Doctor, What Else Can You Do For My Wife?

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Discussion:NMS after Anti-Psychotic & SSRI• 29 cases of NMS after SGA + SSRI / serotonergicanti-depressant reported– Risperidone (10), clozapine (7), ziprasidone (2) aripiprazole(2), quetiapine (3)– Paroxetine (6), fluoxetine (4) – CYP2D6 inhibition– Fluvoxamine (3), sertraline (3), escitalopram (2),citalopram (1)– Sertraline – CYP3A4 inhibition1. Pharmacodynamics: dopamine inhibition2. Cytochrome P450 inhibition ↑ anti-psychoticconcentrationAssociation Between Selective Serotonin-Reuptake Inhibitors, Second-Generation Antipsychotics, and Neuroleptic MalignantSyndrome. The Annals of Pharmacotherapy n 2008 September, Volume 42
Discussion:NMS-Like Syndrome afterAnti-Depressants• After SSRI / serotonergic anti-depressantwithout concomitant administration of antipsychotics• Paroxetine + alprazolam• VenlafaxineAssociation Between Selective Serotonin-Reuptake Inhibitors, Second-Generation Antipsychotics, and Neuroleptic MalignantSyndrome. The Annals of Pharmacotherapy n 2008 September, Volume 42
Page 1 and 2:
Doctor,What else can You do for My
Page 3 and 4:
Madam Tang• Past Medical History:
Page 5 and 6:
Day 1Transfer from Psychiatric Unit
Page 7 and 8:
Day 1Special Observation Ward• Af
Page 9 and 10:
Day 2Transfer to Cohort Ward• Tra
Page 12 and 13:
Discussion:What are the Differentia
Page 14 and 15:
Day 1-2Investigations• Complete B
Page 16 and 17:
Day 2ECG
Page 18 and 19:
Day 2Chest X-Ray
Page 20 and 21:
Day 2CT Brain (Plain) Report• No
Page 22 and 23:
Day 1-4Temperature ChartD1 D2 D3 D4
Page 24 and 25:
Summary / Problemsat this Juncture1
Page 26 and 27:
Day 5Lumbar Puncture• Lumbar Punc
Page 28 and 29:
Day 1-9Temperature ChartD1 D2 D3 D4
Page 30 and 31:
Day 8Septic Workup• Sputum cultur
Page 32 and 33:
Day 8Advice fromInfectious Disease
Page 34 and 35:
Day 11-15Temperature ChartD11 D12 D
Page 36 and 37:
Day 10Patient Reviewed Again• Fev
Page 38 and 39:
23Discussion:What are the Different
Page 40 and 41:
Discussion:What else Can We Do?•
Page 42 and 43: Discussion:NMS: Clinical Features
Page 44 and 45: Day 10The Clinical Picture is Compa
Page 46 and 47: Day 5-8Blood Pressure/Pulse ChartHy
Page 48 and 49: Discussion:Is Elevated Creatine Kin
Page 50 and 51: Day 1-10Temperature ChartD1 D2 D3 D
Page 52 and 53: Discussion:What else Can We Do?Can
Page 54 and 55: Day 10Drug Record in Our PatientFlu
Page 56 and 57: Discussion:Why is so Important to D
Page 58 and 59: Conclusion:Most Likely Diagnosis in
Page 60 and 61: Discussion:NMS: Epidemiology• Inc
Page 62 and 63: Discussion:Why does this Patient be
Page 64 and 65: Discussion:What is So Special in Ou
Page 66 and 67: Discussion:NMS in Elderlyhttp://hk.
Page 68 and 69: Discussion:NMS in Elderly• Increa
Page 70 and 71: Discussion:Why does our Patient wit
Page 72 and 73: Discussion:Treatment of NMS• Mild
Page 74 and 75: Discussion:Treatment of NMS:Dantrol
Page 76 and 77: Day 11-22Temperature ChartD11 D12 D
Page 78 and 79: Day 12-24Progress• Physiotherapy:
Page 80 and 81: Day 35Progress inConvalescent Hospi
Page 82 and 83: Day 103Discharge• Upon Discharge-
Page 84 and 85: Discussion:SUMMARYWhat Have I Learn
Page 86 and 87: Discussion:What Have I Learned from
Page 88 and 89: After Discharge• Followed Up in M
Page 90 and 91: Discussion:Anti-Psychotics in Elder
Page 94 and 95: Discussion:Age-Related Physiologica
Page 96 and 97: Discussion:NMS in ElderlyNeurolepti
Page 98 and 99: Day 2Abdominal X-Ray
Page 100 and 101: Discussion:What are the Differentia
Page 102 and 103: Day 5Lumbar Puncture• Lumbar Punc
Page 104 and 105: Typical vs. Atypical Anti-Psychotic
Page 106 and 107: Discussion:Risk Factors of NMS• D
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