Psychiatry
1) Neuroleptic Malignant Syndrome
2) Lithium Toxicity
3) Clozapine Use (Neutropenia)
4) Delirium
5) Dementia
6) Acute Reaction to Stress
7) Post Traumatic Stress Disorder
8) Phobias
9) Panic Disorder
10) Obsessive Compulsive Disorder
11) Schizophrenia
12) Depression Mild/Moderate
13) Depression Severe
14) Bipolar/Affective Disorder
15) Anorexia Nervosa
16) Bulimia Nervosa
17) Tobacco Use
18) Alcohol/Drug Harmful Use
19) Alcohol/Drug Dependence
20) Wernicke's Encephalopathy
21) Korsakoff Syndrome
, Neuroleptic Malignant Syndrome
Definition: Rare but life threatening reaction to neuroleptic medications leading to fever,
muscular rigidity and altered mental state
Symptoms: Causes:
- High fever Typical antipsychotics:
- Muscular stiffness - Haloperidol
- Altered mental status - Fluphenazine
- Autonomic nervous system - Bromperidol
dysfunction - swings in blood
pressure, sweating and saliva Atypical antipsychotics:
secretion - Risperidone
- Aripiprazole
Differentials: - Olanzapine
- Serotonin syndrome - Clozapine
- Lethal catatonia - Quetiapine
- Malignant hyperthermia
- Heat stroke Diagnosis:
- Urinalysis
- Arterial blood gases
- Creatinine phosphokinase blood test
- Increased creatinine kinase
Treatment:
- Transfer to hospital
- Stop antipsychotics
- Maintain electrolyte balance using IV
fluids
- Lower blood pressure
- Muscle and skeletal relaxants
, Lithium Toxicity
Definition: Condition where there is too much lithium (mood stabilizer) in the blood
Symptoms: Causes:
- Tremor - Dosage increase
- Diarrhoea - Dehydration
- Vomiting - Medication interactions
- Ataxia - Problems with kidney functions
- Confusion
- Slurred speech Diagnosis:
- Acne exacerbation - Blood chemistry to check electrolyte
- Urine test to determine serum lithium
Differentials: - Blood test to check kidney function
- Neuroleptic malignant syndrome - Lithium > 1.5m/L
- Alcohol withdrawal syndrome - Increase in U&Es
- Serotonin syndrome - Increase in TFTs
- Benzodiazepine withdrawal - Increase in Ca
Management:
- BMI, U&E, TFT, Ca monitored every
6 months
- Weekly bloods to prevent toxicity
Treatment:
- IV fluids to restore electrolytes
- Monitoring vital signs
- Hemodialysis to remove waste from
blood
1) Neuroleptic Malignant Syndrome
2) Lithium Toxicity
3) Clozapine Use (Neutropenia)
4) Delirium
5) Dementia
6) Acute Reaction to Stress
7) Post Traumatic Stress Disorder
8) Phobias
9) Panic Disorder
10) Obsessive Compulsive Disorder
11) Schizophrenia
12) Depression Mild/Moderate
13) Depression Severe
14) Bipolar/Affective Disorder
15) Anorexia Nervosa
16) Bulimia Nervosa
17) Tobacco Use
18) Alcohol/Drug Harmful Use
19) Alcohol/Drug Dependence
20) Wernicke's Encephalopathy
21) Korsakoff Syndrome
, Neuroleptic Malignant Syndrome
Definition: Rare but life threatening reaction to neuroleptic medications leading to fever,
muscular rigidity and altered mental state
Symptoms: Causes:
- High fever Typical antipsychotics:
- Muscular stiffness - Haloperidol
- Altered mental status - Fluphenazine
- Autonomic nervous system - Bromperidol
dysfunction - swings in blood
pressure, sweating and saliva Atypical antipsychotics:
secretion - Risperidone
- Aripiprazole
Differentials: - Olanzapine
- Serotonin syndrome - Clozapine
- Lethal catatonia - Quetiapine
- Malignant hyperthermia
- Heat stroke Diagnosis:
- Urinalysis
- Arterial blood gases
- Creatinine phosphokinase blood test
- Increased creatinine kinase
Treatment:
- Transfer to hospital
- Stop antipsychotics
- Maintain electrolyte balance using IV
fluids
- Lower blood pressure
- Muscle and skeletal relaxants
, Lithium Toxicity
Definition: Condition where there is too much lithium (mood stabilizer) in the blood
Symptoms: Causes:
- Tremor - Dosage increase
- Diarrhoea - Dehydration
- Vomiting - Medication interactions
- Ataxia - Problems with kidney functions
- Confusion
- Slurred speech Diagnosis:
- Acne exacerbation - Blood chemistry to check electrolyte
- Urine test to determine serum lithium
Differentials: - Blood test to check kidney function
- Neuroleptic malignant syndrome - Lithium > 1.5m/L
- Alcohol withdrawal syndrome - Increase in U&Es
- Serotonin syndrome - Increase in TFTs
- Benzodiazepine withdrawal - Increase in Ca
Management:
- BMI, U&E, TFT, Ca monitored every
6 months
- Weekly bloods to prevent toxicity
Treatment:
- IV fluids to restore electrolytes
- Monitoring vital signs
- Hemodialysis to remove waste from
blood
