Rethinking Psychiatry: From Cultural Category to Personal Experience

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Catatonia: a critical review and therapeutic recommendations

Neuroleptic malignant syndrome (NMS) can be caused by various drugs. We report a case of a 60-year-old woman who presented with high-grade fever, muscular rigidity, tachycardia, tachypnoea and altered sensorium along with seizures. She had been taking olanzapine for the past 2 years for psychosis. For the last month valproate was added to her treatment. Her blood investigations revealed hyponatraemia and raised serum ammonia and creatinine phosphokinase (CPK) levels. In view of hyperthermia, muscular rigidity, autonomic disturbances, altered mental status and raised CPK, a diagnosis of NMS was made. Valproate could have probably precipitated NMS; although the patient was taking antipsychotics for a long time, it was only with the addition of valproate that she developed these symptoms. Raised serum ammonia levels also indicated the presence of valproate toxicity. Seizures were probably due to electrolyte disturbances. Offending drugs were withdrawn. The patient improved with treatment by dopamine agonist and other supportive treatments.

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An atypical case of neuroleptic malignant syndrome precipitated by valproate

I agree with Natarajan and Ravikumar that overseas doctors have been treated very shabbily.1 One of the surprising features of the whole affair has been the lack of outcry from UK and EU doctors in protest. The British Medical Association's response has been muted to say the least. But is this so surprising? In medicine, as in life, there are winners as well as losers and the simple truth is that UK and EU doctors are the winners here. Their jobs will be protected. They will not have to prove that they are better than overseas doctors to get a job; they will merely have to be available and be able to do the job.2

But UK and EU doctors should not become too smug. It is likely that, over the coming years, the large increase in the number of UK medical graduates will make medical unemployment a reality in this country.3 What will they do then? They could go abroad; but in light of the UK's treatment of overseas doctors they should not count on too warm a welcome. Who will speak up for them? We would do well to remember the words of Martin Niemoller, a German pastor: ‘First they came for the Jews and I did not speak out—because I was not a Jew. Then they came for the communists and I did not speak out—because I was not a communist. Then they came for the trade unionists and I did not speak out—because I was not a trade unionist. Then they came for me—and there was no one left to speak out for me’.

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International medical graduates.

Neuroleptic Malignant Syndrome (NMS) is an idiosyncratic and potentially life-threatening reaction to neuroleptic drugs. Lithium is a first-line mood stabilizer used in the treatment and prophylaxis of bipolar disorder. There are several case reports of lithium-associated NMS, but only when it was given in combination with antipsychotics. Therefore, the possibility of NMS being secondary to the antipsychotics could not be ruled out in those cases. Here we present a case of lithium-induced NMS in a patient who was not being treated concomitantly with any other agent known to cause NMS. The patient, a 74-year-old female with a 30-year history of bipolar affective disorder, was admitted to the emergency room of the All India Institute of Medical Sciences, New Delhi, with history of high fever and generalized weakness for 10 days before the admission. NMS was established based the presence of three cardinal symptoms. She was started on intravenous fluids to correct her sodium levels slowly and requested to follow-up at the psychiatry clinic.

Neuroleptic Malignant Syndrome Associated with Lithium Toxicity.

Extreme elevation of creatinine phosphokinase levels in neuroleptic malignant syndrome associated with atypical antipsychotics.

Objective: Latin American-trained international medical graduates (IMGs) in psychiatry residency face multiple challenges that go beyond their medical training. These challenges call for innovative problem-solving. Although the professional development of IMGs has been discussed in the professional literature, little is written about their experiences. In this report, a group of IMGs reflect on their experiences and describe how they solved challenges. Method: Using cogenerative ethnography, four IMGs trained in Colombia, the Dominican Republic, and Mexico provided insights on their challenges and solutions while adapting to psychiatric residency training. Individual interviews, focused discussion, and written reports were analyzed using data reduction, data display, and conclusion-drawing techniques. Results: We illustrate the challenges of IMG training in psychiatry using their reflections and stories. We categorize these challenges into three domains: immigration and acculturation, social adjustment, a...

/pdf/challenges-and-solutions-for-latin-american-trained-1aekfye3ce.pdf

Carlina Mejia

Papers

Extreme elevation of creatinine phosphokinase levels in neuroleptic malignant syndrome associated with atypical antipsychotics.

Challenges and Solutions for Latin American-Trained International Medical Graduates in Psychiatry Residency