What is the cause of neuroleptic malignant syndrome?
Neuroleptic malignant syndrome (NMS) is an idiosyncratic, life-threatening reaction to antipsychotic medications, with haloperidol being the most common cause. It is characterized by elevated temperatures, "lead pipe" muscle rigidity, altered mental status, choreoathetosis, tremors, and autonomic dysfunction (e.g., diaphoresis, labile blood pressure, incontinence, dysrhythmias). While this patient's temperature is only 102.7, students should note that any patients with temperatures greater than 105 most likely have non-infectious etiologies for temperature elevation. NMS is thought to be due to too much D2 blockade in the substantia nigra and hypothalamus. Treatment consists of stopping the causative agent and providing supportive care. Medications such as dantrolene, bromocriptine, amantadine, and lorazepam are also often used. Tardive dyskinesia is a chronic movement disorder that results from prolonged use of antipsychotics and can include involuntary and periodic movements of the tongue or lips, mouth puckering, or flailing movements either of the extremities or of the spine. Neuroleptic-induced acute dystonia is an acute spasm of a muscle or muscle group associated with the use of antipsychotic agents. It presents with patients complaining of neck twisting (torticollis), fixed upper gaze, facial muscle spasms, or dysarthria from tongue protrusions. In a similar family with dystonia, neuroleptic-induced akathisia is an extrapyramidal syndrome that is manifest by agitation and restlessness. Schizophrenia, catatonic type, a diagnosis of exclusion, usually does not present with this degree of impairment.
Do you have to be admitted to a psychiatric hospital if you have no history?
For an acute psychiatric episode, the first goal is medically stabilizing the patient. Subsequently, a patient who presents without previous history of a psychiatric episode does not necessarily need to be admitted. This, of course, depends on the identity and severity of the condition, and whether it can be treated in the emergency department.
Why is the pharmacist's strategy appropriate?
B) The pharmacist's strategy is appropriate because nonadherence is a primary reason that patients don't respond to treatments for AD.
What is an open ended question in a pharmacist interview?
Answer A is a close-ended question, so inappropriate. Answer B asks for permission to correct or supplement information, so it is correct. Answer C is a closeended question, so inappropriate. Answer D is a leading question that will put the patient on the defensive, so inappropriate.
How long does it take for pimavanserin to improve?
Continued improvement was seen through 6 weeks. An adequate trial of pimavanserin is necessary to judge efficacy.
Is clozapine safe for PD?
Meta-analysis data suggest that clozapine is the most efficacious antipsychotic medication used in the treatment of PD psychosis. However, it is associated with potentially lifethreatening bone marrow toxicity in 1% of patients. Its use is also limited given the need for frequent monitoring in a patient population that often has difficulty with mobility and travel. There are little to no data on the efficacy of haloperidol in patients with PD due to its dopaminergic blocking properties. Quetiapine is generally well tolerated, but efficacy data are equivocal. Pimavanserin is the only US Food and Drug Administration (FDA)-approved medication for the treatment of hallucinations in PD psychosis, and because it affects a minimal number of receptor types, its side-effect profile is favorable from a risk-benefit standpoint
Is it beneficial to take an SSRI before a drug?
Although it is true that when considered in aggregate, antidepressants are all considered beneficial, clinicians are most likely to select an SSRI before a drug in another class. It is estimated that 70% of patients prescribed antidepressant therapy are taking an SSRI. Individual agents in the class can be beneficial given their ability to affect other symptoms such as anxiety.
Can you use azathioprine with phototherapy?
Cyclosporine and azathioprine should not be used with phototherapy. Pimecrolimus is a topical drug. Dupilumab is indicated following optimization of topical therapy and after treatment failure of one or more oral immunosuppressive drugs