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Clinical Vignette: Preventing Complication in A Man with Agitation A 30-year-old man, who is a heavy alcohol drinker, presented to the emergency department with agitation, altered sensorium, marked tremors, visual hallucinations. On assessment, he is unaware of the time, place, and person. His blood pressure and pulse were 160/11 and 115/min on arrival but fluctuated on monitoring. A GP had given him haloperidol IM and diazepam IV to control his behavioral disturbance.  What treatment-complication could arise? a)        Seizures b)       Over-sedation c)        Respiratory depression d)       Arrhythmia e)        Worsening agitation Benzodiazepines for the Treatment of Catatonia Safest Treatment Option for Delirium Tremens WHO Alcohol Withdrawal Treatment Guidelines

Common Crisis Situations in Clinical Practice Point out the crises seen in day to day clinical practice. Developmental crises common to all occur in  Stressful states of human maturation and transition. e.g. hospitalization Situational crises person faces stressful and traumatic event e.g. flood, earthquake, rape, etc. WHO Guidelines for the Treatment of Alcohol Withdrawal

Zolpidem, a positive allosteric modulator of gamma-aminobutyric acid receptors, seems to be a safe and effective treatment alternative. 

Benzodiazepines for the Treatment of Catatonia Benzodiazepines are the first-choice treatment for catatonia, regardless of the underlying condition. Benzodiazepines are positive allosteric modulators of GABA-A receptors and will correct deficient GABA-ergic function in the orbitofrontal cortex. Following a positive Lorazepam Challenge Test , repeated doses of benzodiazepines can a treatment. Their use is safe, easy, and effective, with remission rates reported to be as high as 70–80%. About 65% Rates in a Naturalistic Study In a naturalistic study of 66 children and adolescents with catatonia, they found that benzodiazepines improved catatonia in 65% of cases , that there was no relation between dose and level of improvement, that the dose was higher sometimes (up to 15 mg of lorazepam) than the dose recommended in pediatric patients, and that side effects were few. Two-thirds Improved in a Trial of 107 adults In a recent trial in 107 adult inpatients ( 49% with a psychotic disorde...

Neuroleptic malignant syndrome  Manifestations MNEMONIC FEVER Fever Encephalopathy Vitals Unstable Enzymes Rigidity of Muscles Treatment Dantrolene D2 agonists (e.g., bromocriptine).