Chlorpromazine-induced neuroleptic malignant syndrome and its response to diazepam

We have observed two cases of chlorpromazine-induced neuroleptic malignant syndrome (NMS); both were transiently responsive to intravenous diazepam challenge, but not to blind placebo or amyobarbitol. The interrelationship, via feedback between central dopaminergic and gamma-aminobutyric (GABA) systems is reviewed. A theoretical role for a relative DA-GABA imbalance during NMS and treatment implications are discussed.     

Are complex multiple-choice options more difficult and discriminating than conventional multiple-choice options?

Differences in item difficulty between conventional and complex multiple-choice (M-C) items measuring objectives written at the six levels of the cognitive domain and three content areas within a basic health professions subject matter area were investigated. Conventional and complex M-C items were also compared in terms of item discrimination. Five hundred fifteen senior baccalaureate nursing students randomly responded to one of two packages of 18 one-item pharmacology achievement tests. Items in the two packages were matched in all respects except for the type of option. A 2 X 3 X 6 repeated measures ANCOVA with method of pharmacology as the covariate showed a statistically significant (p less than .01) interaction of option X content X cognitive level. Scheffé tests revealed that complex items were more difficult than conventional option items at the knowledge level only across all content areas investigated. No statistically significant differences were found between the two option types discriminating ability. Results of this research question the validity of the assumption that complex items are more difficult and discriminating than conventional M-C items.     

A circulating lupus-like coagulation inhibitor induced by chlorpromazine

A variety of immune phenomena have been associated with chlorpromazine. One such factor, the lupus-like anticoagulant, while nonspecific, has been reported in 26 to 75% of chronic chlorpromazine recipients, although the exact incidence is unknown and requires further investigation. Such patients may have an enhanced risk of bleeding profiles (hemophilia-like) or, conversely, thrombotic events. A case of such a lupus-like anticoagulant with a circulating inactivator of coagulation is discussed in light of the recent literature.