Page 613 - First Aid for the USMLE Step 1 2020, Thirtieth edition [MedicalBooksVN.com]_Neat

Psychiatry ` Psychiatry—Pathology Psychiatry ` Psychiatry—Pathology sEctiON iii 569

Psychiatric emergencies
caUsE MaNiFEstatioN trEatMENt
Serotonin syndrome Any drug that  5-HT. 3 A’s:  Activity (neuromuscular; Cyproheptadine (5-HT
2
Psychiatric drugs: MAOIs, eg, clonus, hyperreflexia, receptor antagonist)
SSRIs, SNRIs, TCAs, hypertonia, tremor, seizure),
vilazodone, vortioxetine, Autonomic instability (eg,
buspirone hyperthermia, diaphoresis,
Nonpsychiatric drugs: diarrhea), Altered mental
tramadol, ondansetron, status
triptans, linezolid, MDMA,
dextromethorphan,
meperidine, St. John’s wort
Hypertensive crisis Eating tyramine-rich foods (eg, Hypertensive crisis Phentolamine
aged cheeses, cured meats, (tyramine displaces other
wine, chocolate) while taking neurotransmitters [eg,
MAOIs NE] in the synaptic cleft
Ž  sympathetic stimulation)
Neuroleptic malignant Antipsychotics (typical Malignant FEVER: Dantrolene, dopamine
syndrome > atypical) + genetic Myoglobinuria, Fever, agonist (eg, bromocriptine),
predisposition Encephalopathy, Vitals discontinue causative agent
unstable,  Enzymes (eg,
CK), muscle Rigidity (“lead
pipe”)
Delirium tremens Alcohol withdrawal; occurs 2–4 Altered mental status, Benzodiazepines (eg,
days after last drink hallucinations, autonomic chlordiazepoxide, lorazepam,
Classically seen in hospital hyperactivity, anxiety, diazepam)
setting when inpatient cannot seizures, tremors,
drink psychomotor agitation,
insomnia, nausea
Acute dystonia Typical antipsychotics, Sudden onset of muscle Benztropine or
anticonvulsants (eg, spasms, stiffness, and/or diphenhydramine
carbamazepine), oculogyric crisis occurring
metoclopramide hours to days after medication
use; can lead to laryngospasm
requiring intubation
Lithium toxicity  lithium dosage,  renal Nausea, vomiting, slurred Discontinue lithium, hydrate
elimination (eg, acute kidney speech, hyperreflexia, aggressively with isotonic
injury), medications affecting seizures, ataxia, nephrogenic sodium chloride, consider
clearance (eg, ACE inhibitors, diabetes insipidus hemodialysis
thiazide diuretics, NSAIDs).
Narrow therapeutic window.
Tricyclic TCA overdose Respiratory depression, Supportive treatment, monitor
antidepressant hyperpyrexia, prolonged QT ECG, NaHCO (prevents
3
toxicity Tri-CyCliC’s: Convulsions, arrhythmia), activated
Coma, Cardiotoxicity charcoal
(arrhythmia due to Na
+
channel inhibition)

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