Knowledge, attitude, and practice (KAP) Study on Serotonin Syndrome Among Neuro Physicians

Prakash, Sanjay; Rathore, Chaturbhuj; Rana, Kaushik

doi:10.4103/aian.aian_603_19

Cited by 11 publications

(9 citation statements)

References 11 publications

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“…SS is very much underdiagnosed mainly because it is not caused by only one type or even class of drugs, and the overlap of its symptoms with many neurological and general conditions [ Figure 1 ] and the range of its symptoms make diagnosis difficult, especially in the absence of proper history of medication or substance use. [ 19 ]…”

Section: Results Of Literature Searchmentioning

confidence: 99%

“…The state of knowledge about drugs linked to SS or drugs used in the management of SS was much the same. [ 19 ] The study pointed out that even neurophysicians lacked awareness of the seven main clinical features of the “Hunter’s criteria,” namely agitation, tremor, fever, diaphoresis, clonus (spontaneous, induced, or ocular), hyperreflexia, and hypertonia or rigidity. [ 19 ]…”

Section: Results Of Literature Searchmentioning

confidence: 99%

“…Clonus is one of the most important clinical signs of SS; however, most physicians do not even consider clonus while examining a patient presenting with psychological or neurological symptoms. [ 19 , 39 ] There is a need to apprise physicians of all Hunter’s criteria and most importantly the diagnostic value of clonus.…”

Section: Results Of Literature Searchmentioning

confidence: 99%

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Serotonin syndrome: An often-neglected medical emergency

Badar

2024

Journal of Family and Community Medicine

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Optimum serotonin level in the serotonergic synapses of the central nervous system (CNS) is related to mood, behavior, and sleep. Serotonin syndrome (SS) is a rare yet very dangerous adverse effect resulting from increased serotonin in CNS. The diagnosis of SS is based on the presence of clinical symptoms, which can include agitation, confusion, rapid heart rate, high blood pressure, dilated pupils, muscle rigidity, tremors, sweating, and diarrhea. SS is invariably caused by inadvertent use of serotonergic medicines. There is an ever-growing list of medicines that are associated with the risk of SS. Some of the common classes of drugs that can contribute to the development of SS include selective serotonin reuptake inhibitors, serotonin–norepinephrine reuptake inhibitors, monoamine oxidase inhibitors, tricyclic antidepressants, stimulants (e.g., amphetamines and cocaine), lithium, opioids, drugs used for recreational purposes like ecstasy Methylenedioxymethamphetamine (MDMA), and some herbal supplements (e.g., St. John’s Wort). SS can occur when these medications are taken alone or in combination, especially when a new medication is added, or the dose of an existing medication is changed. The management of SS typically involves discontinuing the use of the substance that caused the excess serotonin levels and providing supportive care, such as intravenous fluids and electrolytes. In severe cases, benzodiazepines may be used to control agitation and muscle rigidity, while serotonin antagonists, such as cyproheptadine, may be used to reduce serotonin levels. The literature review points to a general unawareness among physicians about the condition or drugs associated with it. Consequently, this potentially fatal condition is overlooked. There is a need for regular information updates and reminders to all those who prescribe medications to the patients.

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Section: Results Of Literature Searchmentioning

confidence: 99%

Section: Results Of Literature Searchmentioning

confidence: 99%

Section: Results Of Literature Searchmentioning

confidence: 99%

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Serotonin syndrome: An often-neglected medical emergency

Badar

2024

Journal of Family and Community Medicine

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“…Even today, many practitioners are still unaware of SS. Just 31% of neurologists and 17% of psychiatrists were familiar with the Hunter criteria for SS in two different surveys[ 28 , 29 ]. Merely 11% of psychiatrists and 17% of neurologists recognized that clonus is one of the most distinctive characteristics of SS.…”

Section: Introductionmentioning

confidence: 99%

“…There have also been reports of SS by food and herbal products[ 1 , 30 , 31 ]. The serotonergic properties of several medications are not known to physicians[ 28 , 29 ]. Despite the lack of rigorously established efficacy, cyproheptadine remains the recommended therapy for SS[ 1 ].…”

Section: Introductionmentioning

confidence: 99%

Serotonin syndrome controversies: A need for consensus

Prakash,

Shah,

Prakash

2024

World J Crit Care Med

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Serotonin syndrome (SS) is a drug-induced clinical syndrome resulting from increased serotonergic activity in the central nervous system. Although more than seven decades have passed since the first description of SS, it is still an enigma in terms of terminology, clinical features, etiology, pathophysiology, diagnostic criteria, and therapeutic measures. The majority of SS cases have previously been reported by toxicology or psychiatry centers, particularly in people with mental illness. However, serotonergic medications are used for a variety of conditions other than mental illness. Serotonergic properties have been discovered in several new drugs, including over-the-counter medications. These days, cases are reported in non-toxicology centers, such as perioperative settings, neurology clinics, cardiology settings, gynecology settings, and pediatric clinics. Overdoses or poisonings of serotonergic agents constituted the majority of the cases observed in toxicology or psychiatry centers. Overdose or poisoning of serotonergic drugs is uncommon in other clinical settings. Patients may develop SS at therapeutic dosages. Moreover, these patients may continue to use serotonergic medications even if they develop mild to moderate SS due to several reasons. Thus, the clinical presentation (onset, severity, and clinical features) in such instances may not exactly match what toxicologists or psychiatrists observe in their respective settings. They produce considerable diversity in many aspects of SS. However, other experts discount these new developments in SS. Since SS is a potentially lethal illness, consensus is required on several concerns related to SS.

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