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Volume 32 number 4 airport rev.p65
Haloperidol Induced Dystonia
Syed O. Quadri, M.D.
Cecilia De Vargas, M.D.
Adharsh P. Sahadevan, M.D.
Lina Maria Reyes, M.D.
side which this patient suffered from. Haloperidol interferes
Haloperidol is a typical antipsychotic used in the treatment
with the effects of neurotransmitters in the brain which are
of Schizophrenia, and more acutely in the treatment of acute
the chemical messengers that nerves manufacture and re-
psychosis and delirium. It is in the butyrophenone class of
lease to communicate with one another. It blocks receptors
antipsychotic medications and has pharmacological effects
for the neurotransmitters (specially the Dopamine and Sero-
similar to the phenothiazines. Haloperidol is the first of the
tonin Type II receptors) on the nerves. As a result, the nerves
butyrophenone series of major antipsychotics.
are not “activated” by the neurotransmitters released by othernerves. The treatment of dystonia is usually straightforward
and almost always affective. Intramuscular administration of
This is a 17 year old Latin American male with the diagnosis
anticholinergics like Beztropine or Diphenhydramine or the
of Substance induced mood disorder with psychosis Vs Bi-
use of antihistamines like Promethazine is usually very effec-
polar I Disorder, , severe with psychotic features. The patient
tive. In some cases Benzodiazepines are very helpful to treat
had been transferred to the psychiatric unit after being medi-
cated twice with Haloperidol because of physical aggressiontowards others from a local medical facility. This is his first
This patient gives a picture of Haloperidol causing physical
admission to a psychiatric hospital. The patient had been
and emotional distress due to its severe side effects. Fortu-
using Marijuana and Methamphetamines for more than a year.
nately, it is very simple and easy to treat the side effects
The urine toxicology results were positive for Marijuana and
caused by Haloperidol. It is seen periodically that the Emer-
gency room physicians use Haloperidol as the drug of choiceto calm people down who are either aggressive or psychotic.
The patient was seen to be confused, incoherent, disoriented,
The only problem is, when it is used in large doses the pa-
dishelved with disorganized speech and violent behavior to-
tient frequently ends up with severe side effects such as
wards others. He would say things out of context and sen-
acute Dystonia as seen in this patient. Physicians need to be
tences which made no sense during the interview. He was
very careful in using chemical restraints with patients and
laughing inappropriately and also had crying spells simulta-
keep in mind the potential side effects the patient might have
neously. Patient was noticed to have been leaning his head
towards his right side and was unable to move the neck. Atthe same time, patient had slurred speech with his tongue
protruding to the outside of his mouth. On examination he
1. Casey DE. Neuroleptic-induced acute dystonia. In:
was not able to either move his neck or put his tongue back in
Widiger TA, Frances AJ, Pincus HA, First MB, Ross R, Davis
the mouth. Patient was in severe distress due to his awkward
W, editors. DSM-IV source book. Vol. 1. Washington, DC:
posture. This picture is typical of Dystonia, one of the ex-
American Psychiatric Association; 1994. pp. 545–559.
trapyramidal side effects of Haloperidol seen in males andyounger age groups. The patient was completely relieved of
2. Van Harten PN, Matroos GE, Hoek HW, Kahn RS. The
the distress with intramuscular injections of Diphenhydramine
prevalence of tardive dystonia, tardive dyskinesia, parkin-
sonism and akathisia: the Curaçao extrapyramidal syn-dromes study: I. Schizophr Res. 1996;19:195–203.
Dystonia is defined as a neurological movement disorder in
3. Van Harten PN, Hoek HW, Matroos GE, Koeter M, Kahn
which sustained muscle contractions cause twisting and re-
RS. Intermittent neuroleptic treatment and risk for tardive
petitive movements or abnormal postures. The movements
dyskinesia: Curaçao extrapyramidal syndromes study: III.
which are involuntary and sometimes painful may affect a
Am J Psychiatry. 1998;155:565–567.
single muscle, a group of muscles such as those in the arms,legs, neck or the entire body. Acute Dystonia is a condition
4. Aguilar EJ, Keshavan MS, Martinez-Quiles MD,
which can be induced in a person who gets medications like
Hernandez J, Gomez-Beneyto M, Schooler NR. Predictors of
Haloperidol. Acquired Torticollis is a form of dystonia which
acute dystonia in first-episode psychotic patients. Am J Psy-
affects the neck muscles and the face is turned to the same
Continued on page 6
Volume 32, Number 4
El Paso Physician 5
Haloperidol Induced Dystonia
Syed O. Quadri, M.D., University of Arizona, Department of
5. Keepers GA, Casey DE. Prediction of neuroleptic-induced
dystonia. J Clin Psychopharmcol. 1987;7:342–345.
Cecilia DeVargas, M.D, Assistant Professor
6. Mazurek MF, Rosebush PI. Circadian pattern of acute, neu-
Director of Child/Adolescent Unit at El Paso Psychiatric
roleptic-induced dystonic reactions. Am J Psychiatry.
7. Nasrallah HA, Churchill CM, Hamdan-Allan GA. Higherfrequency of neuroleptic-induced dystonia in mania than in
Adharsh P. Sahadevan, M.D., Resident Instructor, Texas Tech
schizophrenia. Am J Psychiatry. 1988;145:1455–1456.
University H.S.C., Department of Neuropsychiatry, El Paso,
8. Khanna R, Das A, Damodaran SS. Prospective study ofneuroleptic-induced dystonia in mania and schizophrenia. Am
Lina Maria Reyes, M.D., University of Miami, Department of
Psychiatry and Behavioral Sciences.
9. Arana GW, Goff DC, Baldessarini RJ, Keepers GA. Efficacyof anticholinergic prophylaxis for neuroleptic-induced acutedystonia. Am J Psychiatry. 1988;145:993–996.
10. Rupniak NMJ, Jenner P, Marsden CD. Acute dystoniainduced by neuroleptic drugs. Psychopharmacology.
6 El Paso Physician
Volume 32, Number 4
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ALLERGY TESTING PATIENT INSTRUCTIONS Your appointment is on: ___________________________________________________________________________________ Your doctor or provider has recommended that you be tested for inhalant and/or food allergies to determine if various foods, pollens or other airborne allergens may be contributing to your currentsymptoms. Please read the following guidelines prio