Psychiatric Emergencies

Abstract

The complexity of oncology and supportive care is such that psychotropic drugs are themselves potential causes of urgent or emergent clinical problems. Polypharmacy and medication interactions increase the risk of drug-related emergencies. Serotonin syndrome is characterized by mental status changes, autonomic hyperactivity, and neuromuscular abnormalities varying from mild to life-threatening. Use of standardized diagnostic criteria can be helpful. Neuroleptic malignant syndrome presents with muscle rigidity, mental status changes, autonomic instability, and hyperpyrexia. Treatment of both syndromes is focused on removal of the precipitating agents and supportive interventions. Psychotropic drugs that are well tolerated in healthy persons are potentially dangerous in high acuity and end stage disease settings. Overdose and intoxication with psychotropic drugs are usually accidental or idiosyncratic in oncology and supportive care though the medications might be used in suicide attempts. Benzodiazepine intoxication risks hypotension, decreased respiratory drive, and exacerbation of delirium. Antipsychotic drugs may cause or exacerbate anticholinergic delirium. Typical and second generation antipsychotics may cause or exacerbate dangerous cardiac conduction delays including torsades de pointes. Antidepressants, frequently involved in suicides, are variably toxic or lethal between classes. Tricyclic antidepressants and monoamine oxidase inhibitors are particularly dangerous. In all cases of psychotropic drug intoxication or overdose treatment involve withdrawal of offending agents and support of affected organ systems. Emergencies related to psychotropic drugs are