Observations in tardive dyskinesia.
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Biomedical subjects
Publications and source records attributed to D Mehta.
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An elderly depressed couple with multiple physical problems decided that death was preferable to their present lifestyle, and made a suicide pact. At the last minute the wife felt unable to go through with it and the couple entered a psychiartic hosptial. During their 3-week stay they were treated appropriately with amitriptyline and psychotherapy. Since discharge they have been followed closely for two years. Some psycho- and socio-dynamic and therapeutic aspects are discussed.
A suicidal 67-year-old woman with manic-depressive psychosis took an overdose of asprin, amitriptyline and diazepam. The initial effects were pyrexia, tachycardia, hyperpnea, metabolic acidosis, electrocardiographic changes, hypoprothrombinemia, gastritis, and pancreatitis. Four to six weeks later, she was examined because of persistent abdominal pain with mausea, anorexia anemia, and possibly a malabsorption syndrome. An exploratory laparotomy was performed. The surgeon found several previous adhesions, a small intestinal volvulus, and a nodular pancreas. This suggested previous perforation of the small bowel from enteritis, causing a "blind-loop" syndrone. The invilved section of the small bowel was resected. With appropriate treatment, the patient is well three months after operation.
This report concerns an elderly woman with primary empty sella syndrome and bipolar affective illness. She had no endocrine, visual, or neurologic dysfunction and had received electroconvulsive therapy with no long-term adverse effects. Remission of the affective illness has been maintained for five years with lithium carbonate therapy.
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The neurologic side effects of antipsychotic drugs in the treatment of major psychiatric disorders are causing great concern. The status of tardive dyskinesia in 13 elderly psychiatric patients at the 5-year follow-up point, is reported. In 11 of the 13, tardive dyskinesia persisted. tamong these 11 patients, the severity was reduced in 2, increased in 2, and unchanged in 7. Only in 2 of the total 13 subjects had the tardive dyskinesia disappeared. However, both of these patients were receiving neuroleptic drugs and had parkinsonism, a syndrome that might have masked the dyskinesia. Recommendations are made for prophylaxis and for good clinical judgment in the use of antipsychotic drugs.
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