••• Chapter 42^ Ethics, Psychosocial, and Psychiatric Pearls^427
❍ Why are men more likely to complete suicide as compared with women?
Men tend to use more aggressive approaches to their attempts (ie, use of handguns and hanging), whereas women
tend to use more “slowly effective” or “ineffective” approaches to suicide such as ingestion of pills or wrist cutting.
❍ What potentially detrimental effect on the fetus is most often seen in patients with preexisting mental
disorders (ie, bipolar, schizophrenia, and depression)?
Complications due to noncompliance with prenatal care.
❍ What is the difference between low potency and high potency neuroleptics?
Low potency neuroleptics have greater sedative, postural hypotensive, and anticholinergic effects. High potency
neuroleptics have greater extrapyramidal effects.
❍ What are the autonomic side effects of antipsychotics?
Dry mouth, urinary retention, orthostatic hypotension, and sedation.
❍ What are the extrapyramidal side effects of antipsychotics?
Dystonia, akathisia, Parkinsonism, tardive dyskinesia, and neuroleptic malignant syndrome (NMS).
❍ What is the timeframe for the occurrence of extrapyramidal side effects with the use of antipsychotics?
(1) Dystonic Reaction → hours to days
(2) Akathisia → weeks
(3) Parkinsonism → months
(4) Tardive dyskinesia → years
❍ What treatment is used in the case of dystonic reactions when using antipsychotics?
Benadryl or anticholinergics (benztropine/Cogentin or trihexyphenidyl).
❍ What is NMS?
A life-threatening neurological disorder characterized by hyperthermia, rigidity, and an increase in creatinine
phosphokinase (CPK) caused by the use certain neuroleptics (haloperidol, chlorpromazine, etc). It can occur at any
time during the use of neuroleptics.
❍ What is the treatment of NMS?
Treatment includes discontinuation of antipsychotic, aggressive IV hydration, and dantrolene.
❍ What options are available for chemical restraint?
(1) Benzodiazepines
(a) Lorazepam—Ativan
(b) Midazolam—Versed
(c) Diazepam—Valium
(2) Sedative hypnotics
(a) Haloperidol—Haldol
(b) Droperidol—Inapsine