Clomipramine induced neuroleptic malignant syndrome and pyrexia of unknown origin

Haddow, Alison; Harris, Dawn; Wilson, Martin; Logie, Hannah

doi:10.1136/bmj.329.7478.1333

Cited by 22 publications

(13 citation statements)

References 17 publications

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“…It is one of the serious side effects of SSRI. Patients who have a similar presentation makes it difficult to be distinguished from NMS 66. Milestones that characterize serotonin syndrome are shivering, hyperreflexia, myoclonus, and ataxia 67,68.…”

Section: Clinical Features Of the Neuroleptic Syndromementioning

confidence: 99%

Neuroleptic malignant syndrome: an easily overlooked neurologic emergency

Oruch¹,

Pryme²,

Engelsen³

et al. 2017

NDT

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Neuroleptic malignant syndrome is an unpredictable iatrogenic neurologic emergency condition, mainly arising as an idiosyncratic reaction to antipsychotic agent use. It is characterized by distinctive clinical features including a change in mental status, generalized rigidity, hyperpyrexia, and dysautonomia. It can be lethal if not diagnosed and treated properly. Mortality and morbidity attributed to this syndrome have recently declined markedly due to greater awareness, earlier diagnosis, and intensive care intervention. In most cases, the syndrome occurs as a result of a rapid increase in a dose of neuroleptic, especially one of the long-acting ones. Pathophysiology behind this syndrome is attributed to a dopamine receptor blockade inside the neurons rendered by the offending drug and excessive calcium release from the sarcoplasmic reticulum of skeletal myocytes. Laboratory tests, although not diagnostic, may assist in assessing the severity of the syndrome and also the consequent complications. The syndrome has been described in all age groups and occurs more in males than in females. Genetics appears to be central regarding the etiology of the syndrome. Stopping the use of the offending agent, cold intravenous fluids, and removal of the causative agent and its possible active metabolites is the cornerstone of treatment. Periodic observation of psychotic patients recently started on antipsychotic medications, especially those being treated with depot preparations, may aid to an early diagnosis of the syndrome and lead to early treatment.

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Section: Clinical Features Of the Neuroleptic Syndromementioning

confidence: 99%

Neuroleptic malignant syndrome: an easily overlooked neurologic emergency

Oruch¹,

Pryme²,

Engelsen³

et al. 2017

NDT

View full text Add to dashboard Cite

show abstract

“…Concomitant use of lithium, other psychotropic drugs, higher potency agents, depot formulations, comorbid substance abuse or neurologic disease, and acute medical illness (including trauma, surgery, and infection) are other commonly listed risk factors that have not been substantiated in casecontrol studies [36,37]. Dehydration present in 92% of patients is a risk factor for NMS as well as an early complication of NMS, but this is not clear [38].…”

Section: Discussionmentioning

confidence: 99%

Neuroleptic malignant syndrome in trauma patient

Gragnani

Cezillo

Oliveira

et al. 2015

Burns

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“…So if mild cases are going undetected that is a semantic issue (serotonergic side effects vs mild ST) of minor consequence, not a major concern about serious or life-threatening adverse events. The main lesson is the same as in Haddow's much criticized report 18 : side effects are more common and less typical in the aged, so minimize the administration of above average doses to the frail elderly. …”

Section: Misleading Casesmentioning

confidence: 99%

Misleading Cases

Gillman

2005

Journal of the American Medical Directors Association

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Clomipramine induced neuroleptic malignant syndrome and pyrexia of unknown origin

Cited by 22 publications

References 17 publications

Neuroleptic malignant syndrome: an easily overlooked neurologic emergency

Neuroleptic malignant syndrome: an easily overlooked neurologic emergency

Neuroleptic malignant syndrome in trauma patient

Misleading Cases

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