Neuroleptic malignant syndrome following combination of sertraline and paroxetine: a case report

Uğuz, Faruk; Sönmez, Erdem Önder

doi:10.1016/j.genhosppsych.2012.11.004

Cited by 11 publications

(5 citation statements)

References 15 publications

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“…Lastly, the observation of cases of NMS apparently precipitated by antidepressants, lithium, or other mood stabilizers have further highlighted a possible pathogenetic role for serotonin, although these drugs are unlikely to trigger NMS alone, in the absence of previous antipsychotic use. However, it was postulated that an excess of central serotonin due to antidepressant use could determine a ‘relative hypodopaminergic state’, which might increase the risk of developing NMS [96, 97]. In our case review, only statistical trends were found for an association between antidepressants and worse clinical picture of NMS, and further studies based on larger samples are warranted before any clear role of these drugs can be confirmed.…”

Section: Discussionmentioning

confidence: 70%

Second-Generation Antipsychotics and Neuroleptic Malignant Syndrome: Systematic Review and Case Report Analysis

et al. 2015

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BackgroundNeuroleptic malignant syndrome (NMS) is a rare, severe, idiosyncratic adverse reaction to antipsychotics. Second-generation antipsychotics (SGAs) were originally assumed to be free from the risk of causing NMS, however several cases of NMS induced by SGAs (SGA-NMS) have been reported.ObjectivesThe aim of this study was to systematically review available studies and case reports on SGA-NMS and compare the presentation of NMS induced by different SGAs.Data SourcesCitations were retrieved from PubMed up to November 2013, and from reference lists of relevant citations.Study Eligibility CriteriaEligibility criteria included (a) primary studies reporting data on NMS, with at least 50 % of the sample receiving SGAs; or (b) case reports and case reviews reporting on NMS induced by SGA monotherapy, excluding those due to antipsychotic withdrawal.Study Appraisal and Synthesis MethodsA standardized method for data extraction and coding was developed for the analysis of eligible case reports.ResultsSix primary studies and 186 individual cases of NMS induced by SGAs were included. Primary studies suggest that SGA-NMS is characterized by lower incidence, lower clinical severity, and less frequent lethal outcome than NMS induced by first-generation antipsychotics. Systematic analysis of case reports suggests that even the most recently marketed antipsychotics are not free from the risk of inducing NMS. Furthermore, clozapine-, aripiprazole- and amisulpride-induced NMS can present with atypical features more frequently than other SGA-NMS, i.e. displaying less intense extrapyramidal symptoms or high fever.LimitationsCase reports report non-systematic data, therefore analyses may be subject to bias.Conclusions and Implications of Key FindingsClinicians should be aware that NMS is virtually associated with all antipsychotics, including those most recently marketed. Although apparently less severe than NMS induced by older antipsychotics, SGA-NMS still represent a relevant clinical issue.Electronic supplementary materialThe online version of this article (doi:10.1007/s40268-014-0078-0) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 70%

Second-Generation Antipsychotics and Neuroleptic Malignant Syndrome: Systematic Review and Case Report Analysis

et al. 2015

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“…It can be associated with neurological disorders, such as Parkinson’s disease, encephalitis and dementia. Although antipsychotics are the most common type of drugs involved in cases of NMS, other classes of compounds have been reported to cause NMS-like symptoms: these include mood stabilizers, such as lithium [ 18 , 19 ] and carbamazepine [ 20 ], antidepressants such as paroxetine, sertraline [ 21 ], and amitriptyline [ 22 ], and antiemetic agents such as metoclopramide [ 23 ]. Although these latter cases associated with antidepressants were classified as NMS, alternatively they may have been examples of serotonin syndrome (see ‘Differential Diagnoses’ below).…”

Section: Epidemiologymentioning

confidence: 99%

Neuroleptic Malignant Syndrome: A Review from a Clinically Oriented Perspective

et al. 2015

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Neuroleptic malignant syndrome (NMS) is a rare but potentially life-threatening sideeffect that can occur in response to treatment with antipsychotic drugs. Symptoms commonly include hyperpyrexia, muscle rigidity, autonomic dysfunction and altered mental status. In the current review we provide an overview on past and current developments in understanding the causes and treatment of NMS. Studies on the epidemiological incidence of NMS are evaluated, and we provide new data from the Canada Vigilance Adverse Reaction Online database to elaborate on drug-specific and antipsychotic drug polypharmacy instances of NMS reported between 1965 and 2012. Established risk factors are summarized with an emphasis on pharmacological and environmental causes. Leading theories about the etiopathology of NMS are discussed, including the potential contribution of the impact of dopamine receptor blockade and musculoskeletal fiber toxicity. A clinical perspective is provided whereby the clinical presentation and phenomenology of NMS is detailed, while the diagnosis of NMS and its differential is expounded. Current therapeutic strategies are outlined and the role for both pharmacological and non-pharmacological treatment strategies in alleviating the symptoms of NMS are discussed.

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“…Both of these drugs will increase the levels of free 5-hydroxytryptamine (5-HT) in the body. 3 Although excess 5-HT in the body may cause serotonin syndrome, the patient never showed paroxysmal or hyperreflexia and therefore did not meet Hunter’s criteria for the diagnosis of serotonin syndrome. 4 MH is a genetic disease inherited in an autosomal-dominant pattern.…”

Section: Discussionmentioning

confidence: 91%

Risperidone-induced neuroleptic malignant syndrome: a case report

Deng

Qiu

Wang

2022

Therapeutic Advances in Psychopharmacology

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Neuroleptic malignant syndrome (NMS) is a rare illness that results from reactions to antipsychotics. However, the diagnosis of NMS is challenging due to its atypical clinical presentation and unclear pathogenesis. We report the case of a patient with NMS induced by irregular use of antipsychotics, especially risperidone (RSP). He had typical hyperthermia, muscle rigidity and rhabdomyolysis, which led to renal impairment. We carefully analysed the mechanism by which NMS occurred in this patient. An interesting aspect of the case is the synergistic involvement of risperidone, antidepressants, opioids and stress. Because of these complex predisposing factors, it is difficult to completely rule out the diagnosis of malignant hyperthermia (MH). In addition, the rare phenomenon of elevated lipase and amylase was observed in this patient.

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Neuroleptic malignant syndrome following combination of sertraline and paroxetine: a case report

Cited by 11 publications

References 15 publications

Second-Generation Antipsychotics and Neuroleptic Malignant Syndrome: Systematic Review and Case Report Analysis

Second-Generation Antipsychotics and Neuroleptic Malignant Syndrome: Systematic Review and Case Report Analysis

Neuroleptic Malignant Syndrome: A Review from a Clinically Oriented Perspective

Risperidone-induced neuroleptic malignant syndrome: a case report

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