This article covers Psychiatric Emergencies Examples.

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Week 5: Psychiatric Emergencies Examples


Complete the chart below with the following information:

  • Onset and Causes
  • Additional Notes
  • S/Sx
  • Treatment
(Psychiatric Emergencies Examples)


EmergencyNeuroleptic Malignant Syndrome (NMS)
Onset/CausesWithin hours or days after exposure to a causative drug, with most exhibiting symptoms within 2 weeks and nearly all within 30 daysPrimary trigger of NMS is dopamine receptor blockade and the standard causative agent is an antipsychotic. Potent typical neuroleptics such as haloperidol, fluphenazine, chlorpromazine, trifluoperazine, and prochlorperazine have been most frequently associated with NMS and thought to confer the greatest risk.Idiosyncratic-time limited reaction.(Psychiatric Emergencies Examples)
Additional NotesMore common in men than women
S/SxFeverMuscle rigidityAutonomic instabilityClouding of consciousness, LOCElevated WBC/CPK
TxWithhold neurolepticsHydrate (IV)Consider Dantrolene(Psychiatric Emergencies Examples)

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EmergencyDelirium Tremens (DTs)
Onset/CausesOccurs when one tops taking alcohol after a duration of drinking heavily like 4-5 pints of wine or 7-8 pints of beer or I pint of heavy alcohol use without getting adequate food (Grover & Bhosh, 2018).
Additional NotesMay also be caused by head injury, or infection. Or illness in people with a history of heavy alcohol use say ten years.
S/SxTremors or shaking hands and feet Chest pain Confusion Dehydration Sleep that lasts a day or more Anger or excitability, Seizures or more(Psychiatric Emergencies Examples)
TxBenzodiazepines for alcohol withdrawal symptoms Intravenous fluids to treat dehydration, antipsychotics if the patient has hallucinations and anticonvulsants if having seizures.(Psychiatric Emergencies Examples)
EmergencySerotonin Syndrome (SS)
Onset/CausesOccurs when one uses two or more medications , illicit drugs or nutritional supplements that increase serotonin levels like migraine medication and an antidepressant
Additional NotesSome medications like antiretroviral used to treat ARVs and some antibiotics may also increase serotonin levels.
S/SxAgitation or restlessness, confusion, increased heart rate and high blood pressure. Loss of muscle coordination and dilated pupils among others (Buckley et al., 2014).(Psychiatric Emergencies Examples)
TxIn mild cases stop the medication or lower its dosage to lower the serotonin levels. Prescription medication that stops the body from producing serotonin level like tropisetron, ondansetron and palonosetron.  

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EmergencyTyramine Reaction/Hypertensive Crisis
Onset/CausesInteraction between monoamine oxidase inhibitors (MAOIs) and tyramine in food (Sadeghi et al., 2016).
Additional NotesGenetic predisposition may also cause tyramine reaction(Psychiatric Emergencies Examples)
S/SxNose bleeds, severe headache, changes in vision, chest pain and shortness of breath.
TxIntravenous benzodiazepines to control agitation and seizure control. Hospitalization is recommended if the patient’s symptoms do not resolve in 6 hours.
EmergencyAcute Dystonia
Onset/CausesOnset   occurs shortly after taking a dopamine receptor- blocking agent or increasing dosage. Believed to be caused by an imbalance of dopaminergic –cholinergic within the basal ganglia. The cause of the imbalance could be due to diseases like Wilson’s disease, Parkinson’s disease or Huntington’s disease. Other causes include stroke, birth injury, and traumatic brain injury(Psychiatric Emergencies Examples)
Additional NotesDepending on the cause, acute dystonia symptoms can be reversible or irreversible.
S/SxDifficulties with jaw movement swallowing, or speech, pain, and fatigue. Social withdrawal, Anxiety, Depression,
TxAdministration of intramuscularly anticholinergic drugs or antihistamines (Termsarasab et al., 2016).

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EmergencyTardive Dyskinesia* (adverse reaction not always emergency state)
Onset/CausesA collection of delayed onset iatrogenic movement disorders secondary to dopamine receptor blocking agents’ phenomenology.
Additional NotesIn some cases it may be accompanied by sensory phenomenon like paresthesia
S/SxFacial grimacing, sticking out the tongue, sucking or fish like movement of the mouth.
TxDiscontinuation of the neuroleptic drug causing the symptoms Administration of drugs like deutetrabenazine or valbenazine (Caroff, 2020).
EmergencyLithium Toxicity
Onset/CausesOccurs after daily intake of lithium  but the blood  serum  level has reached toxic range
Additional NotesLab values? Lithium levels above 1.5 mEq/L Severe Lithium toxicity is 2.0 mEq/L Above 2.0 – the toxicity is life threatening Safe lithium levels are -0.6 and 1.2 mill equivalents per liter(mEq/L( Hedya et al, 2020).(Psychiatric Emergencies Examples)
S/SxDrowsiness, diarrhea, vomiting, stomach pains, fatigue, tremors, and muscle weaknesses
TxIntravenous fluids administration to ensure the patient is not dehydrated and that the lithium is moving out of the system.
Psychiatric Emergencies Examples

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Psychiatric Emergencies Examples
Psychiatric Emergencies Examples
EmergencyTricyclic Antidepressant (TCA) Toxicity
Onset/CausesOnset is 6 hours after excessive medication of TCA type Acute TCA toxicity could be accidental or purposeful overdose.
Additional NotesChronic TCA toxicity is possible and can present acutely.
S/SxConstipation, blurred vision. Dry mouth, constipation, weight gain or loss, increased heart rate amongst others (Khalid & Waseem, 2017).(Psychiatric Emergencies Examples)
TxAdministration of intravenous sodium bicarbonate as an antidote.
EmergencyNeonatal Abstinence Syndrome
Onset/CausesGroup of conditions caused when a baby withdraws from some drugs they are exposed to in the womb before they are born. These drugs are like opioids taken by the mother during pregnancy. Other drugs include heroin, codeine, oxycodone, methadone or buprenorphine.(Psychiatric Emergencies Examples)
Additional NotesThey drugs pass into the neonates system through the placenta making the baby dependent on the drug just like their mother.
S/SxBlotchy skin, breathing difficulties, fussiness, high-pitched cry or excessive crying, overactive reflexes and tight muscle tone.
TxSwaddling to make the baby comfortable. Giving the child extra calories due to their increased activity. Intravenous fluid if the baby is vomiting, or has diarrhea to rehydrate the child. Methadone may be necessary for heroine withdrawal or benzodiazepine for alcohol withdrawal (Wachman et al., 2018).(Psychiatric Emergencies Examples)


Buckley, N. A., Dawson, A. H., & Isbister, G. K. (2014). Serotonin syndrome. Bmj348.

Caroff, S. N. (2020). Recent advances in the pharmacology of tardive dyskinesia. Clinical Psychopharmacology and Neuroscience18(4), 493.

Grover, S., & Ghosh, A. (2018). Delirium tremens: assessment and management. Journal of clinical and experimental hepatology8(4), 460-470.

Hedya, S. A., Avula, A., & Swoboda, H. D. (2020). Lithium toxicity. StatPearls [Internet].

Khalid, M. M., & Waseem, M. (2017). Tricyclic antidepressant toxicity.

Sadeghi, N., Oveisi, M. R., Jannat, B., Behzad, M., Hajimahmoodi, M., & Zareakram, E. (2016). Tyramine in malt beverages interfering with monoamine oxidase inhibitor drugs. Journal of Biosciences and Medicines4(08), 10.

Termsarasab, P., Thammongkolchai, T., & Frucht, S. J. (2016). Medical treatment of dystonia. Journal of clinical movement disorders3(1), 1-18.(Psychiatric Emergencies Examples)

Wachman, E. M., Schiff, D. M., & Silverstein, M. (2018). Neonatal abstinence syndrome: advances in diagnosis and treatment. Jama319(13), 1362-1374.

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