Volume 36 · Number 8
AUGUST 2006

Post-ictal Symptoms and Neuroleptic Malignant Syndrome

By Joseph S. Goveas, MD; Stanley N. Caroff, MD

Editor’s Note: This monthly presentation describes a case of a psychiatric disorder, discusses past treatment attempts, offers options for continuing treatment, and explains the reasons the solution was selected. Submissions of interesting psychiatric case reports are welcomed. Please e-mail Managing Editor Shannon O’Connor at [email protected] for further information.

A 45-year-old patient with chronic psychosis and electroencephalogram (EEG)-confirmed partial complex seizures was hospitalized with altered mental status, urinary incontinence, drowsiness, and headaches, after being observed to have tonic–clonic movements and having been found on the floor by his family. A preliminary diagnosis of post-ictal state was made. He had been receiving 450 mg/day of clozapine, 3 mg/day of benztropine, and 75 mg of haloperidol decanoate intramuscularly every 4 weeks for bizarre delusions and auditory hallucinations.

ABOUT THE AUTHORS

Dr. Goveas is geriatric psychiatry fellow, Section of Geriatric Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA, and previously was in clinical practice at the Department of Psychiatry, Franciscan Skemp Healthcare – Mayo Health System, La Crosse, WI. Dr. Caroff is professor of psychiatry, University of Pennsylvania School of Medicine, and chief, Inpatient Psychiatry Service, Veterans Affairs Medical Center, Philadelphia.