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Psychiatry


Answer 1
  1. Discontinue haloperidol. The patient is suffering from neuroleptic malignant syndrome. It is characterized by hyperthermia, muscle rigidity, diaphoresis, leukocytosis, elevated creatine phosphokinase, and frequently, delirium.1 The American Psychiatric Association recommends that the first step in treatment is to discontinue antipsychotic medication followed by supportive treatment for fever and cardiovascular symptoms.2 Increasing haloperidol or changing to haloperidol decanoate injections would worsen this potentially fatal illness. Benztropine is effective for antipsychotic-induced parkinsonism. Although muscle rigidity is a common symptom of this condition, it is not accompanied by fever, tachycardia, or hypertension. Lorazepam can be effective for antipsychotic-induced akathisia, which is characterized by somatic restlessness.

    REFERENCES
    1. Sadock BJ, Sadock VA. Biological therapies. In: Synopsis of psychiatry. Philadelphia: Lippincott, Williams & Wilkins; 2003:505-1150.
    2. American Psychiatric Association. Practice guideline for the treatment of patients with schizophrenia. 2nd ed. American Psychiatric Association practice guidelines for the treatment of psychiatric disorders compendium 2002. Washington (DC): The Association; 2002:349-461.

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