From the Editor
I started seeing him after his psychiatrist retired. For the most part, our interactions were unremarkable: quick visits when we would talk about his walks, and then I would offer a prescription. Imagine my surprise when I heard that he had been admitted to the ICU with fever, rigidity, and decreased consciousness.
Neuroleptic malignant syndrome, what my patient developed, is rare and potentially deadly. What’s the DSM description? The differential? What are the implications for future treatment? In the first selection, Drs. Eelco F. M. Wijdicks and Allan H. Ropper (both of the Mayo Clinic Hospital) provide a concise and lucid review for The New England Journal of Medicine. They summarize the literature and offer practical suggestions. “Neuroleptic malignant syndrome is a distinctive and alarming syndrome that occurs in some persons who have been exposed to dopamine-blocking agents, particularly (but not exclusively) antipsychotic drugs.” We discuss the review and its takeaways.

How much of primary care is focused on mental healthcare? In the second selection, Avshalom Caspi (of the University of Oslo) and his co-authors attempt to answer that question, drawing on Norwegian data. In a new study for Nature Mental Health, they analyzed 350 million contacts with primary care (yes, you read that correctly) over a 14-year period. “One out of every 8 or 9 encounters that a primary care physician is for a mental-health concern.”
In the third selection, Lucy Foulkes (of the University of Oxford) writes about mental health awareness efforts. While focusing on the UK, her comments are relevant here, with campaigns by Bell Canada and others. She raises several objections, including that these efforts aren’t matched by improved access to care. “We do not have clear evidence about the impact of mental health awareness efforts. It may be that these efforts are merely a waste of time or that they are actively harmful. Or it may be that despite the above concerns, there is still a net gain that makes the efforts worthwhile.”
DG
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