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Late

Friday

Night

Charts

Posted

on

October

am

by

Rambus

This

weekend

Ill

be

showing

you

many

long

term

charts

for

all

the

different

areas

in

the

markets

as

part

of

the

Quarterly

Report

I

do

for

Catherine

Austin

Fitts

who

is

the

founder

of

the

Solari

Report

Its

a

lot

of

work

but

it

forces

me

to

look

at

the

big

picture

for

signs

that

our

bull

market

which

has

been

in

place

since

the

low

is

still

intact

and

viable

When

we

just

look

at

the

short

term

charts

its

easy

to

miss

the

big

picture

and

what

it

means

for

the

long

term

All

bull

markets

Im

currently

updating

about

long

term

charts

that

I

hope

to

get

finished

for

part

of

this

Weekends

Report

Sir

Plunger

will

be

posting

his

Weekend

Report

also

I

can

tell

you

from

the

long

term

charts

that

I

have

updated

so

far

that

many

have

begun

to

trade

below

their

month

sma

which

is

the

first

sign

their

bull

market

might

be

in

trouble

There

has

been

a

big

change

in

the

last

three

months

especially

the

last

month

so

its

time

to

pay

close

attention

to

what

the

charts

are

showing

us

All

the

bestRambus

Posted

in

public

UUP

UpdateUS

Dollar

ETF

Posted

on

October

pm

by

Rambus

Many

investors

are

giving

up

on

the

US

dollar

as

it

has

been

consolidating

for

some

time

now

There

is

a

pattern

on

the

shorter

term

daily

chart

which

is

starting

to

come

alive

but

needs

a

little

more

work

to

complete

Below

is

a

daily

chart

for

the

UUP

which

is

still

showing

bull

market

chariteristics

as

it

has

been

forming

higher

highs

and

higher

lows

which

is

creating

an

uptrend

I

have

shown

you

many

cases

of

a

classic

HS

pattern

when

the

price

action

forms

the

left

shoulder

and

head

inside

of

a

wedge

with

the

right

shoulder

low

forming

on

the

backtest

or

fairly

close

to

the

backtest

to

the

top

rail

of

the

wedge

pattern

or

neckline

symmetry

line

In

mid

September

we

looked

at

this

blue

bullish

falling

wedge

which

could

have

been

a

stand

alone

pattern

that

could

have

started

the

next

impulse

leg

higher

for

the

UUP

As

you

can

see

the

price

action

failed

to

take

out

the

top

of

the

blue

falling

wedge

That

suggested

to

me

a

bigger

consolidation

pattern

is

most

likely

to

form

It

will

still

be

a

consolidation

pattern

but

a

slightly

bigger

consolidation

pattern

Just

like

the

daily

PM

combo

chart

we

looked

at

this

morning

with

the

uncompleted

expanding

rising

wedge

building

out

the

UUP

also

has

an

Note

how

the

left

shoulder

and

head

formed

inside

the

blue

bullish

falling

wedge

with

the

right

shoulder

low

testing

the

neckline

symmetry

line

today

Again

keep

in

mind

this

HS

consolidation

pattern

wont

be

complete

until

the

neckline

is

broken

to

the

upside

If

the

low

this

morning

holds

support

on

the

neckline

symmetry

line

the

last

order

of

business

is

for

the

UUP

to

rally

above

the

neckline

to

complete

this

high

level

consolidation

pattern

Below

is

a

longer

term

daily

chart

which

shows

an

even

bigger

HS

bottom

building

out

There

is

some

really

nice

symmetry

taking

place

on

this

chart

starting

with

the

neckline

symmetry

line

which

shows

the

low

for

the

right

shoulder

The

small

HS

consolidation

pattern

we

just

looked

at

on

the

daily

chart

above

is

also

showing

a

neckline

symmetry

line

which

is

showing

the

bottom

for

the

right

shoulder

as

well

On

the

left

side

of

the

HS

the

UUP

built

out

a

HS

top

which

led

to

the

February

bottom

this

year

Now

we

have

a

HS

Below

is

the

HUI

UUP

and

GLD

combo

chart

weve

been

following

which

has

done

a

little

morphing

but

the

main

theme

of

this

area

being

a

place

for

some

type

of

consolidation

pattern

to

build

out

is

still

in

place

Each

has

been

testing

an

important

trendline

over

the

last

two

days

Will

they

hold

is

the

question

Posted

in

public

Weekend

Report

Rate

ShockTime

to

find

out

who

has

been

swimming

naked

Posted

on

October

am

by

Plunger

What

Happened

Could

everything

have

changed

in

a

hour

period

Apparently

Yes

Over

the

span

of

hours

markets

woke

up

and

realized

that

the

FED

may

be

at

the

cusp

of

committing

Policy

Error

Recently

bonds

have

been

teetering

on

the

edge

and

this

week

Jerome

Powell

gave

bonds

a

push

off

the

ledge

Bonds

delivered

a

message

and

the

stock

market

was

listening

Stocks

got

derailed

along

with

bonds

Yields

blew

out

and

sucked

the

air

out

of

the

stock

market

So

why

the

big

move

in

bonds

Two

reasons

Less

demand

for

LT

bonds

due

to

the

higher

cost

of

hedging

caused

by

higher

yields

higher

USD

and

emerging

markets

dropping

FED

Chair

Powell

advertising

he

plans

on

being

very

aggressive

with

rates

He

plans

on

raising

rates

until

something

breaks

The

market

interpreted

Powells

remarks

as

Policy

Error

Market

players

know

that

when

something

does

break

the

FEDs

policy

response

will

likely

be

too

slow

they

will

lose

their

grip

and

risk

assets

will

crater

Thats

what

happened

this

week

Just

Another

Step

along

the

Post

Bubble

Contraction

Highway

Thats

what

this

is

its

the

initial

shock

from

around

the

world

finally

reaching

the

worlds

financial

center

All

year

long

we

have

seen

foreign

markets

diverging

away

from

the

USA

Capital

flows

towards

the

center

have

made

the

US

seem

impervious

to

any

problems

outside

the

inner

core

In

the

course

of

hours

everything

changed

Using

Warren

Buffets

quip

its

now

time

to

find

out

who

has

been

swimming

naked

In

our

last

PBC

report

I

showed

how

Ray

Dalio

has

publicly

come

on

board

to

the

PBC

model

Since

then

the

Stanley

Drukenmiller

interview

hit

the

internet

where

he

espoused

these

same

concepts

Stan

pointed

out

how

the

markets

are

filled

with

naked

zombies

floating

around

waiting

to

blow

up

once

liquidity

is

withdrawn

and

rates

begin

to

rise

This

is

all

part

and

parcel

of

the

PBC

So

this

week

the

markets

visibly

took

the

This

Weeks

Big

Story

Rate

Shock

Before

I

show

some

charts

let

me

say

I

remain

firmly

planted

in

the

Lacy

Hunt

school

of

interest

rates

This

week

I

attended

his

presentation

at

the

Stansberry

seminar

in

Las

Vegas

where

he

updated

his

views

on

the

course

of

interest

rates

in

a

PBC

Bottom

line

is

one

should

expect

rates

on

the

long

term

year

US

Government

bond

to

continue

to

trend

lower

over

the

next

years

This

of

course

is

a

non

consensus

view

but

based

on

sound

analysis

and

history

Therefore

the

pop

in

rates

we

are

currently

witnessing

is

temporary

and

The

over

use

of

credit

FED

QE

is

subject

to

the

law

of

diminishing

returns

therefore

the

productivity

of

debt

ultimately

decreases

the

velocity

of

money

Slowing

money

velocity

leads

to

lower

inflation

over

time

this

has

been

occurring

for

years

now

The

long

bond

yield

is

a

reflection

of

the

inflation

rate

When

economic

growth

rates

are

below

secular

trend

it

has

been

for

years

now

you

get

lower

inflation

and

lower

bond

yields

Synchronized

Global

Monetary

deceleration

is

now

occurring

everywhere

in

the

world

which

will

lead

to

decelerating

economic

growth

The

above

is

the

well

grounded

case

for

lower

long

term

Government

bond

yields

over

the

next

years

even

though

these

rates

are

presently

rising

The

historical

record

supports

this

view

In

after

the

debt

crash

in

the

USA

the

economy

went

into

a

depression

and

bond

yields

trended

lower

for

years

In

despite

massive

intervention

by

the

government

throughout

the

and

the

devaluation

of

the

USD

against

gold

the

US

Government

LT

bond

trended

down

for

the

next

years

In

post

Japan

despite

never

before

seen

massive

central

bank

intervention

and

money

printing

JGBs

trended

down

in

yields

for

the

next

years

So

long

term

year

Government

rates

should

continue

to

trend

down

over

the

next

years

in

the

USA

but

for

now

we

see

rates

rising

With

both

government

and

corporate

bonds

rising

things

are

starting

to

blow

up

This

weeks

news

Mattress

Firm

files

for

Chapter

bankruptcy

protection

will

close

up

to

stores

Consider

this

the

first

debt

bloated

zombie

floating

around

naked

Mattress

firm

declared

bankruptcy

this

week

Just

years

ago

they

were

a

buy

out

darling

rolling

up

multiple

mattress

companies

all

at

a

market

premium

Here

are

the

headlines

from

August

Mattress

Firm

Holding

Co

MFRM

Bought

Out

at

Premium

This

is

what

the

silvergold

ratio

has

been

telegraphing

all

year

a

march

towards

credit

stress

Previous

Trigger

Points

Investment

Grade

Corporate

Bonds

The

investment

grade

bonds

are

telegraphing

a

much

less

favorable

market

environment

The

Daily

charts

shows

a

clear

break

of

a

HS

neckline

The

TLT

The

TLT

is

not

the

year

but

they

are

longer

duration

government

bonds

and

we

can

see

how

Chairman

Powell

pushed

them

off

the

cliff

this

week

But

lets

now

look

at

the

opportunity

that

will

likely

present

itself

further

down

the

PBC

highway

Long

Term

Year

Government

Bonds

Yes

they

cracked

this

week

and

look

to

be

headed

lower

however

once

the

recession

hits

these

bonds

should

rally

and

give

us

the

opportunity

for

massive

gains

The

below

chart

gives

us

an

objective

for

the

yr

Once

prices

reach

this

level

one

may

consider

looking

for

a

base

to

form

and

going

long

the

year

Economic

lead

indicators

continue

to

point

towards

recession

Last

report

we

saw

how

housing

and

autos

were

showing

gaping

cracks

opening

up

These

two

sectors

are

classic

canary

in

the

coal

mine

indicators

Over

the

past

weeks

they

have

broke

wide

open

Housing

Full

Break

to

the

downside

Daily

UGLY

Autos

Disastrous

September

Sales

Ford

down

Toyota

down

Lexus

down

GM

down

DJ

Autos

These

sectors

are

now

entrenched

in

bear

markets

and

are

engines

of

economic

growth

in

good

times

However

they

are

now

reflecting

underlying

fundamental

weakness

in

the

US

economy

Is

this

the

start

of

a

bear

market

Too

early

to

tell

however

we

are

in

a

bear

market

watch

zone

Signals

are

now

popping

up

indicating

we

may

be

at

a

top

In

the

last

report

I

introduced

the

minus

interest

rate

topping

indicator

Its

the

indicator

hedge

fund

managers

are

watching

for

their

exit

signal

When

it

establishes

an

uptrend

expect

a

rush

to

the

exits

Two

weeks

ago

it

appeared

a

ways

off

before

any

such

signal

But

look

what

happened

this

past

weekit

blew

right

on

through

any

resistance

This

is

a

flashing

red

light

Yield

Curve

Exit

Indicator

Did

the

exit

indicator

just

give

us

a

signal

as

well

Again

it

is

very

early

on

however

when

the

violates

the

low

of

a

topping

consolidation

it

triggers

a

stock

market

exit

The

topping

pattern

we

see

is

not

very

extensive

or

developed

however

we

did

just

violate

the

previous

low

Caution

Dow

Theory

NonConfirmation

Mr

Market

is

a

trickster

and

I

have

suspected

all

year

long

that

as

all

of

the

other

indexes

went

on

to

new

highs

such

as

the

SPX

NASDAQ

Russell

etc

the

Dow

would

eventually

eek

out

a

marginal

all

time

high

just

to

ring

the

bell

That

is

in

fact

what

happened

but

immediately

the

Transports

fell

away

and

did

not

confirm

the

Dows

most

recent

high

therefore

we

are

now

operating

on

a

nonconfirmation

high

So

as

time

progresses

without

a

confirmed

high

the

odds

improve

that

the

final

high

is

in

Keep

in

mind

Dow

Theory

serves

Advance

Decline

LineNYA

Still

early

on

but

we

can

see

advances

over

declines

look

like

they

are

signaling

weakness

here

Percentage

of

stocks

above

their

EMA

Review

this

chart

below

of

the

percent

of

stocks

above

their

Day

moving

averages

I

placed

the

red

dashed

line

at

the

day

of

the

markets

all

time

high

Think

about

it

on

this

ATH

day

only

of

stocks

could

hold

themselves

above

their

EMApathetic

Thats

a

sign

of

market

narrowness

of

breath

Conclusion

It

is

too

early

to

know

if

the

top

of

the

great

bull

is

behind

us

But

signals

are

flashing

everywhere

and

shoes

are

dropping

Bear

market

signals

are

showing

up

where

we

would

expect

them

to

Until

now

dip

buyers

have

always

returned

and

bought

it

thus

propelling

the

market

onto

new

highs

But

we

also

know

the

retail

investor

continues

to

buy

of

the

way

into

a

bear

market

Corporations

are

currently

engaged

in

record

stock

buy

backs

while

simultaneously

managements

are

unloading

personal

stock

positions

Thats

using

the

corporate

treasury

keep

stocks

levitated

while

they

bail

Finally

lets

look

at

the

entire

record

length

bull

run

Recall

when

the

market

peaked

in

January

we

stated

that

it

was

not

likely

to

be

a

final

top

because

its

not

normal

for

RSI

to

peak

with

the

market

Instead

we

usually

see

the

market

hit

new

highs

with

failing

RSI

Well

we

now

have

that

Also

keep

in

mind

the

weekly

RSI

of

is

the

highest

in

the

DOWs

year

history

which

indicates

an

extreme

mania

Although

the

top

in

January

was

not

the

top

for

the

USA

it

was

the

global

synchronous

top

for

the

Commodities

Setting

up

for

a

generational

shorting

opportunity

In

the

last

PBC

report

I

presented

the

thesis

of

commodities

imploding

in

the

PBC

Since

then

they

have

rallied

so

whats

up

This

is

likely

just

an

intermediate

rally

higher

before

demand

is

withdrawn

Trumps

tariffs

are

likely

the

force

behind

the

surge

in

prices

End

product

users

are

scrambling

to

acquire

commodities

they

know

they

will

need

before

tariffs

get

put

on

This

is

causing

a

surge

in

prices

It

now

appears

to

have

completed

its

move

higher

as

it

has

met

its

measured

move

price

objective

Once

it

runs

its

course

the

roll

over

could

be

brutal

Revisiting

Commodities

Big

Picture

You

have

all

seen

the

big

picture

view

of

the

CRB

Lets

now

look

at

the

same

view

but

in

arithmetic

scale

It

makes

the

basement

level

price

objectives

look

more

achievable

We

also

now

have

a

time

window

for

this

price

objective

from

Trust

me

there

is

no

one

out

there

making

this

call

because

they

dont

have

the

chartology

tools

as

we

do

to

make

it

This

is

called

an

asymmetric

trade

since

no

one

out

there

can

see

it

except

for

Rambus

Knights

Uranium

A

Bull

Market

Unfolding

Before

our

Eyes

At

the

beginning

of

this

year

in

my

market

forecast

edition

I

stated

that

uranium

had

the

best

riskreward

proposition

of

any

investment

in

my

lifetime

I

stand

by

that

claim

and

I

believe

we

are

seeing

it

now

launch

into

a

bull

market

There

was

no

more

hated

or

despised

sector

in

the

market

space

than

uranium

and

it

had

undergone

a

decline

in

its

industry

market

cap

A

true

wipe

out

But

the

facts

are

that

of

all

electrical

production

in

the

USA

comes

from

nuclear

uranium

fuel

and

the

USA

only

supplies

of

its

own

fuel

Next

door

in

Canada

ALL

of

its

legendary

uranium

production

is

already

contracted

for

leaving

no

more

for

additional

export

Uranium

at

meant

there

would

be

no

more

new

production

of

uranium

to

supply

a

future

market

Thats

the

meaning

of

the

Cameco

mine

shut

down

Initially

Cameco

took

one

for

the

team

and

now

they

are

playing

catch

up

Uranium

Price

Above

we

see

the

nice

base

that

uranium

is

now

breaking

out

of

Note

the

series

of

higher

lows

over

the

past

years

You

can

see

that

a

move

to

looks

easily

achievable

yet

would

absolutely

launch

all

uranium

stocks

if

achieved

Uranium

ETF

Price

Proxy

Uto

The

below

chart

is

the

ETF

that

is

a

proxy

for

the

uranium

price

Here

we

see

a

very

nice

double

bottom

HS

base

It

has

now

broken

out

above

its

NL

and

is

engaged

in

a

consolidation

back

test

move

Its

measured

move

puts

it

up

to

which

equates

to

a

uranium

price

Coming

from

such

depressed

lows

and

well

developed

bases

the

stocks

would

absolutely

blow

the

doors

off

if

price

were

to

reach

its

initial

objective

of

This

is

why

I

continue

to

buy

into

this

sector

The

stocks

are

stretched

to

the

upside

but

I

think

they

are

going

higher

and

they

just

wont

pull

back

Question

Plunger

I

dont

get

it

you

are

such

a

bear

and

you

are

plunging

into

the

most

volatile

sector

in

the

universe

Really

Answer

Yes

Really

Hey

it

is

what

it

is

just

like

its

oclock

somewhere

there

is

always

a

bull

market

somewhere

and

thats

what

this

looks

like

Looks

like

a

duckwalks

like

a

duckquacks

like

a

duck

its

probably

a

bull

market

UEC

I

have

sold

most

of

my

UEC

because

I

have

come

to

mistrust

management

Every

time

this

stock

starts

to

raise

its

head

up

management

dilutes

the

share

structure

They

did

it

this

week

so

I

took

the

offering

and

immediately

sold

it

just

to

strip

off

the

warrant

Seems

to

me

they

are

quite

comfortable

putting

the

shareholder

last

and

it

smells

like

a

lifestyle

company

They

have

lost

my

trust

but

it

will

probably

still

go

up

anyway

Energy

Fuels

Plenty

of

doubters

of

this

stock

but

I

am

letting

the

chart

speak

for

its

potential

As

a

kicker

they

resume

Vanadium

production

in

November

Seems

to

me

this

pattern

has

all

over

it

Maybe

just

a

BT

before

a

resumed

move

up

Cameco

At

the

cusp

of

greatness

Skyharbour

Discovery

awaits

Western

Unstoppable

Deep

Yellow

Unknown

and

thinly

traded

Comes

with

experienced

exploration

team

Rick

Rule

has

loaded

the

boat

with

Deep

Yellow

So

has

Plunger

In

the

future

I

will

delve

more

into

this

sector

but

for

now

lets

move

on

Scandium

International

Yes

I

have

mentioned

this

before

but

I

would

like

to

share

with

you

what

I

see

here

Maybe

its

because

I

have

a

degree

in

economics

and

engineering

and

have

spent

a

lifetime

in

the

transportation

sector

but

when

I

first

heard

the

Scandium

story

it

hit

me

with

its

full

potential

and

possibilities

This

company

has

first

mover

advantage

and

is

in

the

process

of

creating

an

entire

new

industry

If

they

can

do

it

it

will

change

everything

and

the

world

will

beat

a

path

to

its

door

It

is

why

I

made

a

big

bet

and

The

management

of

this

company

are

quiet

but

they

are

serious

players

with

lots

of

industry

experience

John

Kaiser

presents

a

very

insightful

podcast

where

he

suggests

that

this

company

has

the

possibility

of

becoming

a

bubble

stock

someday

Who

knows

of

course

but

I

see

the

possibility

too

Look

at

the

chart

and

think

from

the

perspective

of

chartology

Does

Kaiser

see

what

I

see

but

with

different

glasses

Weekly

The

drawdown

appears

over

expect

news

flow

in

the

near

future

Gold

in

the

Post

Bubble

Contraction

We

have

had

some

inquiry

as

to

the

path

of

gold

during

a

post

bubble

contraction

In

light

of

Rambus

gold

charts

pointing

toward

lower

lows

from

here

many

think

its

a

dead

asset

Not

at

all

I

am

on

board

with

the

price

objectives

that

Rambus

has

depicted

but

I

also

think

they

could

be

reached

much

quicker

than

many

may

think

The

Real

Price

of

Gold

The

key

is

in

understanding

the

significance

of

the

real

price

vs

the

nominal

price

of

gold

In

an

expanding

economy

with

a

bull

market

in

stocks

gold

declines

relative

to

financial

assets

its

real

price

declines

When

the

contraction

comes

however

gold

goes

up

relative

to

financial

assets

the

real

price

rises

In

a

PBC

virtually

everything

goes

down

including

commodities

in

nominal

terms

Commodities

such

as

oil

account

for

close

to

of

extraction

costs

for

a

gold

mine

Oil

is

used

not

only

for

hauling

ore

but

is

also

a

chief

component

to

explosives

Ultimately

these

lower

costs

flow

through

to

the

bottom

line

of

a

gold

mining

operation

Simultaneously

the

value

of

its

end

product

gold

is

increasing

on

a

real

basis

This

explains

why

the

gold

miners

typically

have

such

robust

bull

markets

during

a

PBC

since

they

run

counter

to

prevailing

trends

Homestake

mining

was

Americas

premiere

mine

during

the

PBC

of

the

It

was

the

Barrick

of

its

day

During

the

inflationary

year

of

its

stock

hit

a

low

of

By

in

the

depth

of

the

depression

it

had

risen

to

Thats

a

bagger

in

a

period

where

the

DOW

had

lost

Those

are

the

kind

of

gains

that

major

companies

can

experience

not

just

the

junior

miners

But

according

to

Rambus

charts

the

generational

entry

point

that

I

speak

of

still

lies

in

front

of

us

It

is

why

I

sit

on

a

cash

hoard

Rambus

charts

target

an

HUI

in

the

vicinity

of

That

could

come

in

a

general

market

sell

off

and

it

may

not

last

for

long

Also

since

the

sector

has

so

much

short

interest

short

sellers

need

to

buy

the

stocks

in

order

to

close

out

their

positions

So

I

plan

on

beating

them

to

the

punch

and

start

taking

initial

positions

before

those

levels

because

it

may

never

get

there

The

PM

sector

has

been

savaged

but

look

for

the

impulse

wave

down

to

continue

on

to

lower

price

objectives

HUI

A

level

entry

would

be

a

lifetime

opportunity

We

have

so

much

more

to

cover

in

future

reports

as

each

week

brings

another

major

market

event

which

validates

our

thesis

You

should

know

that

our

strategy

is

in

synch

with

the

best

investors

in

the

world

Dalio

and

Druckenmiller

and

we

have

a

chartist

Rambus

who

has

no

equal

Its

going

to

be

an

exciting

ride

Posted

in

public

Late

Friday

Night

ChartsThe

Chartology

of

Gold

and

Silver

Posted

on

October

am

by

Rambus

Several

weeks

ago

we

looked

at

some

resistance

points

for

gold

and

silver

from

the

short

to

the

longer

term

time

perspective

Below

is

a

daily

chart

for

gold

which

starts

with

the

five

point

rectangle

reversal

pattern

which

broke

down

in

May

The

backtest

to

the

underside

of

the

five

point

rectangle

took

about

five

weeks

to

complete

forming

a

bearish

rising

wedge

From

that

point

the

impulse

move

down

began

in

earnest

stopping

in

mid

July

to

form

a

small

rectangle

After

trading

sideways

for

about

three

weeks

gold

broke

down

from

that

small

rectangle

and

finally

The

countertrend

rally

stopped

at

the

bottom

of

the

small

July

rectangle

where

support

turned

into

resistance

as

shown

by

the

black

dashed

SR

line

at

which

is

our

first

line

in

the

sand

There

is

also

the

top

rail

of

the

expanding

downtrend

channel

and

the

day

sma

which

are

also

offering

resistance

In

order

to

find

the

next

important

area

of

overhead

resistance

we

need

to

look

at

a

long

term

weekly

chart

going

back

years

which

shows

the

possible

massive

HS

top

The

backtest

to

the

neckline

comes

into

play

around

the

area

and

if

the

backtest

fails

to

hold

resistance

then

the

last

important

line

in

the

sand

is

the

bottom

rail

of

the

triangle

which

is

around

the

area

As

weve

discussed

so

many

times

in

the

past

its

now

up

to

the

bulls

to

show

us

they

mean

business

by

first

taking

out

the

This

last

chart

for

gold

shows

the

parallel

bear

market

downtrend

channel

with

the

week

ema

at

that

does

a

good

job

of

holding

support

during

a

bull

market

and

resistance

during

a

bear

market

impulse

move

Just

like

gold

silver

also

built

out

a

triangle

and

backtested

the

bottom

rail

this

week

at

which

marks

our

first

area

of

overhead

resistance

As

you

can

see

on

this

long

term

monthly

chart

silver

like

gold

also

has

a

massive

HS

top

in

place

along

with

its

bear

market

downtrend

channel

This

last

chart

for

silver

is

a

year

look

which

shows

its

massive

year

double

HS

bottom

along

with

its

bear

market

downtrend

channel

and

its

triangle

Note

the

blue

triangle

that

formed

way

back

in

which

separated

the

first

impulse

leg

up

from

the

second

leg

As

the

charts

above

show

there

is

some

near

term

resistance

at

for

gold

and

for

silver

which

are

basically

being

tested

right

now

Patience

is

the

key

going

forward

until

they

either

begin

their

next

impulse

leg

down

or

breakout

above

overhead

resistance

Have

a

great

weekend

and

all

the

bestRambus

Posted

in

public

XEU

XJY

Update

Posted

on

September

pm

by

Rambus

Sometimes

a

stock

can

push

you

just

far

enough

to

make

you

doubt

the

validity

of

your

analysis

just

at

the

most

opportune

time

Such

has

been

the

case

for

the

US

dollar

where

all

the

evidence

strongly

suggests

its

in

a

bull

market

Im

not

going

to

go

into

a

lot

of

detail

right

here

but

I

want

to

show

you

a

couple

of

charts

for

the

XEU

and

the

XJY

that

still

suggest

theyre

weak

compared

to

the

US

dollar

This

first

chart

is

a

daily

bar

chart

for

the

XEU

which

shows

the

possible

HS

top

building

out

The

last

time

we

looked

at

this

chart

the

price

action

was

building

out

the

right

shoulder

with

the

neckline

symmetry

line

showing

the

height

of

the

right

shoulder

As

you

can

see

the

XEU

traded

slightly

higher

than

the

neckline

symmetry

line

which

for

a

few

days

looked

like

the

possible

HS

top

maybe

failing

Note

the

gap

above

the

neckline

symmetry

line

and

now

the

gap

below

the

neckline

symmetry

line

which

shows

an

island

reversal

above

the

neckline

Next

is

a

longer

term

daily

line

chart

we

looked

at

that

shows

how

symmetrical

the

left

and

right

shoulders

are

as

shown

by

the

black

rectangle

that

measures

time

and

price

This

potential

HS

top

wont

be

complete

until

support

is

taken

out

around

the

area

where

the

neckline

and

the

top

rail

extension

line

come

into

play

Below

is

the

weekly

look

for

perspective

The

XJY

on

the

other

hand

has

been

straight

forward

in

its

impulse

move

to

the

downside

after

competing

the

backtest

to

the

year

and

a

half

bearish

rising

flag

formation

As

you

can

see

the

price

action

is

now

trading

slightly

below

the

initial

breakout

low

just

before

the

backtest

took

place

Below

is

a

little

more

detailed

look

at

the

XJY

chart

from

above

which

shows

the

backtest

to

the

bottom

rail

formed

a

bearish

rising

wedge

on

this

daily

bar

chart

with

the

day

moving

averaging

helping

with

resistance

The

XJY

has

actually

formed

one

of

the

biggest

consolidation

patterns

of

all

the

important

currencies

that

makeup

the

US

dollar

While

many

of

the

currencies

started

to

build

out

their

consolidation

patterns

starting

at

the

beginning

of

the

XJY

started

to

build

out

its

consolidation

pattern

in

the

middle

of

creating

a

three

year

symmetrical

triangle

The

bearish

rising

flag

we

just

looked

at

on

the

daily

chart

above

is

just

a

part

of

the

bigger

three

year

triangle

consolidation

pattern

with

its

bottom

rail

broken

simultaneously

with

the

bottom

rail

of

the

three

year

triangle

Looking

at

the

different

currencies

that

make

up

the

US

dollar

gives

you

a

more

accurate

picture

for

what

direction

the

US

dollar

is

likely

to

move

especially

in

the

intermediate

to

long

term

Posted

in

public

Weekend

Report

The

Post

Bubble

Contraction

Thesis

Receives

Validation

Part

III

Posted

on

September

pm

by

Plunger

In

the

last

two

reports

I

developed

the

thesis

that

we

are

in

the

early

stages

of

a

post

bubble

contraction

PBC

This

contraction

actually

began

in

and

is

now

reasserting

itself

in

the

form

of

a

global

liquidity

crisis

GLC

In

this

edition

I

show

how

this

thesis

just

received

mainstream

validation

and

its

now

time

to

begin

developing

an

investment

strategy

The

FED

and

central

banks

responded

to

the

crisis

by

lowering

rates

to

zero

or

less

and

injected

trillions

of

credit

into

the

system

Indeed

they

were

able

to

reinflate

the

precrisis

bubble

and

put

the

contraction

on

hold

but

only

at

the

price

of

corrupting

the

core

of

money

and

credit

itself

and

their

actions

exasperated

the

gap

between

the

haves

and

the

have

nots

QE

in

the

end

turned

out

simply

to

be

monetary

policy

for

the

rich

The

result

has

been

to

start

a

world

wide

populist

movement

causing

outside

political

contenders

to

win

elections

PBC

Thesis

gets

validated

Since

the

last

report

the

PBC

case

chronicled

here

received

validation

from

the

worlds

most

prominent

hedge

fund

manager

Ray

Dalio

Dalio

seems

to

have

had

a

bout

of

conscience

as

he

enters

the

twilight

of

a

very

successful

investment

career

He

just

completed

a

page

book

titled

A

Template

For

Understanding

Big

Debt

Crises

He

has

offered

the

entire

book

in

PDF

form

for

free

to

anyoneno

strings

attached

He

also

conducted

very

forthright

interviews

on

CNBC

and

Bloomberg

which

one

can

view

on

youtube

Why

would

Dalio

do

this

After

reading

the

book

and

watching

the

interviews

its

quite

evident

to

me

the

man

unequivocally

sees

a

train

wreck

coming

our

way

in

the

form

of

a

PBC

and

its

a

warning

to

all

of

us

No

doubt

he

will

be

able

able

to

navigate

the

waters

and

make

money

during

the

crisis

but

the

man

also

wants

to

be

able

to

sleep

at

night

knowing

he

warned

us

Thanks

Ray

you

are

a

good

man

Here

is

the

book

Big

Debt

Crisis

As

a

minimum

I

recommend

reading

the

first

chapter

up

to

page

I

imagine

most

of

you

will

get

hooked

after

that

and

keep

going

Also

dont

be

surprised

if

you

find

yourself

thinking

Hey

this

is

what

Plunger

has

been

talking

about

all

year

longValidation

What

is

Dalio

really

saying

Realize

who

this

guy

is

He

runs

the

biggest

hedge

fund

in

the

world

Bridgewater

Associates

He

cant

just

come

out

and

say

disaster

is

dead

ahead

Hence

he

says

this

bull

market

is

in

its

inning

and

likely

still

has

years

to

go

If

he

said

it

was

the

inning

he

would

suffer

redemptions

and

be

the

scourge

of

Wall

Street

He

would

be

like

Peter

Schiff

who

is

now

banned

from

CNBC

So

he

clearly

is

hedging

his

comments

but

its

my

suspicion

he

is

positioning

himself

for

the

downside

right

now

That

may

not

mean

shorting

but

he

may

be

using

this

recent

move

to

the

upside

to

exit

long

trades

I

know

you

are

going

to

read

at

least

the

first

chapter

for

yourself

but

below

are

a

few

salient

points

he

makes

You

may

notice

I

have

been

making

some

of

the

same

points

for

most

of

this

year

is

the

equivalent

of

A

bubble

was

followed

by

a

crash

The

FED

then

lowered

rates

to

zero

Todays

market

is

similar

to

the

market

of

Rising

rates

broke

the

market

ushering

in

a

recession

The

next

recession

will

have

fewer

stabilizers

as

monetary

policy

will

exhaust

quickly

In

normal

recessions

lowering

rates

is

enough

to

restart

the

economy

but

when

debt

reaches

todays

levels

its

not

enough

In

countries

with

a

reserve

currency

like

the

USA

a

debt

deflation

is

the

initial

outcome

NOT

an

inflationary

outcome

Initially

there

is

a

large

currency

devaluation

of

about

against

gold

Aggressive

money

printing

typically

begins

years

into

the

contraction

Prolonged

monetization

ultimately

leads

to

the

public

questioning

a

currencies

store

of

value

function

causing

a

flight

to

alternatives

such

as

gold

Ultimately

deploying

Helicopter

money

runs

the

risk

of

over

stimulation

and

may

lead

to

hyperinflation

Its

not

my

intention

to

rehash

the

entire

book

as

I

am

hoping

you

will

read

it

yourself

but

I

would

like

to

highlight

one

chart

in

particular

US

short

term

interest

rates

of

the

past

years

This

chart

really

drives

home

the

point

that

this

next

downturn

has

the

potential

to

be

catastrophic

The

reason

is

because

the

FED

has

already

shot

its

wad

by

bailing

out

the

system

over

the

past

years

He

points

out

that

recessions

are

cushioned

by

the

FED

lowering

rates

which

allow

the

debt

mountain

to

survive

due

to

debt

service

made

easier

But

look

how

long

the

work

out

took

in

the

Now

take

a

look

at

how

little

room

the

FED

has

to

maneuver

this

time

then

consider

how

much

more

debt

is

in

the

system

now

Think

of

how

in

lowering

rates

to

Zero

wasnt

enough

to

rescue

the

system

The

FED

had

to

inject

trillions

into

the

system

once

rates

hit

zero

Next

time

the

economy

is

destined

to

have

an

especially

hard

landing

which

translates

to

crashing

asset

prices

One

has

to

wonder

with

only

a

minuscule

amount

of

rate

reductions

available

this

time

what

is

going

to

keep

all

of

the

outstanding

debt

inflated

in

the

next

crisis

similar

to

I

have

shown

these

two

comparison

charts

before

as

they

are

instructive

The

bull

market

from

to

present

is

eerily

similar

to

the

bull

market

All

other

bull

markets

rise

on

increasing

volume

as

the

bull

gathers

steam

however

these

two

bull

markets

which

were

driven

by

government

stimulus

and

financial

engineering

rose

on

decreasing

volume

This

was

indicative

of

a

gradual

reduction

of

liquidity

in

the

market

When

the

end

came

the

lack

of

liquidity

led

to

a

violent

decline

of

over

the

following

months

ending

in

Note

how

liquidity

was

eventually

drained

from

the

market

through

waves

of

decreasing

volume

Once

the

top

was

in

the

market

lost

almost

in

one

year

Todays

bull

market

also

shows

waning

volume

over

its

entire

run

The

Bear

Market

Violent

selling

Contrast

the

above

bull

markets

with

a

healthy

robust

bull

in

the

Here

we

see

what

is

normal

growing

organic

growth

in

volume

as

the

bull

advances

Before

moving

onto

the

next

PBC

subject

of

commodities

I

would

like

to

mention

that

this

week

the

market

reconfirmed

that

it

was

still

in

a

bull

market

according

to

DOWs

Theory

The

industrials

went

on

to

a

new

all

time

high

within

days

of

the

Transports

doing

the

same

It

has

been

since

January

that

the

DOW

last

peaked

but

for

now

the

bull

has

been

reconfirmed

So

one

might

ask

why

is

Plunger

talking

about

an

upcoming

crisis

when

the

DOW

just

reaffirmed

an

intact

bull

market

Simple

because

its

coming

our

way

and

we

need

to

start

A

Big

Picture

View

of

Commodities

The

key

to

understanding

the

long

term

trend

of

commodities

is

hidden

in

the

currency

charts

Why

is

this

Because

currencies

ultimately

indicate

where

money

is

flowing

into

and

out

of

Rambus

produces

the

best

currency

charts

around

however

I

would

like

to

point

out

this

concept

using

my

own

chart

of

the

Aussie

dollar

The

Australian

Dollar

is

the

principle

commodity

currency

in

the

world

Since

the

Aussie

dollar

conducts

a

large

percent

of

its

foreign

trade

in

the

commodity

sector

it

reflects

commodity

based

money

flows

Nearby

China

consumes

upwards

of

of

some

commodity

categories

iron

ore

cement

etc

and

the

AUD

reflects

the

state

of

the

commodity

demand

The

Canadian

Dollar

is

also

tied

closely

to

commodities

but

it

is

not

as

pure

a

measure

because

of

its

proximity

to

the

USA

When

safe

haven

money

pours

into

the

USA

some

of

that

money

spills

over

into

Canada

so

its

not

as

pure

of

a

commodity

currency

as

the

AUD

is

This

is

an

amazing

chart

Keep

in

mind

you

are

looking

at

a

currency

and

NOT

commodities

themselves

But

it

tracks

the

long

term

trends

of

the

commodity

market

with

precision

What

it

appears

to

be

saying

now

is

that

the

AUD

is

now

finished

with

a

year

back

test

of

the

upward

sloping

trend

line

The

BT

was

actually

a

rising

wedge

formation

which

may

likely

be

a

half

way

measured

move

in

a

trek

to

a

PO

of

If

this

price

objective

is

met

it

means

commodities

are

headed

for

a

massive

violent

fall

What

could

possibly

cause

this

to

happen

A

PBC

in

the

form

of

a

GLC

would

explain

it

in

fact

its

the

perfect

prescription

for

such

an

event

Judging

from

the

AUDs

drop

already

it

doesnt

appear

we

have

those

two

more

years

to

go

that

Ray

Dalio

suggests

remain

Instead

it

appears

we

may

be

much

closer

to

the

end

Below

is

a

close

up

of

the

backtest

wedge

CRB

now

setting

up

for

a

downside

synchronous

move

So

the

Aussie

Dollar

serves

as

a

lead

indicator

for

commodities

and

the

money

flows

are

announcing

a

downside

move

has

already

started

We

have

seen

the

year

BT

move

in

the

AUD

has

now

given

way

to

a

downward

impulse

move

and

commodity

prices

have

now

begun

to

follow

In

the

below

chart

we

plot

the

AUD

gold

copper

oil

and

the

CRB

We

can

see

how

the

the

AUD

is

leading

the

move

while

oil

is

lagging

it

Note

how

the

secular

downtrend

began

in

for

the

group

and

they

were

all

in

a

sloppy

upside

bounce

for

years

from

That

bounce

now

seems

to

be

over

The

takeaway

is

that

the

entire

commodity

complex

has

now

embarked

on

the

next

cyclical

bear

market

within

the

context

of

its

long

term

secular

bear

Once

the

next

recession

arrives

this

trend

should

accelerate

The

decline

we

have

seen

so

far

is

just

the

beginning

of

this

trend

Liquidity

exiting

the

system

The

Global

Liquidity

Crisis

GLC

What

Ray

Dalios

book

should

make

clear

is

that

the

world

is

at

the

cusp

of

a

liquidity

crisis

When

the

crisis

arrives

bids

for

some

asset

classes

could

literally

be

removed

This

is

the

argument

for

commodity

prices

getting

smashed

which

we

will

cover

later

in

this

report

Developing

a

Strategy

for

the

PBC

It

appears

the

end

is

almost

nigh

Dalio

says

inning

Plunger

says

we

are

perhaps

in

the

bottom

of

the

inning

The

stock

markets

are

likely

in

the

final

topping

process

now

and

commodities

have

already

topped

No

one

knows

when

the

final

stock

market

top

gets

put

in

however

right

before

the

December

rate

hike

would

be

a

place

to

look

for

it

Here

is

what

we

do

know

typically

the

first

sectors

that

top

are

the

autos

and

housing

These

sectors

typically

top

at

the

end

of

the

economic

cycle

Both

of

these

sectors

now

appear

to

have

their

tops

behind

them

World

Autos

Broken

Down

Early

Stages

Home

Builders

Setting

Up

for

a

Drop

In

our

last

PBC

report

we

saw

how

markets

on

the

worlds

periphery

are

now

well

into

a

decline

It

can

only

be

a

matter

of

time

before

the

US

market

succumbs

to

these

forces

In

the

chart

below

we

see

a

clear

representation

of

how

the

USA

and

the

rest

of

the

world

are

diverging

How

long

can

this

continue

The

Final

Trigger

What

is

every

hedge

fund

manager

looking

at

as

the

final

bell

that

they

ring

at

the

top

They

are

watching

for

the

yield

curve

to

turn

up

as

the

final

trigger

to

exit

this

market

Its

their

get

to

the

chopper

indicator

It

hasnt

signaled

the

exit

yet

but

once

it

does

take

cover

When

it

turns

up

there

will

be

a

rush

towards

the

exits

Dont

get

trampled

trying

to

get

out

the

door

Look

for

a

breakout

above

a

base

Looks

to

me

the

base

is

in

its

final

stages

of

being

put

in

Once

the

trigger

gets

pulled

asset

classes

across

the

spectrum

will

be

bludgeoned

across

the

board

so

a

short

selling

strategy

would

be

appropriate

but

it

is

not

time

yet

We

need

to

wait

until

a

top

is

in

for

the

general

market

Commodities

however

have

already

topped

Shorting

the

commodity

sector

can

be

considered

an

asymmetric

trade

because

most

people

actually

think

commodities

are

in

a

bull

market

The

recent

commodity

rally

has

planted

recency

bias

in

most

investors

minds

they

still

think

they

are

in

the

midst

of

a

major

bull

market

and

we

are

simply

in

a

short

term

pull

back

Keep

in

mind

that

retail

investors

buy

of

the

way

into

a

new

bear

market

before

they

realize

their

mistake

Put

option

premiums

therefore

are

low

and

the

downside

remains

extensive

as

these

recent

investors

will

ultimately

get

flushed

out

Shorting

the

Major

Commodity

Producers

The

major

commodity

producers

are

deeply

cyclical

and

capital

intensive

companies

They

have

massive

swings

from

cycle

to

cycle

If

you

can

get

the

timing

right

one

can

make

huge

gains

If

you

get

it

wrong

you

get

crushed

If

this

analysis

is

correct

the

CRB

is

about

to

get

sliced

in

half

and

the

major

producers

should

get

crushed

once

again

Once

the

bear

market

is

over

these

producers

will

have

been

beaten

down

to

ridiculously

low

levels

providing

another

one

of

their

lifetime

opportunities

to

go

long

Lets

review

these

classic

companies

as

we

will

use

them

as

indicators

of

a

contraction

or

to

trade

them

once

a

decline

is

confirmed

then

go

long

once

the

future

bottom

is

in

Commodities

Long

Range

Picture

The

CRB

below

shows

the

super

long

view

I

interpret

the

action

since

as

a

bearish

rising

wedge

which

is

undergoing

a

back

test

to

the

year

support

zone

which

it

broke

in

Once

this

BT

is

complete

and

falls

through

the

lower

rising

support

line

of

the

wedge

the

fall

could

be

catastrophic

as

there

is

no

support

underneath

The

measured

move

projects

a

decline

in

the

price

of

commoditiestruely

shocking

A

closeup

view

of

the

year

back

testing

rising

wedge

shows

a

sickly

pathetic

bounce

in

commodities

over

the

past

years

This

is

a

flagging

formation

that

certainly

does

not

take

on

the

appearance

of

a

new

bull

market

Other

Commodity

Indexes

Confirm

the

same

Downtrend

We

have

reviewed

several

other

commodity

indexes

in

past

reports

and

they

all

confirm

this

same

thesis

irregardless

of

their

individual

compositions

Here

are

some

additional

indexes

GSG

IShares

Commodities

USCI

US

Commodity

Fund

Broken

Down

Industry

Dominating

Commodity

Producers

FCX

Dominant

in

world

copper

production

Deeply

cyclical

boom

and

bust

company

has

the

look

of

having

already

broken

down

Look

how

many

of

these

companies

have

taken

on

the

chart

pattern

which

crude

oil

built

out

from

prior

to

its

collapse

An

extended

tilted

rise

supported

by

a

SR

line

that

ultimately

gave

way

RIO

Tinto

Iron

Ore

and

base

metals

market

dominator

appears

to

be

putting

in

a

rolling

top

on

the

monthly

chart

It

has

fallen

out

of

its

steep

rising

channel

and

is

now

engaged

in

a

BT

to

the

rising

channel

RIOs

weekly

chart

shows

how

It

has

broken

through

its

HS

NL

and

is

now

flirting

with

a

declining

W

EMA

It

appears

to

be

early

on

in

the

process

of

breaking

down

The

daily

chart

confirms

its

in

a

topping

process

as

moving

averages

have

rolled

over

and

price

may

be

in

an

aggressive

back

test

to

the

NL

BHP

Worlds

Biggest

Mining

Company

Although

its

uptrend

is

still

intact

it

may

be

running

out

of

steam

Watch

closely

for

a

break

below

its

trend

line

and

M

EMA

to

signal

a

more

bearish

view

Until

then

it

has

done

nothing

wrong

Glencore

Oil

and

exotic

metals

This

is

an

innovative

company

willing

to

do

things

and

go

where

others

refuse

to

go

DNC

cobalt

is

a

big

product

for

this

company

This

chart

looks

to

have

clearly

peaked

It

is

famous

for

wild

swings

Anglo

American

Precious

metals

wrap

up

This

company

does

it

all

gold

diamonds

PGM

group

metals

coal

iron

ore

copper

The

company

has

world

wide

operations

Their

PGM

output

is

close

to

of

world

production

so

this

company

is

very

sensitive

to

autos

and

world

economic

growth

It

is

the

one

to

watch

as

an

indicator

of

the

health

of

world

economies

and

is

famous

for

its

huge

percentage

moves

both

up

and

down

Presently

the

monthly

chart

appears

to

be

hanging

on

but

only

by

its

finger

nails

TECK

Resources

Large

Canadian

broad

resource

company

appears

to

be

in

its

final

stages

prior

to

a

industry

break

down

The

weekly

shows

it

may

be

in

the

process

of

rolling

over

SCCO

Chilean

Massive

Copper

Producer

has

now

broken

down

and

is

no

longer

in

a

bull

market

SQM

Lithium

Production

Bull

Flag

or

Bear

Flag

It

is

struggling

to

stay

above

its

M

EMA

We

will

see

if

the

Lithium

boom

is

over

Conclusion

The

message

of

these

charts

is

that

across

the

spectrum

the

commodity

sector

seems

to

have

flamed

out

but

its

early

in

a

downtrend

In

the

short

term

it

is

currently

bouncing

higher

in

a

retracement

to

its

recent

breakdown

The

two

year

commodity

rally

got

everyones

juices

flowing

and

claims

of

a

long

term

commodity

bull

market

were

pronounced

from

every

mountain

top

The

consensus

continues

to

be

a

long

term

bull

market

lies

ahead

b

ut

the

charts

are

pointing

in

the

opposite

direction

In

fact

they

seem

to

be

validating

the

PBC

thesis

which

is

just

now

reasserting

itself

after

laying

dormant

for

the

past

years

as

the

FED

and

central

banks

aggressively

intervened

As

the

GLC

asserts

itself

liquidity

will

be

removed

from

markets

and

prices

could

experience

a

violent

bear

market

similar

to

what

occurred

in

This

helps

explain

how

the

CRB

index

could

literally

be

cut

in

half

in

a

short

period

of

time

It

seems

the

nonconsensus

big

money

bet

will

be

to

position

oneself

for

the

downside

In

the

meantime

we

have

a

model

from

which

to

view

the

process

from

It

has

already

began

at

the

periphery

of

the

worlds

economy

and

is

now

moving

towards

the

major

markets

of

the

world

Meanwhile

safe

haven

money

moves

towards

the

core

resulting

in

the

USA

hitting

new

highs

Yesterday

another

domino

dropped

in

India

The

clock

is

ticking

Addendum

Uranium

Update

Uranium

stocks

have

performed

quite

well

lately

having

rocketed

off

their

well

formed

bottoms

as

of

late

Many

of

us

find

themselves

planted

well

on

the

sidelines

looking

in

afraid

to

touch

this

sector

because

it

has

burned

so

many

in

the

past

Here

are

my

thoughts

for

this

group

We

dont

know

yet

if

this

is

the

start

of

an

actual

sustained

bull

market

but

each

day

it

does

take

on

the

appearance

of

one

We

will

need

more

backing

and

filling

to

know

for

sure

But

the

big

gains

come

from

those

who

get

in

early

This

is

what

occurred

in

the

previous

bull

market

which

began

in

the

early

If

one

missed

the

first

year

he

missed

the

big

percentage

gains

Keep

in

mind

this

sector

underwent

a

collapse

of

its

industry

market

cap

so

it

has

been

well

beaten

down

and

even

though

the

I

have

mentioned

several

times

before

that

the

uranium

sector

offers

us

the

best

risk

reward

proposition

of

anything

in

my

lifetime

for

long

term

investors

So

here

is

a

nugget

of

insight

I

offer

seasonality

No

guarantee

however

starting

in

October

the

wind

will

be

at

your

back

for

uranium

plays

Rarely

have

I

ever

seen

such

a

biased

time

zone

to

be

in

a

market

sector

than

what

lies

ahead

over

the

next

two

months

Virtually

most

of

the

gains

are

registered

in

the

months

of

October

and

November

Editors

Note

Plunger

is

Rambus

Chartologys

Resident

market

Historian

His

work

is

published

exclusively

at

O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O 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Neuroleptic

Malignant

Syndrome

Rare

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Database

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Neuroleptic

Malignant

Syndrome

Synonyms

of

Neuroleptic

Malignant

Syndrome

DrugInduced

Movement

Disorder

Hyperthermia

NeurolepticInduced

Acute

Dystonia

General

Discussion

Neuroleptic

malignant

syndrome

is

a

rare

but

potentially

lifethreatening

reaction

to

the

use

of

almost

any

of

a

group

of

antipsychotic

drugs

or

major

tranquilizers

neuroleptics

These

drugs

are

commonly

prescribed

for

the

treatment

of

schizophrenia

and

other

neurological

mental

or

emotional

disorders

Several

of

the

more

commonly

prescribed

neuroleptics

include

thioridazine

haloperidol

chlorpromazine

fluphenazine

and

perphenazine

The

syndrome

is

characterized

by

high

fever

stiffness

of

the

muscles

altered

mental

status

paranoid

behavior

and

autonomic

dysfunction

Autonomic

dysfunction

alludes

to

defective

operations

of

the

components

of

the

involuntary

autonomic

nervous

system

leading

to

wide

swings

of

blood

pressure

excessive

sweating

and

excessive

secretion

of

saliva

A

genetic

basis

for

the

disorder

is

suspected

but

not

proven

It

does

appear

to

be

clear

that

a

defect

in

the

receptors

to

dopamine

dopamine

receptor

antagonism

is

an

important

contributor

to

the

cause

of

neuroleptic

malignant

syndrome

Signs

Symptoms

Symptoms

of

neuroleptic

malignant

syndrome

usually

include

very

high

fever

to

degrees

F

irregular

pulse

accelerated

heartbeat

tachycardia

increased

rate

of

respiration

tachypnea

muscle

rigidity

altered

mental

status

autonomic

nervous

system

dysfunction

resulting

in

high

or

low

blood

pressure

profuse

perspiration

and

excessive

sweating

Other

symptoms

may

include

liver

or

kidney

failure

abnormally

high

potassium

levels

hyperkalemia

major

destruction

of

skeletal

muscle

tissue

rhabdomyolysis

or

blood

clots

in

veins

and

arteries

Causes

Neuroleptic

malignant

syndrome

comes

about

most

likely

as

a

result

of

dopamine

receptor

antagonism

Dopamine

is

a

chemical

substance

neurotransmitter

found

in

the

brain

and

elsewhere

in

the

central

nervous

system

that

acts

to

convey

messages

from

one

cell

to

another

In

some

way

the

use

of

a

particular

drug

blocks

the

receptor

in

the

brain

cell

for

dopamine

When

the

dopamine

receptors

in

the

hypothalamus

or

another

bundle

of

nerve

fibers

nigrostriatal

pathways

andor

the

spinal

cord

are

blocked

increased

muscle

rigidity

is

the

result

The

interference

with

the

dopamine

receptors

in

the

hypothalamus

is

also

probably

responsible

for

high

body

temperature

as

well

as

the

swings

in

blood

pressure

Some

clinicians

believe

that

neuroleptic

malignant

syndrome

may

be

related

to

malignant

hyperthermia

a

genetic

disorder

characterized

by

an

abnormal

reaction

to

anesthesia

drugs

See

related

disorders

section

for

more

information

about

malignant

hyperthermia

Affected

Populations

Neuroleptic

malignant

syndrome

may

affect

any

person

taking

neuroleptic

drugs

Men

appear

to

be

at

higher

risk

than

women

Some

clinicians

believe

that

the

stronger

neuroleptic

medications

are

more

likely

to

precipitate

an

attack

of

NMS

Although

twothirds

of

cases

are

thought

to

occur

within

the

first

week

of

start

of

treatment

the

syndrome

may

begin

at

any

time

during

treatment

Recurrence

of

an

attack

of

NMS

is

not

uncommon

The

risk

of

recurrence

is

closely

related

to

the

time

elapsed

between

the

end

of

the

original

episode

of

neuroleptic

malignant

syndrome

and

the

beginning

of

renewed

administration

of

an

antipsychotic

drug

If

the

waiting

period

is

two

weeks

or

less

about

will

have

a

recurrence

If

the

waiting

period

is

more

than

two

weeks

the

percentage

of

patients

experiencing

a

relapse

drops

to

about

Related

Disorders

Symptoms

of

the

following

disorders

can

be

similar

to

those

of

neuroleptic

malignant

syndrome

Comparisons

may

be

useful

for

a

differential

diagnosis

Anaphylaxis

is

an

abnormally

severe

allergic

reaction

to

a

substance

Major

symptoms

may

include

severe

itching

hives

flushing

swelling

vomiting

diarrhea

difficulty

breathing

and

unconsciousness

High

fever

is

not

a

symptom

of

this

disorder

For

more

information

on

this

disorder

choose

Anaphylaxis

as

your

search

term

in

the

Rare

Disease

Database

Lethal

catatonia

is

a

condition

similar

to

NMS

and

not

infrequently

confused

with

it

A

detailed

history

may

indicate

that

the

patient

has

endured

catatonic

states

while

not

on

neuroleptic

medications

If

so

the

chances

are

that

the

presenting

syndrome

is

NMS

A

lethal

catatonia

patient

will

respond

to

the

administration

of

neuroleptics

It

is

however

almost

impossible

to

predict

whether

the

patients

symptoms

will

worsen

or

improve

Patients

with

lethal

catatonia

almost

invariably

endure

a

period

of

agitation

and

excitement

prior

to

the

catatonia

This

is

in

contrast

to

the

patient

with

NMS

in

which

the

first

symptom

is

Heat

stroke

is

a

very

serious

condition

characterized

by

an

abrupt

and

rapid

increase

in

body

temperature

that

may

reach

as

high

as

to

degrees

F

Heat

stroke

usually

results

from

exposure

to

an

extremely

hot

environment

The

skin

may

become

hot

flushed

and

dry

Rapid

loss

of

fluids

may

result

in

the

inability

to

sweat

Sweating

is

necessary

to

cool

the

body

There

may

also

be

an

increase

in

pulse

rate

and

respiration

The

affected

individual

may

become

disoriented

and

eventually

experience

convulsions

or

slip

into

unconsciousness

Measures

such

as

wrapping

the

individual

in

cold

wet

sheets

Malignant

hyperthermia

is

a

genetic

disorder

characterized

by

an

abnormal

response

to

muscle

relaxants

and

general

anesthesia

drugs

Symptoms

of

Malignant

Hyperthermia

are

apparent

only

after

the

patient

has

been

placed

under

general

anesthesia

Along

with

rapidly

elevating

body

temperature

that

may

rise

as

high

as

degrees

muscle

rigidity

andor

muscle

twitching

occurs

The

patient

may

also

exhibit

a

very

rapid

and

irregular

heartbeat

abnormally

low

blood

pressure

sickly

sweet

breath

headache

nausea

and

vomiting

It

is

not

known

whether

neuroleptic

malignant

hyperthermia

is

a

variant

form

of

Malignant

Hyperthermia

but

some

researchers

have

suggested

that

these

disorders

may

The

serotonin

syndrome

mimics

neuroleptic

malignant

hyperthermia

If

the

use

of

selective

serotonin

reuptake

inhibitors

SSRIs

results

in

symptoms

such

as

altered

mental

state

autonomic

dysfunction

see

above

and

neuromuscular

defects

then

the

condition

is

likely

to

be

serotonin

syndrome

Since

SSRIs

are

being

used

in

increasing

amounts

it

is

not

unreasonable

to

expect

that

the

incidence

of

serotonin

syndrome

will

increase

as

well

The

serotonin

syndrome

may

be

distinguished

from

NMS

in

most

cases

by

a

detailed

history

in

which

any

changes

in

medication

andor

dosages

are

clarified

In

addition

serotonin

syndrome

usually

is

not

accompanied

by

severe

muscle

The

following

disorder

may

be

associated

with

the

extended

use

of

neuroleptic

drugs

It

is

not

necessary

for

a

differential

diagnosis

Tardive

dyskinesia

is

a

disorder

that

results

from

the

longterm

use

of

neuroleptic

drugs

and

is

characterized

by

involuntary

and

abnormal

movements

of

the

jaw

lips

and

tongue

Typical

symptoms

include

grimacing

sticking

out

the

tongue

and

sucking

or

fishlike

movements

of

the

mouth

A

high

percentage

of

schizophrenic

people

who

have

spent

long

periods

of

time

in

mental

hospitals

taking

neuroleptic

drugs

have

a

high

risk

of

developing

tardive

dyskinesia

For

more

information

on

this

disorder

choose

tardive

dyskinesia

for

your

search

term

in

the

Rare

Disease

Database

Diagnosis

The

diagnosis

of

neuroleptic

malignant

syndrome

is

based

on

the

presence

of

characteristics

that

include

treatment

with

neuroleptic

drugs

within

the

past

weeks

high

body

temperature

greater

than

degrees

centigrade

muscle

rigidity

and

at

least

five

of

the

following

Change

in

mental

status

Rapid

heart

beat

tachycardia

Low

or

high

blood

pressure

hypo

or

hypertension

Excessive

sweating

diaphoresis

Excessive

saliva

production

sialorrhea

Tremor

Incontinence

Increased

creatine

phosphokinase

or

increased

urinary

myoglobin

Increased

number

of

white

blood

cells

leukocytosis

Increased

concentrations

of

metabolic

acids

in

blood

and

urine

Exclusion

of

other

druginduced

psychiatric

or

systemic

illness

Standard

Therapies

Treatment

Treatment

of

neuroleptic

malignant

syndrome

consists

of

withdrawal

of

neuroleptic

medications

under

a

doctors

supervision

immediate

measures

to

restore

appropriate

water

and

nutrient

levels

and

steps

to

lower

the

individuals

body

temperature

Medications

prescribed

as

treatment

may

include

skeletal

muscle

relaxants

such

as

dantrolene

stimulators

of

dopamine

production

and

activity

such

as

bromocriptine

andor

continuous

perfusion

of

central

nervous

system

depressants

such

as

diazepam

Complications

that

may

result

from

neuroleptic

malignant

syndrome

such

as

kidney

renal

insufficiency

deficiency

of

oxygen

reaching

the

tissues

hypoxia

andor

decreased

alkalinity

of

the

blood

and

tissues

acidosis

can

be

extremely

serious

and

must

be

treated

immediately

Once

patients

have

recovered

from

neuroleptic

malignant

syndrome

about

will

be

able

to

tolerate

an

antipsychotic

at

some

point

in

the

future

Physicians

usually

switch

to

a

different

antipsychotic

class

and

to

an

atypical

antipsychotic

Such

patients

must

be

carefully

monitored

since

recurrences

of

neuroleptic

malignant

syndrome

are

not

infrequent

Electroconvulsive

treatments

have

been

prescribed

for

patients

with

neuroleptic

malignant

syndrome

with

varied

results

Investigational

Therapies

Information

on

current

clinical

trials

is

posted

on

the

Internet

at

wwwclinicaltrialsgov

All

studies

receiving

US

government

funding

and

some

supported

by

private

industry

are

posted

on

this

government

website

For

information

about

clinical

trials

being

conducted

at

the

National

Institutes

of

Health

NIH

in

Bethesda

MD

contact

the

NIH

Patient

Recruitment

Office

Tollfree

TTY

Email

prplccnihgov

For

information

about

clinical

trials

sponsored

by

private

sources

contact

wwwcenterwatchcom

Supporting

Organizations

Malignant

Hyperthermia

Association

of

the

United

States

North

Main

St

PO

Box

Sherburne

NY

USA

Phone

Email

infomhausorg

Website

httpwwwmhausorg

MedicAlert

Foundation

International

Colorado

Avenue

Turlock

CA

USA

Phone

Tollfree

Email

Inquiriesmedicalertorg

Website

httpwwwmedicalertorg

Mental

Health

America

N

Beauregard

Street

Floor

Alexandria

VA

USA

Phone

Tollfree

Email

infoctrmentalhealthamericanet

Website

httpwwwmentalhealthamericanet

National

Alliance

on

Mental

Illness

N

Fairfax

Drive

Suite

Arlington

VA

Phone

Tollfree

Email

membershipnamiorg

Website

httpwwwnamiorg

National

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