Manic stupor or stupor resulting from treatment of mania?

Full text

I LETTERS TO EDITOR
MANIC STUPOR OR STUPOR RESULTING
FROM TREATMENT OF MANIA?
Sir,
Dr. Chittaranjan Andrade shared a case in
a letter to the editor
in
the July
2001
issue of Indian
Journal of Psychiatry (Andrade, 2001) and he, as
proposed by Dr. Fink (Fink, 2001) must be
congratulated for bringing this treatable, life
threatening condition to the notice of psychiatric
fraternity and we must also thank Dr. Fink for
giving guidelines to manage excited manic
patients in the same letter. But confusion lingers
regarding the two letters mentioned above. The
same symptoms which
Dr.
Andrade has proposed
to present as symptoms of manic stupor in the
given case has been explained on the basis of
neurotoxicity by Dr. Fink. These are mutism,
negativism, and probably rigidity. The explanation
proposed by Dr. Fink seems to be more plausible
as the symptoms seem to be anti psychotic
induced.
The discussed case had an excitatory psychosis
and was provisionally diagnosed as catatonic
excitement, secondary to an unspecified
psychotic process, which was later on
retrospection, was revised to
a
diagnosis of mania
when patient was more communicable and
cooperative. He was given a total of 40mg of
intravenous Haloperidol during the first 24 hours
after which he developed the above-mentioned
symptoms. Later during the day he had an
occasion of "breakthrough excitement" which was
considered as a point in favour of diagnosis of
mania (personal communication with Dr.
Chittaranjan Andrade).
Though NMS was ruled out and there is no doubt
of
mania
being the diagnosis
in
this case (personal
communication with Dr. Chittaranjan
Andrade),
still
patients with such acute excited states which have
been variously described as Bell's mania, manic
delirium,
delirious mania, catatonic mania and
oneiroid state (Fink, 1999) are prone to neurotoxic
state induced by parenteral administration of high
potency antipsychotics and when this state is
accompanied by fever and autonomic instability,
the syndrome is labeled "neuroleptic malignant
syndrome", a type of malignant catatonia (Fink,
1996). This patient seems to have suffered from a
similar neurotoxic state though not having NMS.
REFERENCES
Andrade, C. & Rao, N., S., K. (2001)
Manic Stupor-Letter to the editor. Indian Journal
of
Psychiatry,
43(3), 285-286.
Fink, M. (1996) Neuroleptic Malignant
Syndrome. One entity or two. Biological
Psychiatry, 39,1-4.
Fink, M. (1999) Delirious mania. Bipolar
Disorders,
1,54-60.
Fink, M. (2001) Treating Manic Stupor-
Letter to the editor. Indian Journal of Psychiatry,
43(3),
286-287.
SUBHASH CHANDRA GUPTA,
D.P.M.,
Resident .SARITA
E. PAUL*, M.D, Associate Professor in Psychiatry.
SOUMYA BASU, Resident ,
D.P.M.
Central Institute of
Psychiatry, Kanke, Ranchi-834006.
'Correspondence
Response
MANIC
STUPOR:
DIAGNOSIS AND
TREATMENT
Sir,
The confusion alluded to can be best
resolved through the explanation that catatonic
stupor is a syndrome of differing etiologies. All
physical examinations and laboratory
investigations in our patient resulted in normal
findings. There was no evidence of hyperthermia,
autonomic instability, and other characteristic
features of the neuroleptic malignant syndrome
(NMS).
Might the
stupor,
instead, have comprised
85