0071643192.pdf

PSYCHOBEHAVIORAL DISORDERS

796

SYMPTOMS/EXAM/DIAGNOSIS

Severe muscle rigidity and hyperthermia plus two or more of the following:

diaphoresis, dysphagia, tremor, incontinence, altered mental status, mutism,

tachycardia, increased or labile blood pressure, leukocytosis, increased creati-

nine phosphokinase

DIFFERENTIAL

Same as for MAOI toxicity

TREATMENT

■ Stop offending drug.

■ Supportive care/ABCs

■ Activated charcoal/gastric lavage for overdose

■ Benzodiazepines for agitation and muscle rigidity

■ Refractory cases may need paralysis (use a nondepolarizing paralytic like

vecuronium or rocuronium!) and intubation.

■ Active cooling

■ The use of dantrolene and dopaminergic agents such as bromocriptine

and amantadine are controversial.

COMPLICATIONS

Dysrhythmias, renal failure, seizures, pneumonia, DIC, death

Acute Dystonic Reaction

SYMPTOMS/EXAM/DIAGNOSIS

■ Involuntary muscle movements and spasms of the face, neck back, and

extremities, occurring with the first few days of treatment of an anti-

psychotic drug

■ Oculogyric crisis: Continuous rotatory eye movements

■ Laryngeal dystonia: Rare throat-tightening sensation resulting in difficulty

breathing and swallowing; can be life threatening

TREATMENT

Stop or decrease dose of drug. Administer diphenhydramine for control of

acute reaction. Use benztropine to prevent recurrence. Consider changing to

atypical antipsychotic agent.

Disulfram Reaction

SYMPTOMS/EXAM/DIAGNOSIS

■ Patients treated with disulfram (Antabuse) who then drink alcohol experi-

ence skin flushing, nausea/vomiting, headache, chest and abdominal dis-

comfort, diaphoresis, vertigo, palpitations, and confusion about 15–30 minutes

after alcohol use.

■ Severe reactions may cause hypotension, seizures, and dysrhythmias.

■ This is secondary to increased acetaldehyde from inhibition of aldehyde

dehydrogenase.

TREATMENT

Supportive care, IV fluids, and dopamine for hypotension; observe or admit

for severe symptoms