Syndrome(Neuro-vegetatif)Malinについて

Abstract

In the present paper, two cases of syndrome (neuro-vegetatif) malin have been reported and discussed mainly from the semeiological view point. Since 1960, when Delay described this syndrome, it has been the object of psychiatrists' attention in France, while it was introduced in Japan by Otsuka and his collaborators in 1974 for the first time. According to Itoh, the syndrome is not so rare as Delay estimated but so frequent that psychiatrists have to pay attention to physical conditions of patients under neuroleptic medication. Incidentally the authors experienced two shizophrenics who presented severe neuro-vegetative symptoms consisting of high fever, extrapyramidal symptoms and dehydration due to excessive sweating. Paricularly, a case was suffered from a rapid developement of decubitus, which represents the trophic disturbance.It is important to differentiate this syndr ome from lethal catatonia(catatonie pernicieuse). The authors' patients fell into stupor that seemed to be accopanied by a certain disturbance of alertness at the onset of the syndrome, while the lethal catatonia would usually present psychomotor excitement. Moreover, so severe extrapyramidal symptoms as seen in our cases are not common in patient with lethal catatonia. Above all, the close relationship between administration, particularly parenteral application, of neuroleptica and onset of the syndrome is the most decisive factor as far as the diagnosis is concerned. Etiology of the syndrome is yet unclear in the mean time, but it appears that the syndrome may have some etiological similarity to malignant hyperthermia due to anesthesia. Since the mortality of the syndrome is as high as nearly 30%, it is important for prevention and early discovery of the syndrome malin to bear the possible risk in mind in case of drug treatment with psychotropic agents such as potent neuroleptica.