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Meningitis, heat stroke, lithium intoxication, catatonia, and acute dystonic reactions gure in the differential diagnosis Of course, neuroleptic medication must be discontinued as soon as any of the severe extrapyramidal reactions are recognized It has been common practice to avoid future administration of the offending neuroleptic, but the risk of using another class of antipsychotic agents has not been fully addressed The neuroleptic malignant syndrome bears an uncertain relationship to malignant hyperthermia by way of its clinical aspects but also in its response to bromocriptine and dantrolene (see later) Malignant hyperthermia is an inherited disorder that, in susceptible individuals, is triggered by inhalation anesthetics and skeletal muscle relaxants (page 1272) This disorder was described before the introduction of neuroleptic drugs and in a small proportion of cases has been related to a mutation of the ryanodine receptor gene on chromosome 19q A genetic factor is also suspected to underlie the neuroleptic malignant syndrome (a polymorphism in the D2 receptor gene; see Suzuki et al), possibly provoked by fatigue and dehydration There is no evidence that the occurrence of one of these syndromes confers a susceptibility to the other It hardly needs to be pointed out that the antipsychotic drugs have been much overused This would be suspected just from the frequency with which they are being prescribed These medications have speci c indications, noted earlier and in Chaps 56, 57, and 58, and the physician should be certain of the diagnosis and the indication for their use That the neuroleptic drugs can produce tardive dyskinesia in nonpsychotic patients is reason enough not to prescribe them for nervousness, apprehension, anxiety, mild depression, insomnia, and the many normal psychologic reactions to trying environmental circumstances These drugs are not curative but only suppress or partially alleviate symptoms, and they should not serve as a substitute for, or divert the physician from, the use of other measures for the relief of abnormal mental states.

Four classes of drugs the monoamine oxidase (MAO) inhibitors, the tricyclic compounds, the serotoninergic drugs, and lithium are particularly useful in the treatment of depressive illnesses The adjective antidepressant refers to their therapeutic effect and is employed here in deference to common clinical practice Antidepressive or antidepression drugs would be preferable, since the term depressant still has a pharmacologic connotation that does not necessarily equate with the therapeutic effect For example, barbiturates and chloral hydrate are depressants in the pharmacologic sense and mood elevators or antidepressants in the clinical sense

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A, DB, is incorrect because this type of connector is trapezoidal and has no copper connectors or retaining tab C, BNC, and D, mini-DIN, are incorrect because they are both round 19 D Mice do not use BNC connectors BNC connectors are used by coaxial cables and are designed for network or modem connections A, DB, is incorrect because this type of connector is used by serial mice B, Mini-DIN, and C, PS/2, are incorrect because PS/2 mice use a mini-DIN connector, which is often referred to as a PS/2 connector 20 A Parallel communications are faster than serial communications This is because parallel communications support the transfer of multiple bits at a time, whereas serial communications are marked by the transfer of one bit at a time Most printers are parallel due to the large amounts of data that they are sent by the computer B, serial communications result in fewer errors than parallel communications, is incorrect because parallel and serial communications differ in their methods of data transfer, not in their reliability or error rates C, parallel communications are compatible with more computer types than serial communications, is incorrect because all computers use both serial and parallel communications D, serial communications devices are easier to configure than parallel communications devices, is also incorrect These communications types refer to data transfer methods, not different device types or configurations In fact, some devices, such as printers and scanners, are available in either parallel or serial versions

The observation that iproniazid, an inhibitor of MAO, had a moodelevating effect in tuberculous patients initiated a great deal of interest in compounds of this type and led quickly to their exploitation in the treatment of depression Iproniazid proved exceedingly toxic to the liver and was soon taken off the market, as were several subsequently developed MAO inhibitors; but other drugs in this class, much better tolerated, are still available These include isocarboxazid (Marplan), phenelzine (Nardil), and tranylcypromine (Parnate), the latter two being the more frequently used Tranylcypromine, which bears a close chemical resemblance to dextroamphetamine, may produce unwanted stimulation, but the most common adverse effect of all the MAO inhibitors is postural hy-

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