Side effects of antipsychotic agents: Neuroleptic malignant syndrome

Abstract

Summary - Neuroleptic malignant syndrome is a rare, potentially life-threatening complication which is an unpredictable, idiosyncratic reaction to antipsychotics. In patients receiving traditional antipsychotics, neuroleptic malignant syndrome occurs with an incidence of 0.2-3.3%. However, neuroleptic malignant syndrome also appears in patients treated with atypical antipsychotics, especially Clozapine. A possible cause of neuroleptic malignant syndrome is blockade of dopamine receptors in the nigrostriatal tracts or hypothalamic nuclei. If signs and symptoms of the Neuroleptic malignant syndrome are identified in time, full recovery is possible. This is a report of a female patient with neuroleptic malignant syndrome treated by traditional antipsychotics. As soon as neuroleptic malignant syndrome symptoms were recognized, the antipsychotic drugs were discontinued, symptomatic therapy was initiated and symptoms of neuroleptic malignant syndrome disappeared. However, the patient's psychotic symptoms persisted and an atypical antipsychotic was administered. During the next few days the psychotic symptoms gradually disappeared and the patient accomplished good recovery.

A Serious Side Effect of Antipsychotic Therapy: Neuroleptic Malign Syndrome

“…The number of lethal outcomes among patients with NMS has significantly decreased, from 25% prior to 1984, to 7-11% in recent years due to timely detection of the initial symptoms and immediate therapeutic procedures (2 After the withdrawal of all NMS symptoms, antipsychotic agents should be discontinued for at least two weeks. During the wash-out period, the following agents can be used: clonazepam, lorezapam, mood elevators if necessary and antipsychotic agents with a different mechanism of action (clozapine or olanzapine) with low affinity for dopamine receptors.…”

“…However, clinicians should be bear in mind that although NMS is striking in its classic form, the condition is heterogeneous in terms of onset, presentation, progression and outcome, as in our cases. Common laboratory abnormalities include elevated creatine kinase levels, leukocytosis, elevated The factors for increased risk of NMS have been reported as following: rapid increase in the dosage of antipsychotics, dehydration, psychomotor agitation, intramuscular application of antipsychotics, organic brain damage (IVC, Parkinson and Wilson's disease, addicts), fixation over a longer period of time, male gender, younger age (under the age of 50 years), concomitant administration of antipsychotics and abrupt discontinuation of anticholinergic medications (2,3,6).…”

“…The number of lethal outcomes among patients with NMS has significantly decreased, from 25% prior to 1984, to 7-11% in recent years due to timely detection of the initial symptoms and immediate therapeutic procedures (2). Discontinuation of antipsychotics as well as of other psycho-pharmaceuticals should be the first intervention.…”

“…During the wash-out period, the following agents can be used: clonazepam, lorezapam, mood elevators if necessary and antipsychotic agents with a different mechanism of action (clozapine or olanzapine) with low affinity for dopamine receptors. Depot preparations are excluded from therapy (2).…”

“…Neuroleptic malign syndrome (NMS) is a rare, idiosyncratic, potentially life-threatening complication known to occur primarily during therapy with dopamine receptor antagonists such as antipsychotics (1,2). However, NMS has also been associated with the use of a few antinausea agents, other drugs that affect central dopaminergic neurotransmission, and even by sudden discontinuation of antiparkinsonian medications (3)(4)(5).…”