Advice about management

The most important practice point in the management of a patient with DLB is caution in (or preferably avoidance of) the use of neuroleptic medications, which are the mainstay of antipsychotic treatment in other patient groups. Severe neuroleptic sensitivity reactions (! 32) can precipitate irreversible parkinsonism, further impair consciousness level, and induce autonomic disturbances reminiscent of neuroleptic malignant syndrome. They occur in 40 to 50 per cent of neuroleptic-treated DLB cases and are associated with a two- to threefold increased mortality. Acute D 2 receptor blockade is thought to mediate these effects; and, despite initial reports, atypical antipsychotics seem to be as likely to cause neuroleptic sensitivity reactions as older drugs. A scheme for the management of the non-cognitive symptoms of DLB is given in Fig 1.

Fig. 1 Management of the non-cognitive symptoms of DLB.

Until safe and effective medications become available, there is no doubt that the mainstay of clinical management is to educate patients and carers about the nature of their symptoms and to suggest coping strategies. The clinician must ascertain which symptoms are most troublesome for the sufferer and explain the risks and benefits associated with changes in medication. (33) In these circumstances where the clinician is walking a therapeutic tightrope between parkinsonism and psychosis, the best outcome is invariably a compromise between a relatively mobile but psychotic patient and a non-psychotic but immobile individual. The patient and his carers may only be able to decide which is the lesser of these evils after experiencing both states.

Funny Wiring Autism

Funny Wiring Autism

Autism is a developmental disorder that manifests itself in early childhood and affects the functioning of the brain, primarily in the areas of social interaction and communication. Children with autism look like other children but do not play or behave like other children. They must struggle daily to cope and connect with the world around them.

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