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Year 4 - Mental Health > Psychiatric emergencies > Flashcards

Flashcards in Psychiatric emergencies Deck (6)
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1
Q

what is the incidence of clozapine-induced agranulocytosis? When is risk highest?

A

1-2%

Risk highest 6-18 weeks after start of Tx.

2
Q

how would you manage a pt with clozapine-induced agranulocytosis?

A
  1. stop clozapine and any other potentially marrow-suppressing drugs (e.g. sodium valproate). Avoid other antipsychotics for a couple of weeks where possible (if needed, aripiprazole has lleast potential for BM suppression).
  2. urgently contact consultant haematologist.
  3. avoid sources of infection.
  4. consider lithium (stimulates granulopoiesis), G-CDF or GM-CSF.
3
Q

how would a pt with neuroleptic malignant syndrome present?

A

Onset usually within 2 weeks of 1st dose.

  • fever
  • muscle rigidity
  • autonomic instability: tachycardia, labile BP, diaphoresis
  • confusion
4
Q

which investigations suggest a Dx of NMS?

A

Bloods

  • raised CK
  • leucocytosis
  • raised transaminases
  • +/- electrolyte abnormalities

Urine dip
- myoglobinuria

5
Q

how would you manage a pt with NMS?

A
  1. stop antipsychotic
  2. fluid resuscitation (prevent renal failure) +/- sodium bicarbonate if rhabdomyolysis (alkalise urine)
  3. give dantrolene: RyR antagonist that prevents release of calcium from sarcoplasmic reticulum of striated muscle - reduced muscle rigidity and hyperthermia).
  4. if acute psychomotor agitation, give benzodiaepines (also works as muscle relaxant)
6
Q

Suggest risk factors for suicide.

A
  1. male
  2. Hx of deliberate self-harm
  3. alcohol or drug misuse
  4. Hx of mental illness e.g. depression, schizophrenia (10% of people with schizophrenia complete suicide)
  5. Hx of chronic disease
  6. advancing age
  7. unemployment or social isolation/living alone
  8. being unmarried, divorced or widowed