scholarly journals Neuroleptic Malignant Syndrome: A Case Aimed at Raising Clinical Awareness

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Jad Al Danaf ◽  
John Madara ◽  
Caitlin Dietsche
Keyword(s):  
Bipolar Disorder ◽  
Differential Diagnosis ◽  
Neuroleptic Malignant Syndrome ◽  
Creatine Phosphokinase ◽  
Supportive Therapy ◽  
Medication List ◽  
Marked Elevation ◽  
Serum Creatine Phosphokinase ◽  
History Of ◽  
Clinical Awareness

A 60-year-old man with a history of bipolar disorder on risperidone, bupropion, and escitalopram was admitted for community acquired streptococcal pneumonia. Four days later, he developed persistent hyperthermia, dysautonomia, rigidity, hyporeflexia, and marked elevation of serum creatine phosphokinase. He was diagnosed with neuroleptic malignant syndrome (NMS) and improved with dantrolene, bromocriptine, and supportive therapy. This case emphasizes the importance of considering a broad differential diagnosis for fever in the ICU, carefully reviewing the medication list for all patients, and considering NMS in patients with fever and rigidity.

The Myth of Elevated Serum Creatine Phosphokinase Level and Neuroleptic Malignant Syndrome

1991 ◽  
Vol 158 (5) ◽  
pp. 706-707 ◽  
Author(s):  
Adityanjee
Keyword(s):  
Case Report ◽  
Neuroleptic Malignant Syndrome ◽  
Creatine Phosphokinase ◽  
Case Reports ◽  
Elevated Serum ◽  
Original Description ◽  
Related Complication ◽  
Serum Creatine Phosphokinase ◽  
Creatine Phosphokinase Level ◽  
Recent Case Report

The 1980s witnessed the honeymoon between American psychiatry and an enigmatic and mysterious drug complication called neuroleptic malignant syndrome (NMS). I fear that the 1990s are witnessing the same in British psychiatry. Gone is the era when case reports in British literature described the syndrome without identifying it by name (Allan & White, 1972; Moyes, 1973), ostensibly owing to lack of awareness. Probably, no one had bothered to read the original description in the French-language literature (Delay et al, 1960). The pendulum has now swung to the other extreme. Every known drug-related complication is being labelled NMS. In the US, Addonizio et al (1986) suggested a ridiculously high incidence figure of 12.2%. The same trend for overdiagnosis is seen in the recent case report by Dalkin & Lee (1990). The authors of this case report seem to have forgotten that NMS is an idiosyncratic adverse drug reaction which is dose-independent. There is no reason to label every neuroleptic overdose as NMS on grounds of raised creatine phosphokinase (CPK) level.

scholarly journals Correlation of serum creatine phosphokinase and serum cholinesterase in organophosphate poisoning in children

2019 ◽  
Vol 6 (6) ◽  
pp. 2352
Author(s):  
Dhanalakshmi K. ◽  
Febina K. ◽  
Sarala Sabapathy ◽  
Chaithra R. ◽  
Thileepan N.
Keyword(s):  
Creatine Phosphokinase ◽  
Negative Relationship ◽  
High Serum ◽  
Serum Cholinesterase ◽  
Organophosphate Poisoning ◽  
Median Serum ◽  
Serum Creatine Phosphokinase ◽  
History Of ◽  
Study Population ◽  
Poisoning In Children

Background: Organophosphate (OP) poisoning is one of the most common pesticide poisoning in India in adolescents because of its easy availability. Serum pseudocholinesterase levels are commonly used to assess the severity and to know the prognosis in OP compound poisoning. Serum creatine phosphokinase (CPK) levels is another lab parameter which gets deranged in OP poisoning and has been tried in adults to assess the severity and to know the prognosis. Authors objective was to study the correlation of serum pseudocholinesterase and serum CPK in organophosphate poisoning at admission and to compare outcome with serum CPK levels.Methods: All the children in the age group of 1 month to 18 yrs, who were admitted with the history of suspected OP compound poisoning were enrolled for the study. Estimation of cholinesterase and CPK levels were done at admission and after 1 week. Patients were categorised in to latent, mild, moderate and severe cases based on the S. Cholinesterase levels. These values were analysed to see the correlation.Results: Among 34 OP poisoning cases,13(38%) were males and 21(62%) were females. Mean age of study population was12.6+4.25 yrs. The median CPK values in latent, mild, moderate and severe cases were 121.5 IU/L,276.5 IU/L, 308IU/L and 467IU/L respectively (p=0.015). Spearman’s rho Correlation coefficient was -0.522 between S. Cholinesterase and S CPK at admission which was significant. The median serum CPK level after 1week in non survivors was 2498.0IU/L and in survivors was 201.0IU/L (p0.014).Conclusions: There was a strong negative relationship between serum cholinesterase and serum CPK at admission in OP poisoning. Follow up values at 1 week showed that significantly high serum CPK and low cholinesterase, which was also significant and was associated with mortality.

scholarly journals Case of refractory delirious mania responsive to lithium

BJPsych Open ◽  
2021 ◽  
Vol 7 (4) ◽  
Author(s):  
Manuel Pereira Herrera ◽  
Aphrodite Marta Zimmerman
Keyword(s):  
Bipolar Disorder ◽  
Valproic Acid ◽  
Neuroleptic Malignant Syndrome ◽  
Serotonin Syndrome ◽  
The Other ◽  
Minimal Improvement ◽  
History Of ◽  
Uncommon Condition ◽  
High Doses ◽  
Malignant Catatonia

Delirious mania is an uncommon condition that is challenging to diagnose and treat. More often seen in patients with a history of bipolar disorder, it frequently presents with prominent catatonic features and overlaps with other diseases in the catatonic spectrum, such as neuroleptic malignant syndrome, serotonin syndrome and malignant catatonia. We present a case of delirious mania refractory to high doses of lorazepam, several antipsychotics and valproic acid, which responded dramatically to therapy with lithium after 26 days of minimal improvement with the other medications. The pathophysiology of delirious mania is reviewed, and the unique actions of lithium are discussed, highlighting possible reasons as to why lithium might offer advantages in the treatment of this disease.

scholarly journals Neuroleptic Malignant Syndrome with Very High Serum Creatine Phosphokinase: A Case Report

2012 ◽  
Vol 2 (1) ◽  
pp. 56-59
Author(s):  
Kaniz Fatema ◽  
Mohammad Omar Faruq ◽  
ASM Areef Ahsan ◽  
Rownak Jahan Tamanna ◽  
Fatema Ahmed ◽  
...  
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Creatine Phosphokinase ◽  
Elevated Serum ◽  
High Serum ◽  
Altered Level ◽  
Serum Creatine Phosphokinase ◽  
Level Of Consciousness ◽  
Creatine Phosphokinase Level ◽  
Elevated Creatinine ◽  
High Index Of Suspicion

The neuroleptic malignant syndrome (NMS), characterized by muscular rigidity, altered level of consciousness, dysautonomias and an elevated creatinine phosphokinase level, is a potentially lethal consequence of treatment with neuroleptics. Although it occurs most frequently with conventional anti psychotics, it may also occur with newer anti psychotic agents. Physicians need to have a high index of suspicion with regard to diagnosing NMS in patients taking neuroleptics regardless of duration or dose and presenting with hyperthermia. It is under diagnosed in critical care settings though various neuroleptics are frequently used in intensive care units for various purpose. We report a case involving a 55-yr old man with psychiatric disorder who presented with NMS with extremely elevated serum creatine phosphokinase level and acute renal failure. DOI: http://dx.doi.org/10.3329/birdem.v2i1.12363 Birdem Med J 2012; 2(1) 56-59

History of Abuse, Substance Use Problems, and Bipolar Disorder in a County Jail Setting

2008 ◽  
Author(s):  
Edwin Shirley ◽  
Lisa Stines Doane ◽  
Toyomi Goto ◽  
Norah Feeny ◽  
Sara M. Debanne ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Substance Use ◽  
County Jail ◽  
Substance Use Problems ◽  
History Of

scholarly journals Gambling problems in bipolar disorder in the UK: Prevalence and distribution

2015 ◽  
Vol 207 (4) ◽  
pp. 328-333 ◽  
Author(s):  
Lisa Jones ◽  
Alice Metcalf ◽  
Katherine Gordon-Smith ◽  
Liz Forty ◽  
Amy Perry ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Problem Gambling ◽  
Severity Index ◽  
Gambling Problems ◽  
Rapid Cycling ◽  
Probable Significance ◽  
History Of ◽  
Gambling Severity ◽  
The Uk

BackgroundNorth American studies show bipolar disorder is associated with elevated rates of problem gambling; however, little is known about rates in the different presentations of bipolar illness.AimsTo determine the prevalence and distribution of problem gambling in people with bipolar disorder in the UK.MethodThe Problem Gambling Severity Index was used to measure gambling problems in 635 participants with bipolar disorder.ResultsModerate to severe gambling problems were four times higher in people with bipolar disorder than in the general population, and were associated with type 2 disorder (OR = 1.74, P = 0.036), history of suicidal ideation or attempt (OR = 3.44, P = 0.02) and rapid cycling (OR = 2.63, P = 0.008).ConclusionsApproximately 1 in 10 patients with bipolar disorder may be at moderate to severe risk of problem gambling, possibly associated with suicidal behaviour and a rapid cycling course. Elevated rates of gambling problems in type 2 disorder highlight the probable significance of modest but unstable mood disturbance in the development and maintenance of such problems.

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