The effect of high rapid loading and reloading doses in provoking neuroleptic malignant syndrome (NMS) - abstract

Controversy exists concerning the loading and reloading doses of neuroleptics and the development of neuroleptic malignant syndrome (NMS). Two cases of NMS are presented. The first, with fatal outcome, was initially provoked by an inadvertently rapid loading dose of intravenous chlorpromazine. The second patient was aggressively treated with high doses of depot fluphenazine injections and oral neuroleptics. On two occasions unplanned rechallenged caused recurrence of the syndrome. It appears that high rapid loading and reloading doses to provoke NMS. In support is the finding that, unlike in other countries, NMS is not a rare disorder in Trinidad. Possible reasons are the large doses of neuroleptics that are routinely used, the constant manipulation of patient's medication by service doctors and mental health officers and the general attitude of medical personnel to psychiatric patients. Dosages, drug interaction and route of administration are important factors in inducing NMS. Small doses of neuroleptics with little extrapyramidal side-effects are recommended for untreated patients in the early stages (AU)

Marijuana modified mania

A syndrome seen in four Jamaican patients is described in which increased use of marihuana followed the onset of symptoms of a hypomanic nature. At the time of admission to the hospital the patients exhibited persecutory delusions, auditory hallucinations, withdrawal, and thought disorder. Within three to four days after admission, manic or hypomanic symptoms emerged. It is suggested that these patients had mania and that excess marihuana usage was symptomatic of their illness, leading to a transient, marihuana-induced, schizophreniform phase of their manic illness. A plea is made for a broader approach to the psychiatric implications of marihuana use.(AU)

Tetanus and prophyria

Two cases of tetanus with positive tests for excessive porphyrins and prophobilinogen are presented. The arguments are presented for this being a false positive diagnostic error as well as the arguments for this being a rare coincidence. A third equivocating view is also presented. Investigators are encouraged to follow this series of events in their own cases (AU)

Clinical studies on South Trinidadian children: II. the treatment of neonatal tetanus

Twenty babies with neonatal tetanus were seen in a general hospital in a period of forty months. Conventional treatment and careful nursing permitted the recovery of twelve infants, while tetanus was the sole cause of death in only three of the fatal cases.(AU)

The results and treatment of tetanus

This paper gives a report on the management of twenty-nine (29) cases of tetanus admitted to one hospital during a period of twelve months. The incidence of the disease was roughly the same as previous years. The number of deaths, however were markedly reduced. The poor prognosis of respiratory complication is confirmed. Three principles of therapy, high doses ATS, heavy sedation and the use of barbiturates and chlorpromazine are stressed (AU)