Psychiatric emergencies: Pathology review

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Psychiatric emergencies: Pathology review

Psychological disorders

Mood disorders

Major depressive disorder

Suicide

Bipolar disorder

Seasonal affective disorder

Premenstrual dysphoric disorder

Anxiety disorders

Generalized anxiety disorder

Social anxiety disorder

Panic disorder

Agoraphobia

Phobias

Obsessive-compulsive disorders

Obsessive-compulsive disorder

Body focused repetitive disorders

Body dysmorphic disorder

Stress-related disorders and abuse

Post-traumatic stress disorder

Physical and sexual abuse

Psychotic disorders

Schizoaffective disorder

Schizophreniform disorder

Delusional disorder

Schizophrenia

Cognitive and dissociative disorders

Delirium

Amnesia

Dissociative disorders

Eating disorders

Anorexia nervosa

Bulimia nervosa

Personality disorders

Cluster A personality disorders

Cluster B personality disorders

Cluster C personality disorders

Somatoform and factitious disorders

Somatic symptom disorder

Factitious disorder

Substance use disorders and drugs of abuse

Tobacco dependence

Opioid dependence

Cannabis dependence

Cocaine dependence

Alcohol use disorder

Sleep disorders

Bruxism

Nocturnal enuresis

Insomnia

Night terrors

Narcolepsy (NORD)

Sexual dysfunction disorders

Erectile dysfunction

Male hypoactive sexual desire disorder

Orgasmic dysfunction

Female sexual interest and arousal disorder

Genito-pelvic pain and penetration disorder

Pediatric disorders

Attention deficit hyperactivity disorder

Disruptive, impulse control, and conduct disorders

Learning disability

Fetal alcohol syndrome

Tourette syndrome

Autism spectrum disorder

Rett syndrome

Shaken baby syndrome

Enuresis

Encopresis

Psychiatric emergencies

Suicide

Serotonin syndrome

Neuroleptic malignant syndrome

Psychological disorders review

Mood disorders: Pathology review

Amnesia, dissociative disorders and delirium: Pathology review

Personality disorders: Pathology review

Eating disorders: Pathology review

Psychological sleep disorders: Pathology review

Psychiatric emergencies: Pathology review

Drug misuse, intoxication and withdrawal: Hallucinogens: Pathology review

Malingering, factitious disorders and somatoform disorders: Pathology review

Anxiety disorders, phobias and stress-related disorders: Pathology Review

Trauma- and stress-related disorders: Pathology review

Schizophrenia spectrum disorders: Pathology review

Drug misuse, intoxication and withdrawal: Stimulants: Pathology review

Drug misuse, intoxication and withdrawal: Alcohol: Pathology review

Developmental and learning disorders: Pathology review

Childhood and early-onset psychological disorders: Pathology review

Assessments

Psychiatric emergencies: Pathology review

USMLE® Step 1 questions

0 / 3 complete

Questions

USMLE® Step 1 style questions USMLE

of complete

A 55-year-old woman comes to the emergency department (ED) for evaluation of recurrent left flank pain and vomiting. She has a history of recurrent nephrolithiasis and recently noticed gross blood in her urine. Medical history is notable for obesity, hypertension, hyperlipidemia, depression, and type II diabetes mellitus. The patient has been taking ondansetron at home for nausea as well as losartan, metformin, rosuvastatin, and sertraline for her other medical conditions. On physical exam, the patient has left costovertebral angle tenderness. Blood is detected on urinalysis. The patient's symptoms are well controlled during the ED visit, and she is subsequently discharged with prescription analgesia, additional antiemetics, and urology follow-up. Three days later, the patient is brought back to the ED altered, diaphoretic, and agitated. Temperature is 39.4°C (103°F), pulse is 122/min, respirations are 20/min, and blood pressure is 184/95 mmHg. She has bilateral mydriasis and myoclonus. Which of the following medications was the most likely precipitant of this patient's clinical presentation?

Transcript

Content Reviewers

Antonella Melani, MD

Contributors

Filip Vasiljević, MD

Jake Ryan

Talia Ingram, MSMI, CMI

A 53 year old male named Noah is brought to the emergency department by his son, who found him with an empty bottle of fluoxetine in his hand.

His son mentions that Noah was recently diagnosed with depressive disorder.

Upon physical examination, you realize that Noah has a body temperature of 38.9 degrees Celsius, or 102.02 degrees Fahrenheit, and a blood pressure of 162 over 95 millimeters of mercury.

In addition, Noah’s pupils appear dilated, and his muscles are very stiff.

Finally, neurological examination reveals that Noah has overactive reflexes.

Later that day, a 34 year old female named Amelia is brought to the emergency department by her husband.

He explains that Amelia has a medical history of schizophrenia, and a few days back she took multiple doses of haloperidol.

Upon physical examination, Amelia’s body temperature is 38.7 degrees Celsius or 101.66 degrees Fahrenheit, and her blood pressure is 170 over 100 millimeters of mercury.

Similarly to Noah, Amelia has muscle stiffness, but neurological examination reveals diminished reflexes.

All right, now, both Noah and Amelia seem to have some form of psychiatric emergency, which is when a psychiatric condition becomes life-threatening and requires prompt treatment.

For your exams, some high yield psychiatric emergencies include suicide attempts, serotonin syndrome, acute dystonia, neuroleptic malignant syndrome, tyramine-induced hypertensive crisis, and delirium tremens.

Now, a very relevant psychiatric emergency, not only for your exams, are suicide attempts.

Suicide is when someone takes their own life intentionally.

Sources

  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
  4. "Diagnostic and Statistical Manual of Mental Disorders" NA (1980)
  5. "Suicide prevention strategies revisited: 10-year systematic review" The Lancet Psychiatry (2016)
  6. "Psychiatric Emergencies in the Intensive Care Unit" AACN Advanced Critical Care (2015)
  7. "Neuroleptic Malignant Syndrome" American Journal of Psychiatry (2007)
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