Neuroleptic Malignant Syndrome

Letters to the Editor NEUROLEPTIC MALIGNANT SYNDROME Sir, A 35 year male, indoor patient was referred by a physician for poor cooperation for diet, self care, impaired sleep, tightness of extremities and reduced mobility. Past history of vague fever and abnormal behaviour for which he changed different physicians and psychiatrists without improvement, reported treatment with antipsychotics, chloroquine, antibiotics including ciprofloxacin and antihypertensives. Past routine investigations including repeated peripheral smearforM.P. and serum widal was negative. M.R.I. was also reported normal. On examination, temperature was normal, BP was 140/90 mm Hg, cogwheel rigidity was present, no other abnormality was found, patient was neither communicative nor cooperative. Patient was provisionally diagnosed as psychosis with catatonic features and was kept on single dose of haloperidol 3mg orally with pacitane 4mg which caused marked worsening in form of mutism, akinesia, rigidity, pyrexia and hypertension (170/110 mg Hg). On investigation following was observed-C.P.K. 1856 i.u./ml, TLC 12000/mm 3 , blood urea 70mg/dl, serum creatinine-1.6mg%. Considering past/present history, examination and investigations, especially C.P.K. diagnosis of neuroleptic malignant syndrome was made. Anti psychotics were immediately stopped. Patient was treated with bromocriptine 5 mg, robinaxol, amantadine three times daily, lorazepam 12 mg per day l/V and nitrazepam 20 mg orally by ryle's tube. Carbamazepine 800 mg per day with clonazepam 6 mg per day were given to reduce behavioural problems and rigidity. Dose was titred according to presenting symptom. Patient improved and was discharged within a week. It is advisable that whenever there is exacerbation or appearance of other symptoms and signs or patient is not improving when already on treatment, drug side effects and change in diagnosis must be considered. N.M.S. is one of lethal side effects of neuroleptics having a mortality above 25 percent even when treated adequately and effectively. If timely diagnosed and treated life of the patient can be saved. Antipsychotics are not always safe and should be used with caution. MARRIAGE AND SCHIZOPHRENIA Sir, We have read with special interest the paper, "Marriage and schizophrenia' (Thara & Srinivasan, 1997). We congratulate the authors for carrying out research in terms of second generation studies in schizophrenia i.e. to study the processes and details of the course and outcome of schizophrenic patients as well as their living situations. The paper raises a number of important issues for further consideration. The striking observation is that 70% patients were married and 80% marriages were intact. A follow up …