Match each clinical presentation describing a medication-induced psychiatric emergency or toxidrome with its most appropriate definitive pharmacological treatment.
- A 45-year-old man develops severe 'lead-pipe' muscle rigidity, a temperature of 104°F (40°C), and altered mental status a week after starting fluphenazine.Bromocriptine
- A 28-year-old woman presents with ocular clonus, hyperreflexia, tremor, and agitation shortly after taking linezolid while on chronic sertraline therapy.Cyproheptadine
- A 72-year-old man exhibits hot and dry skin, dilated pupils, tachycardia, urinary retention, and visual hallucinations after an intentional amitriptyline overdose.Physostigmine
- A 22-year-old man presents to the emergency department with a sustained upward deviation of his eyes and a twisted neck hours after receiving an injection of haloperidol.Benztropine
Answer
Fluphenazine-induced NMS matches with Bromocriptine; Sertraline/linezolid-induced Serotonin Syndrome matches with Cyproheptadine; Amitriptyline-induced Anticholinergic Toxicity matches with Physostigmine; Haloperidol-induced Acute Dystonia matches with Benztropine.
Each psychiatric emergency requires a specific pharmacological intervention that targets the underlying receptor pathophysiology. NMS is caused by dopamine blockade and is treated with bromocriptine (dopamine agonist). Serotonin syndrome is caused by excess serotonin and is treated with cyproheptadine (serotonin antagonist). Anticholinergic toxicity is treated with physostigmine (increasing acetylcholine). Acute dystonia is caused by a relative excess of acetylcholine following dopamine blockade and is treated with benztropine (anticholinergic).
Step-by-Step Solution
Key Concept
Pharmacological management of acute psychiatric medication-induced emergencies and toxidromes.