Psychiatric Emergencies Part 2 of 2 (Psychiatry) (Pharmacology) - USMLE Step 1

Summary

This lecture from Mad Medicine delves into critical psychiatric emergencies, highlighting acute dystonias, lithium toxicity, tricyclic antidepressant toxicity, and suicidal tendencies. It explains the underlying mechanisms, symptoms, and treatment options for each condition, emphasizing the importance of timely intervention. Acute dystonia is treated with benztropine, while lithium toxicity necessitates careful management of hypothyroidism and nephrogenic diabetes insipidus. TCA toxicity requires supportive care and sodium bicarbonate treatment. The lecture underscores the gravity of suicidal thoughts and the need for immediate psychiatric evaluation when a plan is present, ensuring viewers understand the significance of these emergencies in clinical practice.

Takeaways

• 😀 Acute dystonia is a serious symptom of extrapyramidal signs associated with high-potency first-generation antipsychotics.
• 😀 Symptoms of acute dystonia can include uncontrollable muscle contractions and Parkinsonism, and require immediate treatment.
• 😀 Benztropine is the first-line treatment for acute dystonia, acting as an anticholinergic agent.
• 😀 Lithium is a critical first-line treatment for bipolar disorder but has significant side effects, including tremors and hypothyroidism.
• 😀 Long-term effects of lithium can include nephrogenic diabetes insipidus, cardiac issues, and Epstein's anomaly, particularly in pregnant patients.
• 😀 Tricyclic antidepressant (TCA) toxicity can lead to severe symptoms like seizures, anticholinergic effects, and cardiac complications.
• 😀 Sodium bicarbonate is an effective treatment for TCA toxicity, counteracting cardiac sodium channel blockade.
• 😀 Suicidal thoughts are a major psychiatric emergency and can be triggered by various factors, including previous attempts and social influences.
• 😀 Immediate psychiatric evaluation and hospitalization are essential for patients expressing intent and a plan for suicide.
• 😀 Understanding these psychiatric emergencies is crucial for medical professionals to ensure timely and effective patient care.

Q & A

What are psychiatric emergencies?

Psychiatric emergencies are acute disturbances in behavior, mood, or thoughts caused by medications or substances, requiring immediate treatment to prevent harm to the patient or others.

What is acute dystonia and what causes it?

Acute dystonia is a symptom of extrapyramidal symptoms (EPS) related to the use of high-potency first-generation antipsychotics, such as haloperidol. It is characterized by uncontrollable muscle contractions that occur shortly after drug use.

How is acute dystonia treated?

Acute dystonia is primarily treated with benztropine, an anticholinergic agent that blocks M1 receptors to alleviate symptoms.

What are the common side effects of lithium?

Common side effects of lithium include acute tremors, long-term hypothyroidism, nephrogenic diabetes insipidus, bradycardia, and Epstein's anomaly, especially in pregnant patients.

What should be done if a patient presents with lithium-induced hypothyroidism?

If a patient presents with lithium-induced hypothyroidism, they should be treated with levothyroxine, while continuing lithium therapy to manage bipolar symptoms.

What is TCA toxicity and what are its key symptoms?

Tricyclic antidepressant (TCA) toxicity occurs when there is an overdose of TCAs. Key symptoms include seizures, anticholinergic effects (such as hyperthermia), coma, and cardiac toxicity characterized by prolonged QT intervals and arrhythmias.

How can TCA toxicity be managed?

Management of TCA toxicity involves supportive care, administering sodium bicarbonate to counteract cardiac sodium channel blockade, and using activated charcoal to reduce absorption of the drug.

What factors increase the risk of suicidal thoughts?

Risk factors for suicidal thoughts include previous suicide attempts, LGBTQ identity, history of physical or sexual abuse, and family history of suicidal behavior.

What should be done if a patient expresses suicidal thoughts?

If a patient expresses suicidal thoughts and indicates a plan to commit suicide, immediate psychiatric evaluation and hospitalization are necessary to ensure their safety.

What is the significance of the acronym 'ADAPT' in relation to acute dystonia?

The acronym 'ADAPT' is used as a mnemonic to help remember the symptoms and characteristics of acute dystonia, emphasizing its importance in recognizing this psychiatric emergency.