Garth Daniels - and - "Syndrome Malin des Neuroleptique"

Despite an ALERT first recorded by Eastern Health in the medical files of Garth Daniels more than fifteen years ago, it appears that little attention was given to this treatment emergent condition first described by Delay and Deneker in 1960. "Syndrome Malin des Neuroleptic" that is Neuroleptic Malignant Syndrome...

The first reaction to it as described by the French clinicians Delay and Deneker is removal of the causative agent... The first recorded response is almost always the correct response... the literature confirms that the standard response has and always should be removal of the causative agent. Interestingly, that is precisely the response executed by Eastern Health when Garth was first treated there in 1996. What have been the consequences ?

The introduction of polypharmacy as has been documented in Garth Daniels volumes of medical records merely reinforces the notion that polypharmacy serves to "mask" underlying symptoms of this potentially fatal condition... So, why has it continued by other service providers?

Garth Daniels - A Paridigm Shift, Polypharmacy and the TGA

The Therapeutic Goods Administration ( Australia) is equivalent to the Food and Drug Administration (USA).

In 2008 the TGA convened a scientific study of reports based on numerous cases submitted to it by a psychiatrist who has an interest in forensic and medico - legal issues in psychiatry. The case studies encompassed numerous reports which described adverse events and complicated psychotropic medication histories over an extended periods of time.  The scientific study was undertaken by the Psychiatric Drug Safety Expert Advisory Panel established by the TGA.

In its Executive Summary The Panel considered that "the reports were most valuable for highlighting a number of issues associated with the use of psychotropic medicines, including

• ...extent of the problems associated with polypharmacy...
• lack of evidence for the use of many of the prescribed combinations...
• potential of increased adverse events when multiple medications are used concurrently...
• clinicians difficulties in "distinguishing" side effects as akathesia from underlying psychiatric disorders
• inconsistencies between current Australian Product Information documents and international monographs...

...there was usually clear evidence of a temporal relationship between the onset of symptoms ( e.g. akathesia or suicidal ideation ) and the use of medication and evidence that the symptom improved on discontinuation or reduction in dose of the drug...."

Why is it that on each and every occasion Garth Daniels presented to hospital...whether voluntary or involuntary is not the question... Why has it been that his drug prescription is always increased culminating in unnecessary traumatic and lengthy inpatient hospital stays?

Perhaps now there is a paradigm shift... initiated as a result of a short stay at St.Vincents Hospital and recognition that the alternative to a C-Max dose.. and polypharmacy is a reduction.

Therapeutic dose should be based on the rate of clearance the formula of which equates to dosing rate divided by drug concentration, shouldn't it ?