Haloperidol-induced neuroleptic malignant syndrome complicated by hyperosmolar hyperglycemic state.

Neuroleptic malignant syndrome (NMS) is a life-threatening neurologic emergency that may be caused by neuroleptic agents of any class. The association with hyperosmolar hyperglycemic state (HHS) is rare and carries a grave prognosis. We describe the case of a 25-year-old male patient with haloperidol-induced NMS complicated by HHS that culminated in the patient's death despite all treatment efforts. Physicians caring for diabetic psychiatric patients who are treated with neuroleptic agents should be aware of this association that may be prevented by tight glycemic control.

The diagnosis and treatment of Munchausen's syndrome.

Patients with Munchausen's syndrome--a syndrome characterized by the intentional production of physical symptoms to gain the sick role-present a variety of challenges to health care providers. Their treaters quickly become frustrated by their demanding interpersonal styles, by deception and manipulation, and by multiple unrevealing diagnostic procedures. These difficulties can lead to poor outcomes for patients and staff alike. We present the case of a young woman whose presentation and subsequent evaluation led to significant distress among the hospital staff responsible for her care, and discuss the epidemiology, diagnosis, and management of patients with Munchausen's syndrome. The most important role of the psychiatrist in the treatment of Munchausen's syndrome is to help the primary treatment team manage the patient in the safest and most appropriate way. Such management includes avoiding unnecessary procedures, preventing further self-harm, and avoiding angry or threatening interactions with the patient. The prognosis for patients with Munchausen's syndrome appears to be poor; flexible and creative approaches that emphasize consistency of care and regular outpatient psychiatric treatment have had the greatest success.

Priapism and psychotropic medication.

Priapism is a rare but serious adverse effect of psychotropic drugs resulting from their peripheral alpha-adrenoreceptor blocking action. Two patients developed this during treatment with oral phenothiazines: one was treated surgically with a venous shunt, and the second case resolved after intracavernosal injection of an alpha-adrenoreceptor stimulating drug.