 |
 |
Bob and all, I have seen NMS too, 1-2 cases in 20 years of practice. It is quite dangerous but if one considers it soon enough it can be treated. In fact one of the treatments is bromocriptine. I doubt whether Joe died of that given his clinical picture. I think in fact we had discussed it once before in relation to Joe. In answer to my friend Bob, while one must be careful with powerful drugs with neuroleptics and I think your caution about them being used only for psychosis (and a few other things like Tourette's Syndrome) is worth noting, I feel that neuroleptics can be administered safely in the vast majority of patients. If there is an indication they should be used (in non-PD patients) since psychosis is quite dangerous as well as the side effects from the meds. Bob, as we have exchanged before, I think that you have the experience of being called in when something goes wrong and thus have a skewed view of neuroleptics . In a broader spectrum of psychiatric patients they can be administered with relative safety acutely. Regardless let us hope that the newer neuroleptics are the answer to both the risk and the relative good that can come from pharmacology. They also appear to work better than the older drugs in any case. (BTW I tend to agree with you on Respiridol. I did not have a lot of success with it in the limited time I prescribed it prior to my retirement ) and in any case ANY drug must be used carefully in the elderly.) Regarding Janet's question Tolcapone is not a neuroleptic. Neither are other PD meds. It is a possible cause of NMS is I believe based on a single case report but I am not certain of that.. It certainly makes sense that it could cause it because its discontinuation can cause a drop in the dopamine level in the same way that a neuroleptic can. Neuroleptics (except the newer ones) are dopamine blockers and should be avoided by PWP. Charlie "Robert A. Fink, M. D." wrote: > > I've only seen it twice in fifteen years as a > > Psych-Mental nurse, but here goes. The patient starts > > running a high fever, becomes delirious (which is > > difficult to distinguish from psychosis),becomes very > > rigid, and appears very ill, with elevated vital > > signs, etc. It is somewhat rare and very complicated. > > Best description of NMS I've come across is the > > University of Iowa's VIRTUAL HOSPITAL'S "Clinical > > Pharmacology Seminar 1996-1997", which is extremely > > informative: > > Another (rare) complication of neuroleptic malignant syndrome is > when the myoglobin in the muscles (which are in severe spasm) > breaks down and gets out into the bloodstream. It turns the urine red > (looks like blood but isn't) and eventually can clog the kidney tubules > causing kidney failure. In such cases, dialysis may be necessary. > > Neuroleptics are dangerous drugs. They have some uses in severe > psychosis, but not in other conditions. The "newer" ones like > Risperidal are reputed to have fewer side-effects, but I don't believe it, > having seen some pretty bad reactions from such drugs, especially in > older people. > > Best, > > Bob > > ********************************************** > Robert A. Fink, M. D., F.A.C.S., P. C. > 2500 Milvia Street Suite 222 > Berkeley, California 94704-2636 > Telephone: 510-849-2555 FAX: 510-849-2557 > WWW: <http://www.dovecom.com/rafink/> > > mailto:[log in to unmask] > > "Ex Tristitia Virtus" > > ********************************************* -- ****************************************************************************************** Charles T. Meyer, M.D. Middleton (Madison), Wisconsin [log in to unmask] ******************************************************************************************