Neuroleptic malignant syndrome

Adnet, P.; Lestavel, P.; Krivosic-Horber, R

doi:10.1093/bja/85.1.129

Cited by 257 publications

(267 citation statements)

References 47 publications

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“…The underlying neuropsychiatric diagnoses are typically schizophrenia and affective disorders, but NMS also occurs among patients with other conditions for which AP are used, including dementia, delirium, other psychoses, mental retardation, and Parkinson's disease 3,4,29 . Also, as the majority of cases will eventually require the use of AP to control their underlying psychiatric disorder, the safest approach for prevention of recurrence is the use of slowly titrated lower potency agents 30 . In the series presented here, two thirds of all cases involved women with a past medical history of either psychiatric disorder and, less commonly, dementia, receiving relatively high doses of both classic and newer AP.…”

Section: Discussionmentioning

confidence: 99%

Neuroleptic malignant syndrome

Moscovich

Novak

Fernandes

et al. 2011

Arq. Neuro-Psiquiatr.

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Neuroleptic malignant syndrome (NMS) is a potentially fatal adverse event associated with the use of antipsychotics (AP). The objective of this study was to investigate the profile of cases of NMS and to compare our findings with those published in similar settings. A series of 18 consecutive patients with an established diagnosis of NMS was analyzed, gathering data on demography, symptoms and signs. Two thirds of all cases involved woman with a past medical history of psychiatric disorder receiving relatively high doses of AP. The signs and symptoms of NMS episodes were similar to those reported in other series and only one case had a fatal outcome, the remaining presenting complete recovery. As expected, more than two thirds of our cases were using classic AP (68%), however the clinical profile of these in comparison with those taking newer agent was similar. Newer AP also carry the potential for NMS. Key words: atypical antipsychotics, typical antipsychotics, neuroleptic malignant syndrome.Síndrome neuroléptica maligna RESUMO A síndrome neuroléptica maligna (SNM) é um evento adverso potencialmente fatal associado ao uso de antipsicóticos (AP). O objetivo deste estudo foi investigar as características clínicas de cases da SNM e comparar nossos resultados com os publicados na literatura. Uma série de 18 pacientes com diagnóstico confirmado de SNM foram analisados, associando dados demográficos, apresentação clínica, diagnóstico e tratamento. Dois terços dos casos envolveram mulheres com antecedentes psiquiátricos que recebeceram doses relativamente altas de AP. Os sinais e sintomas foram semelhantes àqueles já relatados na literatura e a maioria dos pacientes teve uma recuperação completa, exceto por um caso com desfecho fatal. Houve predomínio de pacientes que usam medicamentos neurolépticos clássicos (68%), porém não houve diferença nas manifestações destes casos em relação àqueles que usavam AP novos. AP mais novos também têm o potencial de causar SNM. Palavras-Chave: neurolépticos atípicos, neurolépticos típicos, síndrome neuroléptica maligna.

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Section: Discussionmentioning

confidence: 99%

Neuroleptic malignant syndrome

Moscovich

Novak

Fernandes

et al. 2011

Arq. Neuro-Psiquiatr.

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“…Intubation and paralysis may be required in the patient with intractable hyperthermia. Patients who succumb from NMS typically die from complications of extreme hyperthermia including rhabdomyolysis, acute tubular necrosis, and complications of renal failure, dysrhythmias, and cardiovascular collapse secondary to intractable metabolic acidosis [36][37][38]. Renal failure has been associated with a mortality rate of 50% [38].…”

Section: How Should Amantadine Withdrawal or Nms Be Treated?mentioning

confidence: 99%

“…Patients who succumb from NMS typically die from complications of extreme hyperthermia including rhabdomyolysis, acute tubular necrosis, and complications of renal failure, dysrhythmias, and cardiovascular collapse secondary to intractable metabolic acidosis [36][37][38]. Renal failure has been associated with a mortality rate of 50% [38]. Patients with suspected NMS should have screening laboratory analyses including complete blood count, serum chemistries, CPK, lactic acid, arterial or venous blood gas to establish pH, a coagulation profile, and an electrocardiogram.…”

Section: How Should Amantadine Withdrawal or Nms Be Treated?mentioning

confidence: 99%

Case files of the Program in Medical Toxicology at Brown University: Amantadine withdrawal and the neuroleptic malignant syndrome

Brantley¹,

Cohn²,

Babu³

2009

J. Med. Toxicol.

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A sixty-one-year old woman with a history of depression and idiopathic dystonia presented to the emergency department (ED) with fever, nausea, muscle rigidity, and redness in her extremities. The patient had seen various specialists for her dystonia during the preceding year and had tried multiple medication regimens, including benztropine and tizanidine. The patient described her home medications as tizanidine 2 mg three times daily, diazepam 2.5 mg daily, escitalopram 100 mg daily, rosuvastatin 10 mg daily and bupropion 300 mg nightly.At ED presentation her vital signs were: temperature 37.5°C (99.5F), blood pressure 157/76 mmHg, heart rate 105 beats per minute, respirations 24 per minute, and oxygen saturation of 100% on room air. Her physical examination was significant for diaphoresis, tachycardia, diffuse flushing, tremors in her upper and lower extremities, muscle rigidity, and hyperreflexia in the upper and lower extremities. The tremors were low amplitude and worse with intention, while the rigidity had cogwheeling features and was more notable in her lower extremities. Initial laboratory evaluation was significant for a creatine phosphokinase (CPK) of 1146 IU/L. Her electrocardiogram showed sinus tachycardia with normal QRS and QT intervals, and no evidence of acute ischemia.Two months earlier, the patient's neurologist had started her on amantadine 100 mg twice daily for dystonia. Three days prior to ED presentation, the patient abruptly stopped taking her amantadine on the advice of a pharmacist, secondary to bilateral lowerextremity edema. The following day, the patient presented to her primary care physician complaining of nausea, tremors, and diffuse flushing. The physician treated her for an allergic reaction with oral steroids and diphenhydramine. The patient's symptoms worsened over the next day with increasing tremors and rigidity, low-grade fever, nausea, and flushing, which prompted her presentation to the ED.

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“…Many reported cases are associated with haloperidol or the depot antipsychotic fluphenazine (Modecate), probably reflecting their frequent use. 4,9 Atypical antipsychotics may be less likely to cause NMS than conventional antipsychotics due to their weaker dopamine-blocking effects. 6 However, there have been over 25 published cases of clozapine-induced NMS and also reports associated with risperidone (Risperdal), olanzapine (Zyprexa) and quetiapine (Seroquel).…”

Section: Incidencementioning

confidence: 99%

“…3 However, many features of NMS remain controversial as there is no graded scale for signs and symptoms and no recognised spectrum of severity. 4 …”

mentioning

confidence: 99%