Formation of New State as a Life Event

a hypothetical neuroleptic-induced neurotoxic state of a nature different from the NMS? It is very unlikely: why would neuroleptic-induced neurotoxicity suddenly give way to catatonic excitement and then return the patient to a state of stupor? A patient experiencing a drug-induced state of suppression would be expected to remain in the state of suppression until the effect of the drug wore off; thereafter, he would be expected to remain in the recovered state. These arguments underline our contention that our patient exhibited manic stupor not as a neurotoxic process but as a rarely seen phenomenologic variant of the manic syndrome. As the patient himself expressed it, during the phase of stupor he experienced profound happiness and dreams of great deeds which were so intense that he was totally immersed in his thoughts and had no desire to move. On a theoretical note, did our patient suffer from a catatonic excitement which placed him at risk of neuroleptic-induced neurotoxicity? And, as Fink (2001), suggested, should we have eschewed haloperidol in favour of benzodiazepines to contain his excitement? I respectfully submit that there is no empirical evidence that all excited patients are at risk of neuroleptic-induced neurotoxicity. It is conceivable that, just as catatonic stupor is a heterogeneous syndrome, catatonic excitement is likewise heterogeneous. Neuroleptics may be potentially harmful in certain excited states but not in others; if so, these states require empirical characterization. It is also conceivable that neuroleptics may be potentially harmful in the presence of certain variables such as dehydration (Fink, 2001); if so, these risk variables also require identification. Regrettably, the field of catatonia is still a murky area. As a final note: Bell's mania, manic delirium, delirious mania, catatonic mania, lethal catatonia, and oneiroid states are not necessarily synonymous. These syndromes were described by different authors at different points in time. No author differentiated this syndrome from the other descriptions. REFERENCE