Risperidone-induced neuroleptic malignant syndrome: a case report

Abstract

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.

Neuroleptic malignant syndrome in fields other than psychiatry

“…The physical conditions of trauma patients were relatively severe compared with those with other diseases. The major reason for drug administration was postoperative restlessness, 18,19,25,27,28,[30][31][32][33][34][36][37][38][39]44,46,[52][53][54][55][57][58][59][61][62][63][64][67][68][69][70]72,75,78,81,84,86,89 followed by nausea 19,22,24,33,42,51,55,59,61,73,80,86 and delirium 35,…”

“…We performed a review of NMS case reports from clinicians other than psychiatrists in English and Japanese literature. They could be classified into two groups: (1) cases in which NMS onset was triggered by administering causative drugs 17–19,22–89 and (2) cases in which NMS developed from disruption of regular medication (Tables 7 and 8). 8,16,90–114 An example of the former is a case in which antipsychotic drugs were administered for postoperative delirium; an example of the latter is a case in which regular medication (i.e., antipsychotic drugs) to treat schizophrenia was discontinued temporarily because of general anesthesia.…”

“…The physical conditions of trauma patients were relatively severe compared with those with other diseases. The major reason for drug administration was postoperative restlessness, 18,19,25,27,28,30–34,36–39,44,46,52–55,57–59,61–64,67–70,72,75,78,81,84,86,89 followed by nausea 19,22,24,33,42,51,55,59,61,73,80,86 and delirium 35,40,49,56,71,72,74,82,87,88 (Table 10). Haloperidol caused the highest number of NMS cases, 17–19,25–33,35–40,44,46,53–59,61–64,67,69,74–76,81,82,86,87,89 followed by metoclopramide, 19,24,42,55,60,73,77,86 quetiapine, 52,56,70–72 droperidol, 33,34,51,61 and risperidone 41,52,72,84 (Table 11).…”

“…The major reason for drug administration was postoperative restlessness, 18,19,25,27,28,30–34,36–39,44,46,52–55,57–59,61–64,67–70,72,75,78,81,84,86,89 followed by nausea 19,22,24,33,42,51,55,59,61,73,80,86 and delirium 35,40,49,56,71,72,74,82,87,88 (Table 10). Haloperidol caused the highest number of NMS cases, 17–19,25–33,35–40,44,46,53–59,61–64,67,69,74–76,81,82,86,87,89 followed by metoclopramide, 19,24,42,55,60,73,77,86 quetiapine, 52,56,70–72 droperidol, 33,34,51,61 and risperidone 41,52,72,84 (Table 11). Although the results indicated that haloperidol was the drug most commonly used to cure postoperative delirium, statistical analysis is needed to determine whether haloperidol is a significant cause of NMS.…”