Match each psychiatric emergency presentation with its most appropriate specific targeted treatment or intervention.
- A 34-year-old man on maintenance haloperidol presents with profound muscle stiffness, diaphoresis, autonomic instability, and a core temperature of 40.0°C (104.0°F).Initiate bromocriptine or dantrolene therapy
- A 45-year-old woman taking tranylcypromine reports sudden onset of a severe occipital headache and has a blood pressure of 210/120 mmHg after attending a wine and cheese tasting.Administer intravenous phentolamine
- A 28-year-old man prescribed fluoxetine and recently started on linezolid develops agitation, diaphoresis, hyperreflexia, and spontaneous ankle clonus.Administer oral cyproheptadine
- A 52-year-old man with bipolar disorder presents with lethargy, coarse tremors, ataxia, and a measured specific serum medication level of 3.8 mEq/L.Prepare for urgent hemodialysis
- A 22-year-old woman taking divalproex sodium presents with acute disorientation and asterixis; laboratories reveal an ammonia level of 120 µmol/L with normal hepatic transaminases.Administer intravenous L-carnitine
Answer
Match NMS to bromocriptine/dantrolene; MAOI hypertensive crisis to phentolamine; Serotonin Syndrome to cyproheptadine; severe lithium toxicity to hemodialysis; and valproate-induced hyperammonemic encephalopathy to L-carnitine.
Each psychiatric emergency requires precise identification of its underlying etiology to administer the correct targeted intervention. NMS requires dopamine agonism (bromocriptine); a tyramine crisis requires alpha-blockade (phentolamine); Serotonin Syndrome requires serotonin antagonism (cyproheptadine); severe lithium toxicity with neurological compromise requires hemodialysis; and valproate-induced encephalopathy requires L-carnitine to correct depleted stores.
Step-by-Step Solution
Key Concept
Pharmacological and procedural management of acute, life-threatening psychiatric emergencies and medication-induced toxidromes.