Neuroleptic Malignant Syndrome during a Change from Haloperidol to Risperidone

Abstract

Clinicians should closely monitor patients receiving both haloperidol and risperidone or combinations of similar medications.

Atypical Neuroleptic Malignant Syndrome Associated with Use of Clozapine

“…The two pathogenic mechanisms are as follows: the first mechanism is reduction of dopaminergic signals as a result of acute withdrawal or withdrawal of dopaminergic agents [6]; the other mechanism is by blocking the dopamine signal with the use of medications such as metoclopramide and neuroleptics [8]. The increase in epinephrine and serotonin contributes to the alteration in the transmission of dopamine [9], contributing to hyperthermia and rigidity [6].…”

“…NMS is an uncommon and lethal neurological disorder [19], attributed to the administration of typical antipsychotics [2, 6, 8, 20, 21] and less commonly to the atypical antipsychotics, like clozapine [5], which has a direct dopaminergic effect but in less proportion than typical antipsychotics especially in D2 receptors. However, clozapine has an effect over serotoninergic pathways that stimulate the 5-HT 1A receptor (5-hydroxytryptamine) causing recirculation of gamma amino butyric acid in the nucleus accumbens leading to the inhibition of the dopaminergic neurons [22], related to the development of the disease.…”

Biological Perspectives

“…A l l these people should be taught about the four overarching signs and symptoms of NMS (see Table 2) and the importance of taking/administering antipsychotic medications as in-structed. Dosage increases that are excessive, sudden, or due to patient-clinician miscommunication have led to NM!3 (Reeves et al, 2001(Reeves et al, ,2002. These authors illustrate miscommunication with a case in which, after initiation of a haloperidol-to-risperidone switch, the patient continued to take haloperidol from an old bottle, developed a severe case of NMS, and was hospitalized for more than 2 months.…”

“…Although uncommon, NMS may be fatal if left untreated. Estimates of the incidence of NMS range from 0.5% to 2.4"/0, and the mortality rate may be as high as 20% in those who are not treated (Reeves, Mack, & Torres, 2001). Persing (1994) identified four cardinal symptoms of NMS: hyperthermia, muscle rigidity, mental status changes, and autonomic instability.…”

Ein Quetiapin-assoziiertes malignes Neuroleptika-Syndrom mit letalem Ausgang bei einem Patienten mit wahrscheinlicher Alzheimer Demenz

“…Unter Mirtazapin, Haloperidol und Risperidon wurde ein malignes neuroleptisches Syndrom beschrieben. Die Autoren sahen in der zentralen α 2 -adrenergen Blockade mit in Folge erhöhter noradrenerger Aktivität einen möglichen pathophysiologischen Mechanismus für Mirtazapin [10]. Bei einem Olanzapin-induzierten malignen neuroleptischen Syndrom mit letalem Ausgang wurde die Multimorbidität (Diabetes, COPD, arterielle Hypertonie, kongestive Herzerkrankung, Schlaf-Apnoe) für den Tod der 60jährigen Patientin mitverantwortlich gemacht [4].…”