Tardive dyskinesia

- developed months to years after initiation of neuroleptic medications
- choreiform movements involving mouth, lips and tongue
- abnormal movement may develop after stopping the offending agent
- atypical antipsychotics has lower risk of TD
- treatment consists of stopping the offending agent
- TD remits within 3 months of stopping the drug and most patients gradually improve over the course of several years

Neuroleptic malignant syndrome

- rare but life threatening, idiosyncratic reaction to a neuroleptic medication
- characterised by fever, muscular rigidity, dysautonomia (sweating, tachypnea, tachycardia and labile blood pressure) and altered mental status
- thought to be secondary to decreased dopamine activity in CNS either from blockade of dopamine D2 receptor or decrease availability of dopamine itself
- blockade of dopamine neurotransmission in nigrostriatum and hypothalamus results in muscular rigidity and altered thermoregulation
- most common cause are haloperidol, fluphenazine depot preparation and chlorpromazine
- high creatinine kinase and high white cell counts are seen
- complications include rhabdomyolysis and subsequent renal failure
- stop all neuroleptic, correct volume depletion and hypotension with IV fluid
- bromocriptine 5mg tds is the treatment of choice (dantrolene was formerly recommended as initial treatment of choice although recent studies suggest that it is associated with increased mortality when used without bromocriptine)

Dopamine dysregulation syndrome

- a.k.a hedonistic dysregulation
- dysfunction of reward system in Parkinson's disease due to long exposure to dopamine replacement therapy
- characterised by self control problems such as addiction to medication, hypersexuality or gambling
- patient typically increase the amount of dopamine agonist although it will worsen their dyskinesia
- management: L-dopa dosage reduction

Suicide risk

SADPERSONS

S - sex
A - age
D - depression
P - previous attempt
E - ethanol abuse
R - rational thinking loss
S - social support lacking
O - organised plans
N - no spouse
S - sickness