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nerable to extrapyramidal side effects High-potency neuroleptics often require antiparkinsonism drugs (see Table 24 6) The neuroleptic dosage should be reduced, and immediate relief can be achieved with antiparkinsonism drugs in the same dosages as above After 4 6 weeks, these antiparkinsonism drugs can often be discontinued with no recurrent symptoms In any of the extrapyramidal symptoms, amantadine, 100 400 mg daily, may be used instead of the antiparkinsonism drugs Neuroleptic-induced catatonia is similar to catatonic stupor with rigidity, drooling, urinary incontinence, and cogwheeling It usually responds slowly to withdrawal of the offending medication and use of antiparkinsonism agents Tardive dyskinesia is a syndrome of abnormal involuntary stereotyped movements of the face, mouth, tongue, trunk, and limbs that may occur after months or (usually) years of treatment with neuroleptic agents The syndrome affects 20 35% of patients who have undergone long-term neuroleptic therapy Predisposing factors include older age, many years of treatment, cigarette smoking, and diabetes mellitus Pineal calcification is higher in this condition by a margin of 3:1 There are no known differences among any of the antipsychotic drugs in the development of this syndrome Although the atypical antipsychotics appear to offer lower risk, the CATIE study did not address the long-term effects of these drugs Early manifestations include fine worm-like movements of the tongue at rest, difficulty in sticking out the tongue, facial tics, increased blink frequency, or jaw movements of recent onset Later manifestations may include bucco-linguo-masticatory movements, lip smacking, chewing motions, mouth opening and closing, disturbed gag reflex, puffing of the cheeks, disrupted speech, respiratory distress, or choreoathetoid movements of the extremities (the last being more prevalent in younger patients) The symptoms do not necessarily worsen and in rare cases may lessen even though neuroleptic drugs are continued The dyskinesias do not occur during sleep and can be voluntarily suppressed for short periods Stress and movements in other parts of the body will often aggravate the condition Early signs of dyskinesia must be differentiated from those reversible signs produced by ill-fitting dentures or nonneuroleptic drugs such as levodopa, TCAs, antiparkinsonism agents, anticonvulsants, and antihistamines Other neurologic conditions such as Huntington s chorea can be differentiated by history and examination The emphasis should be on prevention Use the least amount of neuroleptic drug necessary to mute the psychotic symptoms; atypical drugs appear to offer less risk as first line agents Detect early manifestations of dyskinesias When these occur, stop anticholinergic drugs and gradually discontinue neuroleptic drugs Weight loss and cachexia sometimes appear on withdrawal of neuroleptics In an indeterminate number of cases, the dyskinesias will remit Keep the patient off the drugs until reemergent psychotic symptoms dictate their resumption, at which point they are restarted in low doses and gradually increased until there is clinical improvement If neuroleptic drugs are restarted, clozapine and olanzapine appear to offer less risk of recurrence The use of adjunctive agents such as benzodiazepines or lithium may help directly or indirectly by.

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5 Nov 2012 ... To implement this concept first create one new website and add one of your existing pdf file to your website after that open Default. aspx page ...

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are present early in about half of cases Treatment includes controlling fever and providing fluid support Dopamine agonists such as bromocriptine, 25 10 mg orally three times a day, and amantadine, 100 200 mg orally twice a day, have also been useful Dantrolene, 50 mg intravenously as needed, is used to alleviate rigidity (do not exceed 10 mg/kg/d due to hepatotoxicity risk) There is ongoing controversy about the efficacy of these three agents as well as the use of calcium channel blockers and benzodiazepines ECT has been used effectively in resistant cases Clozapine has been used with relative safety and fair success as an antipsychotic drug for patients who have had NMS The syndrome must be differentiated from acute lethal catatonia, malignant hyperthermia, neurotoxic syndromes (including AIDS), and a variety of other conditions such as viral encephalitis, Wilson s disease, central anticholinergic syndrome, and hypertonic states (eg, tetany, strychnine poisoning) Akathisia is the most common (about 20%) so-called extrapyramidal symptom It usually occurs early in treatment (but may persist after neuroleptics are discontinued) and is frequently mistaken for anxiety or exacerbation of psychosis It is characterized by a subjective desire to be in constant motion followed by an inability to sit or stand still and consequent pacing It may induce suicidality or feelings of fright, rage, terror, or sexual torment Insomnia is often present In all cases, reevaluate the dosage requirement or the type of neuroleptic drug One should inquire also about cigarette smoking, which in women has been associated with an increased incidence of akathisia Antiparkinsonism drugs (such as trihexyphenidyl, 2 5 mg orally three times daily) may be helpful, but first-line treatment often includes a benzodiazepine (such as clonazepam 05 10 mg three times daily) In resistant cases, symptoms may be alleviated by propranolol, 30 80 mg/d orally, diazepam, 5 mg three times daily, or amantadine, 100 mg orally three times daily Acute dystonias usually occur early, although a late (tardive) occurrence is reported in patients (mostly men after several years of therapy) who previously had early severe dystonic reactions and a mood disorder (see below) Younger patients are at higher risk for acute dystonias The most common signs are bizarre muscle spasms of the head, neck, and tongue Frequently present are torticollis, oculogyric crises, swallowing or chewing difficulties, and masseter spasms Laryngospasm is particularly dangerous Back, arm, or leg muscle spasms are occasionally reported Diphenhydramine, 50 mg intramuscularly, is effective for the acute crisis; one should then give benztropine mesylate, 2 mg orally twice daily, for several weeks, and then discontinue gradually, since few of the extrapyramidal symptoms require long-term use of the antiparkinsonism drugs (all of which are about equally efficacious though trihexyphenidyl tends to be mildly stimulating and benztropine mildly sedating) Drug-induced parkinsonism is indistinguishable from idiopathic parkinsonism, but it is reversible, occurs later in treatment than the preceding extrapyramidal symptoms, and in some cases appears after neuroleptic withdrawal The condition includes the typical signs of apathy and reduction of facial and arm movements (akinesia, which can mimic depression), festinating gait, rigidity, loss of postural reflexes, and pill-rolling tremor AIDS patients seem particularly vul-.

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11 Jan 2018 ... I am saving PDF files for Employee with HttpPostedFilebase where the path of the pdf will be saved in the database. Now I want to display the ...

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