Neuroleptic malignant syndrome: a sixteen years retrospective review

To study demographic characteristics, psychiatric diagnosis, type of neuroleptic drugs administered, course of illness, management and outcome. Retrospective chart review study. This study was carried out for sixteen years [1988-2004] in the Psychiatry unit, Aga Khan University Hospital, Karachi. Sample consisted of 25 cases of Neuroleptic Malignant Syndrome in which 13 were males and 12 were females. The record was taken from the health information management system which keeps a comprehensive chart of each patient. This renders the files retrievable through computer generated search. A specific data collection form was designed for extraction of relevant data. The data was analyzed using SPSS version 13.0. Twenty five cases were identified, of which thirteen were males. Mean age was 45 years [range 20-74 years]. Bipolar affective disorder was the most common diagnosis followed by schizo-affective disorder, schizophrenia, postpartum psychosis, dementia and Parkinsonism. 48% of the patients had previous history of neuroleptic use, while 28% received neuroleptics for the first time. Among neuroleptic users, 20% were on long-acting depot antipsychotics. 52% received per-oral dose [PO], while 32% received intramuscular [IM] dose. 56% patients were on other concomitant medications among which Lithium was the most common [16%]. 96% patients had the cardinal symptoms of fever, rigidity and increased creatine phosphokinase [CPK]. 96% had associated delirium, 80% showed autonomic instability with fluctuation in pulse and blood pressure. Electrolyte disturbance was seen in 84% and diaphoresis with leukocytosis was present in 68% patients. NMS was associated with high ambient temperature with mean temperature of 39.20 C [S.E. 0.3]. Discontinuation of neurolpetic medications and supportive care was carried out in all cases. In our case series we observed mortality rate of 16%. Out of 25 patients, 21 recovered with early diagnosis and adequate management. Risk of NMS can be minimized by use of low potency or atypical antipsychotics, cautious use of concomitant medications and depot preparations and initiation of neurolpetics at lower dose with careful monitoring. With good supportive medical care mortality can be substantially minimized

Gender differences in age at onset of schizophrenia

To evaluate the gender differences in age at onset of schizophrenia. Prospective case control study. Department of Psychiatry, Aga Khan University Hospital, Karachi between January to December 2002. Patients and Sixty patients admitted consecutively to psychiatry ward and meeting the inclusion criteria were enrolled for the study. Age at onset of illness was defined as age at onset of gross psychotic symptoms, age at first contact with psychiatrist and age at index admission. Statistical method included two independent samples t-test. Data was dichotomized into those with family history of schizophrenia versus those without family history of illness and then Chi-square test of association was applied. The mean age of onset of illness was 23.96 years in females and 24.13 years in males. In all other measures used to assess the onset of illness, females were overrepresented at the younger age group. 56.7% patients had a family history of psychotic disorder. Among them the mean ages at onset of illness were 20.59 years in females and 21.85 years in males [c 0.04 df =58]. The illness occurred at a younger age in those with positive family history of schizophrenia [21.22 years] than those without it [25.14 years] with dissipation of gender difference in the former. There was no significant gender difference in age at onset of disorder in this study. Family history of schizophrenia appears to be the most significant factor that eliminates the gender differences in age at onset of schizophrenia