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A general-purpose, web standards-based platform for parsing and rendering PDFs. 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. jquery pdf generator: Generate a thumbnail of PDF file in HTML - Stack Overflow jquery pdf thumbnail generator How to Generate a PDF with JQuery - ByteScout
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