Match each acute psychiatric emergency or adverse medication effect with its most appropriate definitive pharmacological management.
- A patient develops sustained upward deviation of the eyes (oculogyric crisis) and torticollis two days after starting haloperidol.Administer benztropine or diphenhydramine
- A patient presents with altered mental status, diaphoresis, hyperreflexia, and myoclonus after simultaneously taking fluoxetine and tramadol.Administer cyproheptadine
- A patient exhibits lead-pipe muscle rigidity, hyperthermia, autonomic instability, and a markedly elevated creatine kinase level after receiving fluphenazine.Administer bromocriptine or dantrolene
- A patient reports an intense internal feeling of restlessness and an urge to constantly pace the room following an increase in their aripiprazole dose.Administer propranolol
Answer
Acute dystonia matches with benztropine/diphenhydramine. Serotonin syndrome matches with cyproheptadine. Neuroleptic malignant syndrome (NMS) matches with bromocriptine/dantrolene. Akathisia matches with propranolol.
Each psychiatric emergency involves a specific mechanism requiring a targeted pharmacological approach. Acute dystonia is caused by acute D2 receptor blockade leading to a relative excess of acetylcholine, thus requiring anticholinergics (benztropine). Serotonin syndrome results from overstimulation of 5-HT receptors and responds to the serotonin antagonist cyproheptadine. NMS is a life-threatening reaction to dopamine antagonism, treated with dopamine agonists (bromocriptine) or the ryanodine receptor antagonist dantrolene. Akathisia is a form of motor restlessness that best responds to centrally acting beta-blockers (propranolol).
Step-by-Step Solution
Key Concept
Pharmacological management of acute psychiatric medication emergencies and toxidromes