 19

What are the symptoms of lithium toxicity?

Answer 19

Diarrhoea
Vomiting
Coarse tremor
Drowsiness
Convulsions

Question 20

What is the management of lithium toxicity?

Answer 20

Stop immediately
Perform urgent lithium level and U and E
IV fluids
Dialysis may be required if lithium level is greater than 3.0

Question 21

What congenital abnormalities do lithium cause?

Answer 21

Ebstein’s anomaly

Question 22

What blood test should be monitored for sodium valproate and how often?

Answer 22

Should monitor LFTs before and 3-6 months after starting as severe liver injury can occur in rare cases

Question 23

What blood test should be monitored for sodium valproate and how often?

Answer 23

Should monitor LFTs before and 3-6 months after starting as severe liver injury can occur in rare cases

Question 24

How often is ECT usually done?

Answer 24

Usually twice weekly

Question 25

What are the indications for ECT?

Answer 25

Moderate to severe depression Catatonia Mania if patients have not responded to other treatments

Question 26

What are the common side effects of ECT?

Answer 26

Adverse effects of anaesthesia Headache Nausea Cognitive impairment

Question 27

What are the serious side effects of ECT?

Answer 27

Acute confusion immediately following treatment Anterograde amnesia Retrograde amnesia

Question 28

What are the absolute contraindications to ECT?

Answer 28

Raised intracranial pressure Recent cerebrovascular event Unstable cascular aneurysm Recent MI with unstable rhythm

Question 29

What is the mechanism behind alcohol withdrawl?

Answer 29

There is constant GABA replacement by the alcohol so when you stop drinking there is no inhibitory neurotransmission

Question 30

What scale is commonly used to assess alchol withdawl?

Answer 30

Clinical institute withdrawl assessment of alcohol scale (CIWA)

Question 31

What is the treatment of alcohol withdrawl?

Answer 31

Chlordiazepoxide to increase GABA function | THiamine and vitamins to reduce chance of developing Wernicke's encephalopathy

Question 32

What are the features of delerium tremens and how do you treat it?

Answer 32

Coarse tremor, hallucinations, tachycardia, seizures | Chlordiazepoxide

Question 33

When does delerium tremens occur after stopping alcohol?

Answer 33

It is typically 48-72 hours after stopping

Question 34

What are the features of alcohol dependence syndrome?

Answer 34

``` Craving Loss of control Restricted regime Physical dependence Tolerance ```

Question 35

What is the treatment of alcohol dependence?

Answer 35

Chlordiazepoxide for withdrawl symptoms disulfram: promotes abstinence - alcohol intake causes severe reaction due to inhibition of acetaldehyde dehydrogenase. Patients should be aware that even small amounts of alcohol (e.g. In perfumes, foods, mouthwashes) can produce severe symptoms.

Question 36

What are the symptoms of opiod withdrawl?

Answer 36

Dirrhoea, insomnia, restlessness

Question 37

How should opioid withdrawl be treated?

Answer 37

``` Clinical opioid withdrawl scale (COWS) SUbstitute therapy (methadone) Smptomatic treatment (GI disturbance) ```