This article covers Psychiatric Emergencies Examples.
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Week 5: Psychiatric Emergencies Examples
Name:
Complete the chart below with the following information:
- Onset and Causes
- Additional Notes
- S/Sx
- Treatment
Example:
| Emergency | Neuroleptic Malignant Syndrome (NMS) |
| Onset/Causes | Within 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 Notes | More common in men than women |
| S/Sx | FeverMuscle rigidityAutonomic instabilityClouding of consciousness, LOCElevated WBC/CPK |
| Tx | Withhold neurolepticsHydrate (IV)Consider Dantrolene(Psychiatric Emergencies Examples) |
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| Emergency | Delirium Tremens (DTs) |
| Onset/Causes | Occurs 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 Notes | May also be caused by head injury, or infection. Or illness in people with a history of heavy alcohol use say ten years. |
| S/Sx | Tremors 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) |
| Tx | Benzodiazepines for alcohol withdrawal symptoms Intravenous fluids to treat dehydration, antipsychotics if the patient has hallucinations and anticonvulsants if having seizures.(Psychiatric Emergencies Examples) |
| Emergency | Serotonin Syndrome (SS) |
| Onset/Causes | Occurs when one uses two or more medications , illicit drugs or nutritional supplements that increase serotonin levels like migraine medication and an antidepressant |
| Additional Notes | Some medications like antiretroviral used to treat ARVs and some antibiotics may also increase serotonin levels. |
| S/Sx | Agitation 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) |
| Tx | In 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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| Emergency | Tyramine Reaction/Hypertensive Crisis |
| Onset/Causes | Interaction between monoamine oxidase inhibitors (MAOIs) and tyramine in food (Sadeghi et al., 2016). |
| Additional Notes | Genetic predisposition may also cause tyramine reaction(Psychiatric Emergencies Examples) |
| S/Sx | Nose bleeds, severe headache, changes in vision, chest pain and shortness of breath. |
| Tx | Intravenous benzodiazepines to control agitation and seizure control. Hospitalization is recommended if the patient’s symptoms do not resolve in 6 hours. |
| Emergency | Acute Dystonia |
| Onset/Causes | Onset 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 Notes | Depending on the cause, acute dystonia symptoms can be reversible or irreversible. |
| S/Sx | Difficulties with jaw movement swallowing, or speech, pain, and fatigue. Social withdrawal, Anxiety, Depression, |
| Tx | Administration of intramuscularly anticholinergic drugs or antihistamines (Termsarasab et al., 2016). |
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| Emergency | Tardive Dyskinesia* (adverse reaction not always emergency state) |
| Onset/Causes | A collection of delayed onset iatrogenic movement disorders secondary to dopamine receptor blocking agents’ phenomenology. |
| Additional Notes | In some cases it may be accompanied by sensory phenomenon like paresthesia |
| S/Sx | Facial grimacing, sticking out the tongue, sucking or fish like movement of the mouth. |
| Tx | Discontinuation of the neuroleptic drug causing the symptoms Administration of drugs like deutetrabenazine or valbenazine (Caroff, 2020). |
| Emergency | Lithium Toxicity |
| Onset/Causes | Occurs after daily intake of lithium but the blood serum level has reached toxic range |
| Additional Notes | Lab 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/Sx | Drowsiness, diarrhea, vomiting, stomach pains, fatigue, tremors, and muscle weaknesses |
| Tx | Intravenous fluids administration to ensure the patient is not dehydrated and that the lithium is moving out of the system. |
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| Emergency | Tricyclic Antidepressant (TCA) Toxicity |
| Onset/Causes | Onset is 6 hours after excessive medication of TCA type Acute TCA toxicity could be accidental or purposeful overdose. |
| Additional Notes | Chronic TCA toxicity is possible and can present acutely. |
| S/Sx | Constipation, blurred vision. Dry mouth, constipation, weight gain or loss, increased heart rate amongst others (Khalid & Waseem, 2017).(Psychiatric Emergencies Examples) |
| Tx | Administration of intravenous sodium bicarbonate as an antidote. |
| Emergency | Neonatal Abstinence Syndrome |
| Onset/Causes | Group 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 Notes | They drugs pass into the neonates system through the placenta making the baby dependent on the drug just like their mother. |
| S/Sx | Blotchy skin, breathing difficulties, fussiness, high-pitched cry or excessive crying, overactive reflexes and tight muscle tone. |
| Tx | Swaddling 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) |
References
Buckley, N. A., Dawson, A. H., & Isbister, G. K. (2014). Serotonin syndrome. Bmj, 348.
Caroff, S. N. (2020). Recent advances in the pharmacology of tardive dyskinesia. Clinical Psychopharmacology and Neuroscience, 18(4), 493.
Grover, S., & Ghosh, A. (2018). Delirium tremens: assessment and management. Journal of clinical and experimental hepatology, 8(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 Medicines, 4(08), 10.
Termsarasab, P., Thammongkolchai, T., & Frucht, S. J. (2016). Medical treatment of dystonia. Journal of clinical movement disorders, 3(1), 1-18.(Psychiatric Emergencies Examples)
Wachman, E. M., Schiff, D. M., & Silverstein, M. (2018). Neonatal abstinence syndrome: advances in diagnosis and treatment. Jama, 319(13), 1362-1374.
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