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are present early in about half of cases Treatment includes controlling fever and providing fluid support Dopamine agonists such as bromocriptine, 25 10 mg orally three times a day, and amantadine, 100 200 mg orally twice a day, have also been useful Dantrolene, 50 mg intravenously as needed, is used to alleviate rigidity (do not exceed 10 mg/kg/d due to hepatotoxicity risk) There is ongoing controversy about the efficacy of these three agents as well as the use of calcium channel blockers and benzodiazepines ECT has been used effectively in resistant cases Clozapine has been used with relative safety and fair success as an antipsychotic drug for patients who have had NMS The syndrome must be differentiated from acute lethal catatonia, malignant hyperthermia, neurotoxic syndromes (including AIDS), and a variety of other conditions such as viral encephalitis, Wilson s disease, central anticholinergic syndrome, and hypertonic states (eg, tetany, strychnine poisoning) Akathisia is the most common (about 20%) so-called extrapyramidal symptom It usually occurs early in treatment (but may persist after neuroleptics are discontinued) and is frequently mistaken for anxiety or exacerbation of psychosis It is characterized by a subjective desire to be in constant motion followed by an inability to sit or stand still and consequent pacing It may induce suicidality or feelings of fright, rage, terror, or sexual torment Insomnia is often present In all cases, reevaluate the dosage requirement or the type of neuroleptic drug One should inquire also about cigarette smoking, which in women has been associated with an increased incidence of akathisia Antiparkinsonism drugs (such as trihexyphenidyl, 2 5 mg orally three times daily) may be helpful, but first-line treatment often includes a benzodiazepine (such as clonazepam 05 10 mg three times daily) In resistant cases, symptoms may be alleviated by propranolol, 30 80 mg/d orally, diazepam, 5 mg three times daily, or amantadine, 100 mg orally three times daily Acute dystonias usually occur early, although a late (tardive) occurrence is reported in patients (mostly men after several years of therapy) who previously had early severe dystonic reactions and a mood disorder (see below) Younger patients are at higher risk for acute dystonias The most common signs are bizarre muscle spasms of the head, neck, and tongue Frequently present are torticollis, oculogyric crises, swallowing or chewing difficulties, and masseter spasms Laryngospasm is particularly dangerous Back, arm, or leg muscle spasms are occasionally reported Diphenhydramine, 50 mg intramuscularly, is effective for the acute crisis; one should then give benztropine mesylate, 2 mg orally twice daily, for several weeks, and then discontinue gradually, since few of the extrapyramidal symptoms require long-term use of the antiparkinsonism drugs (all of which are about equally efficacious though trihexyphenidyl tends to be mildly stimulating and benztropine mildly sedating) Drug-induced parkinsonism is indistinguishable from idiopathic parkinsonism, but it is reversible, occurs later in treatment than the preceding extrapyramidal symptoms, and in some cases appears after neuroleptic withdrawal The condition includes the typical signs of apathy and reduction of facial and arm movements (akinesia, which can mimic depression), festinating gait, rigidity, loss of postural reflexes, and pill-rolling tremor AIDS patients seem particularly vul-.

allowing control of psychotic symptoms with a low dosage of neuroleptics If the dyskinesic syndrome recurs and it is necessary to continue neuroleptic drugs to control psychotic symptoms, informed consent should be obtained Benzodiazepines, buspirone (in doses of 15 60 mg/d), phosphatidylcholine, clonidine, calcium channel blockers, vitamin E, and propranolol all have had limited usefulness in treating the dyskinetic side effects

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Select Compare Rebate Basis And Correct Accruals in the IMG With report RV15B002 you can check a specific rebate agreement with regards to the amount due for rebate to the accrual amount posted These values may differ if you implement rebate processing retrospectively and thus wishes to take into account old billing documents You may post a rebate correction request to correct the accruals Should you reset rebate processing or alter the pricing procedures, the subtotals used to calculate the rebate in the billing documents may not be available If this is the case, you may select Recalculate Subtotals for Rebate Processing in the IMG This is merely a program RV15B003, which is executed with the selection criteria as the desired billing document number range Following this execution of the program, one will need to restructure the billing rebate index The rebate index is used to settle retroactive rebate agreements Should you change one of the following determining factors you will need to restructure the index:

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