Psychiatry Treatment & Symptoms

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Questions and Answers

What is the main drug of choice for treating muscle injury leading to myoglobinuria and renal failure?

Diphenhydramine

Clozapine

Bromocriptine

Dantrolene (correct)

Which of the following is considered the drug of choice for treatment-resistant schizophrenia (TRS)?

Dopamine agonists

Second-generation antipsychotics

Clozapine (correct)

Amantadine

How long should a patient be antipsychotic-free before restarting treatment after experiencing acute dystonia?

2 weeks (correct)

1 month

6 weeks

4 weeks

What is the mechanism of action for clozapine that contributes to a reduced risk of extrapyramidal symptoms (EPS)?

More affinity for D4 receptors than D2 receptors Signup and view all the answers

Which of the following treatment methods is NOT advised for managing acute dystonia?

Dantrolene Signup and view all the answers

What is one of the consequences of continuing muscle damage in patients with acute dystonia?

Elevated CPK levels Signup and view all the answers

What is a common side effect of antipsychotics that may be seen alongside acute dystonia?

Myoglobinuria Signup and view all the answers

Which dopamine agonist can be considered in the management of acute dystonia?

Amantadine Signup and view all the answers

What is the primary treatment for acute dystonia after the onset of symptoms?

Parenteral anticholinergics Signup and view all the answers

Which of the following symptoms is least likely associated with acute dystonia?

Diaphoresis Signup and view all the answers

Which group of patients is most commonly affected by acute dystonia?

Young males Signup and view all the answers

What would be the most appropriate prophylactic treatment for a patient at risk for acute dystonia?

Anticholinergics Signup and view all the answers

Which aspect of acute dystonia's pathophysiology contributes to heat generation?

D2 blockade in the corpus striatum Signup and view all the answers

Which of the following describes an acute dystonia symptom involving the eye muscles?

Oculogyric crisis Signup and view all the answers

Which symptom is indicative of neuroleptic malignant syndrome rather than acute dystonia?

Elevated temperature over 38°C Signup and view all the answers

What is NOT a recommended treatment option for acute dystonia?

Beta-blockers Signup and view all the answers

What does the term 'tardive' imply in the context of tardive dyskinesia?

Long-term occurrence of symptoms Signup and view all the answers

Which type of antipsychotics is more commonly associated with tardive dyskinesia?

Typical antipsychotics Signup and view all the answers

Which of the following movements is characteristic of tardive dyskinesia?

Rapid, jerky, nonrepetitive movements Signup and view all the answers

What is a common symptom of drug-induced parkinsonism?

Bradykinesia Signup and view all the answers

How can tardive dyskinesia primarily develop?

Long-term treatment with antipsychotics Signup and view all the answers

What is a recommended prophylactic treatment for preventing drug-induced parkinsonism?

Anticholinergics Signup and view all the answers

What characterizes 'rabbit syndrome'?

Involuntary chewing movements of the mouth Signup and view all the answers

What underlying mechanism causes drug-induced parkinsonism?

Blockade of D2 receptors Signup and view all the answers

Study Notes

Treatment Approaches

Shift from first-generation to second-generation antipsychotics is recommended.
Medications like trihexyphenidyl and diphenhydramine are used for treatment.
Valbenazine, Tetrabenazine, and Deutetrabenazine are important in managing side effects.
Acute dystonia presents as sudden muscle contractions, causing symptoms like torticollis, trismus, and oculogyric crisis.
Neuroleptic Malignant Syndrome (NMS) symptoms include muscle rigidity, elevated temperature (>38°C), increased CPK levels, diaphoresis, tremors, confusion, and autonomic disturbances.

Risk Factors and Prophylaxis

Acute dystonia is more prevalent in young males.
Parenteral anticholinergics like promethazine are the treatment of choice for acute dystonia.
Anticholinergics are also used for prophylaxis against side effects.

Consequences of Muscle Damage

Continuing muscle damage may lead to myoglobinuria and renal failure.
Increased CPK levels indicate muscle injury.

Treatment-Resistant Schizophrenia (TRS)

Defined as lack of response to at least two different antipsychotics, with one being second-generation and given adequately.
Clozapine is the drug of choice for TRS due to its unique mechanism, showing more affinity for D4 receptors, thus causing minimal extrapyramidal side effects (EPS).

Restarting Antipsychotics

Antipsychotics should be paused for two weeks before restarting, beginning with second-generation medications.

Miscellaneous Side Effects

Extrapyramidal side effects (EPS) arise from dopamine receptor blockade in the nigrostriatal tract.
EPS is more common with typical antipsychotics and when administered parenterally.

Tardive Dyskinesia

Tardive dyskinesia involves long-term involuntary movements, such as jaw and lip movements.
Choreiform or athetoid movements may occur, along with the rabbit syndrome, which involves rhythmic mouth motions.

Drug-Induced Parkinsonism

Symptoms include tremors (3-6 Hz), rigidity, and bradykinesia.
Caused by long-term antipsychotic use leading to D2 receptor up-regulation.
Anticholinergics are used for prophylaxis and treatment.

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Description

This quiz explores the treatment options and symptoms associated with acute dystonia and neuroleptic malignant syndrome. It includes information on second-generation antipsychotics, Valbenazine, and Tetrabenazine. Test your knowledge about these important psychiatric concepts.