Frank L. Tornatore

Psychotic Exacerbation with Haloperidol

A case illustrating the worsening of a patients schizophrenic symptoms following haloperidol dosage increases is presented. This case is remarkable in that few cases of psychotic exacerbation with haloperidol dosage increases have been reported in the world literature. The possibility exists that, like certain tricyclic antidepressants, neuroleptic medication may possess a “therapeutic window.” The concept of a therapeutic window and its relationship to the phenomenon of psychotic exacerbation is reviewed. In evaluating this condition, the clinician should consider other causes of psychotic exacerbation, such as akathisia and anticholinergic psychosis.

Reactions to Benzodiazepines

The emergence of hostile reactions may involve increased verbal hostility and even physical assault. Often this behavior appears to be triggered by some frustrating stimulus before the patient “lashes out.” Some patients describe being very restless and pace the room before losing control.

Reactions to Antiparkinson Agents

The cardiovascular effects are dose-related. Low doses can cause transient bradycardia; moderate or high doses can cause tachycardia, palpitation, and arrhythmias (due to blockage of vagal effects on the S-A node).

Reactions to Antipsychotics

Presentation and Clinical Significance. There is decreased saliva secretion. The patient frequently complains of thirst or dry mouth.

Reactions to Lithium

Maculopapular eruptions are usually generalized and pruritic (itchy). The eruptions will clear with or without discontinuing or reducing the dosage of lithium or administering antihistamines or topical steroids.

Reactions to Antidepressants: Monoamine Oxidase Inhibitors

Hypertensive crisis usually occurs within several hours after ingestion of a contraindicated food or drug. Symptoms include occipital headaches (which may radiate frontally), sore or stiff neck, nausea, vomiting, palpitations (rapid heartbeat), fever, elevated blood pressure, sweating, photophobia (intolerance to light), and dilated pupils. Tachycardia or bradycardia may be present and can be associated with chest pain. With food reactions, factors to be considered include the amount of food eaten, the rate of gastric emptying, and the dose and potency of the monamine oxidase inhibitor (MAOI).