Neuroleptic Malignant Syndrome in an Adolescent After Brief Exposure to Olanzapine

Abstract

A 17-year-old African-American male developed neuroleptic malignant syndrome (NMS) with hyperthermia, autonomic instability, increased muscle tone, rhabdomyolysis, and obtundation after a maximum of 2 days of treatment with olanzapine and 1 day of treatment with divalproex sodium. Intensive care unit (ICU)-level care was required. Paranoid psychosis with catatonia was present after recovery from the NMS. Because of his continued psychotic symptoms following resolution of the NMS, the alternate atypical antipsychotic, clozapine, was started under close observation. Reports of NMS resulting from atypical antipsychotic agents are generally uncommon, and much more so in the child and adolescent population. However, these agents are frequently prescribed in this population and require due caution.

Effects of risperidone on energy balance in female C57BL/6J mice

“…There may be other explanations with respect to risperidone-induced increases in REE and TEE. The activity of skeletal muscle may contribute to the increased energy expenditure, as AAD treatment results in increased muscle tone in patients (29) and rats (30). Moreover, the automatic nervous system is deeply involved in the regulation of energy metabolism, and one study indicated that AADs induce instability in the automatic nervous system (31), which may increase firing rates of sympathetic nerves leading to increased energy expenditure (18,30).…”

Atypical Neuroleptic Malignant Syndrome in an Adolescent

“…Differential diagnosis of NMS includes serotonin syndrome, malignant hyperthermia (secondary to halothane or succinylcholine), and drug-induced hyperthermia (cocaine, phencyclidine, methylenedioxymethamphetamine) (Hanft et al 2004;Zimmerman et al 2006). NMS may occur in up to 1% of all patients on neuroleptic agents with incidence rates ranging from 0.02% to 3% (Bourgeois et al 2002;Levenson 1985).…”

Memantine and Catatonia

“…1,2,5,27 While there have been case reports of the atypical antipsychotics clozapine, risperidone, aripiprazole, ziprasidone, and olanzapine successfully treating catatonia, [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] these agents have also been reported to cause catatonia. [43][44][45][46][47][48][49][50] In fact, Rosebush and Mazurek noted that the failure to treat catatonia before institution of antipsychotic medication may increase the risk of inducing neuroleptic malignant syndrome. 51 In some benzodiazepine-resistant cases, N-methyl-D-aspartate (NMDA) receptor antagonists, including amantadine (initial dose 100 mg three times a day, up to 500 mg three times a day reported) and memantine (initial dose 5 mg/day, up to 20 mg/day reported) may provide benefit.…”