Declining frequency of neuroleptic malignant syndrome in a hospital population

Article Abstract:

Neuroleptic malignant syndrome is a side effect of the treatment of psychotic behavior with neuroleptic medications. It occurs as a toxic reaction to the drug, and is characterized by muscular rigidity, fever, sweating, stupor, and shortness of breath; in its severe forms it can lead to death. Several investigators have reported a frequency of neuroleptic malignant syndrome of 0.02 percent to 2.4 percent among patients treated with neuroleptic drugs (neuroleptics). In the present study, a significant decrease in the incidence of neuroleptic malignant syndrome was noted in a hospital population after an educational program was implemented for staff and signs of adverse drug reactions were more carefully and more promptly investigated. Patients experiencing fever or muscular stiffness while taking neuroleptics were evaluated by investigators within 24 hours of their complaint. Over a 47-month period, 14 patients were referred for consultation and four were diagnosed with neuroleptic malignant syndrome. Out of the 2,695 patients receiving neuroleptics during the period, the four with the syndrome represented a 0.15 percent frequency of occurrence as compared with a 1.10 percent frequency of occurrence during a previous period. This indicates a 10-fold decrease in the frequency of neuroleptic malignant syndrome in this hospital. It is suggested that earlier detection and treatment of side effects of neuroleptics played a role in the observed decrease, and that risk factors for side effects (such as administration of the drugs by intramuscular injection) may have been reduced as well. Increasing clinical awareness, early treatment of symptoms, and reduction of risk factors may therefore diminish the incidence of neuroleptic malignant syndrome in patients taking neuroleptic medication. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Prevention, Complications and side effects, Neuroleptic malignant syndrome

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Time course of antipsychotic effects of neuroleptic drugs

Article Abstract:

An attempt to define the onset and course of efficacy of neuroleptic (antipsychotic) drugs was performed by examining five previous studies in this area of pharmacological research. Neuroleptic drugs are used to reduce confusion and agitation, and to normalize brain activity in psychotic patients. Side effects of these drugs include apathy, lack of initiative, and the demonstration of a limited range of emotion. These drugs have been used successfully for approximately 35 years in the treatment of psychosis but little is known of their mode of action. Better understanding of the timing of the effects of these drugs and precisely how they work would help to establish better guidelines for clinical therapy and would enable better formulation and interpretation of studies regarding the nature and the action of these drugs. None of the five studies provided any insight into how long it takes for neuroleptics to reduce psychotic symptoms in patients. No conclusion regarding the overall response time or effectiveness of these drugs in reducing psychotic symptoms could be reached. However, it was observed that the reaction of the drug did not appear to change over time: studies over long periods of use produced results similar to studies over shorter periods. The use of sedatives and neuroleptics on two similar groups of acutely psychotic patients achieved equivalent results. Research into the efficacy of the combination of sedative and neuroleptic therapy may yield significant results and is recommended. The use of both these drugs may allow lower dosages of neuroleptics and thus reduce undesirable side effects which commonly occur. The exact time required for neuroleptics to relieve psychotic symptoms is still unknown and further study in this area is strongly recommended.

Care and treatment, Drugs, Dosage and administration, Drug administration and dosage, Psychoses, Psychotic disorders

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Kleptomania: a report of 20 cases

Article Abstract:

The Diagnostic and Statistical Manual of Mental Disorders, third edition, revised (DSM-III-R) identifies kleptomania as the irresistible impulse to steal objects that are not needed for personal use or their monetary value. Often the stealing is spontaneous. Since the impulse to steal is intrusive and senseless, and results in increasing anxiety with efforts to resist it, kleptomania also may be considered a classic compulsion. Therefore, it has been debated whether kleptomania is an impulse-control disorder (as in the DSM-III-R) or a type of obsessive-compulsive disorder. In the present paper, the cases of 20 patients with kleptomania are presented, along with data on their clinical presentations, family histories, and treatment response, as determined by diagnostic interviews. All of the subjects had been diagnosed with a mood disorder (e.g., depression) at some time during their lives, 16 had been diagnosed with an anxiety disorder at some point, and 12 had a history of eating disorders. The first-degree relatives (parents and siblings) of the patients were found to have a 0.31 risk for major mood disorders. Ten of the 18 patients treated for kleptomania (with medications), experienced a reduction or cessation of their stealing. It is therefore suggested that kleptomania may be related to a major mood disorder, and is perhaps one of the 'affective spectrum disorders'. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Case studies, Evaluation, Theft, Kleptomania

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