scholarly journals The Treatment of Clozapine-Withdrawal Delirium with Electroconvulsive Therapy

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
Anish Modak ◽  
Arne Åhlin
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Atypical Antipsychotic ◽  
Electroconvulsive Therapy ◽  
Withdrawal Syndrome ◽  
Literature Search ◽  
Severe Withdrawal ◽  
Multiple Treatments ◽  
Withdrawal Syndromes ◽  
Clozapine Withdrawal

Clozapine, a commonly used atypical antipsychotic, can precipitate a severe withdrawal syndrome. In this report, we describe a case of delirium with catatonic features emerging after the immediate cessation of clozapine subsequent to concerns of developing neuroleptic malignant syndrome. After multiple treatments were found to be inefficacious, electroconvulsive therapy (ECT) was initiated, resulting in significant improvement. A literature search revealed six previous cases of clozapine-withdrawal syndromes of varied symptomatology treated with ECT. To our knowledge, the present case represents the first reported clozapine-withdrawal delirium treated successfully with ECT.

scholarly journals Acute psychosis followed by fever: Malignant neuroleptic syndrome or viral encephalitis?

2014 ◽  
Vol 71 (6) ◽  
pp. 603-607 ◽  
Author(s):  
Zvezdana Stojanovic ◽  
Zeljko Spiric
Keyword(s):  
Cerebrospinal Fluid ◽  
Neuroleptic Malignant Syndrome ◽  
Atypical Antipsychotic ◽  
Electroconvulsive Therapy ◽  
Viral Encephalitis ◽  
First Episode ◽  
Symptomatic Therapy ◽  
Typical Antipsychotic ◽  
Antipsychotic Therapy ◽  
Idiosyncratic Reaction

Introduction. Neuroleptic malignant syndrome is rare, but potentially fatal idiosyncratic reaction to antipsychotic medications. It is sometimes difficult to diagnose some clinical cases as neuroleptic malignant syndrome and differentiate it from the acute viral encephalitis. Case report. We reported a patient diagnosed with acute psychotic reaction which appeared for the first time. The treatment started with typical antipsychotic, which led to febrility. The clinical presentation of the patient was characterised by the signs and symptoms that might have indicated the neuroleptic malignant syndrome as well as central nervous system viral disease. In order to make a detailed diagnosis additional procedures were performed: electroencephalogram, magnetic resonance imaging of the head, lumbar puncture and a serological test of the cerebrospinal fluid. Considering that after the tests viral encephalitis was ruled out and the diagnosis of neuroleptic malignant syndrome made, antipsychotic therapy was immediately stopped. The patient was initially treated with symptomatic therapy and after that with atypical antipsychotic and electroconvulsive therapy, which led to complete recovery. Conclusion. We present the difficulties of early diagnosis at the first episode of acute psychotic disorder associated with acute febrile condition. Concerning the differential diagnosis it is necessary to consider both neuroleptic malignant syndrome and viral encephalitis, i.e. it is necessary to make the neuroradiological diagnosis and conduct cerebrospinal fluid analysis and blood test. In neuroleptic malignant syndrome treatment a combined use of electroconvulsive therapy and low doses of atypical antipsychotic are confirmed to be successful.

scholarly journals What I have learnt from helping thousands of people taper off antidepressants and other psychotropic medications

2021 ◽  
Vol 11 ◽  
pp. 204512532199127
Author(s):  
Adele Framer
Keyword(s):  
Withdrawal Syndrome ◽  
Online Community ◽  
Medical Information ◽  
Scientific Literature ◽  
Drug Withdrawal ◽  
Psychotropic Medications ◽  
Lessons Learned ◽  
Medical Providers ◽  
Drug Reactions ◽  
Withdrawal Syndromes

Although psychiatric drug withdrawal syndromes have been recognized since the 1950s – recent studies confirm antidepressant withdrawal syndrome incidence upwards of 40% – medical information about how to safely go off the drugs has been lacking. To fill this gap, over the last 25 years, patients have developed a robust Internet-based subculture of peer support for tapering off psychiatric drugs and recovering from withdrawal syndrome. This account from the founder of such an online community covers lessons learned from thousands of patients regarding common experiences with medical providers, identification of adverse drug reactions, risk factors for withdrawal, tapering techniques, withdrawal symptoms, protracted withdrawal syndrome, and strategies to cope with symptoms, in the context of the existing scientific literature.

scholarly journals Hyperthermia syndromes in psychiatry

2009 ◽  
Vol 15 (3) ◽  
pp. 181-191 ◽  
Author(s):  
Niraj Ahuja ◽  
Andrew J. Cole
Keyword(s):  
Drug Treatment ◽  
Neuroleptic Malignant Syndrome ◽  
Electroconvulsive Therapy ◽  
Serotonin Syndrome ◽  
Systematic Approach ◽  
Psychiatric Patients ◽  
Initial Diagnosis ◽  
Malignant Hyperpyrexia ◽  
Malignant Catatonia

SummaryPresence of fever in psychiatric patients may signify a number of potentially fatal conditions. Several of these are related to treatments (e.g. neuroleptic malignant syndrome with antipsychotics, serotonin syndrome with serotonergic antidepressants, and malignant hyperpyrexia with anaesthesia used for administration of electroconvulsive therapy) or exacerbated by them (e.g. malignant catatonia with antipsychotics). New classes of drug treatment may be changing the epidemiology of these disorders. We suggest that an initial diagnosis of hyperthermia syndrome is clinically useful as there are some important commonalities in treatment. We outline a systematic approach to identify a particular subtype of hyperthermia syndrome and the indications for more specific treatments where available.

scholarly journals Neuroleptic malignant syndrome: a case responding to electroconvulsive therapy plus bupropion

2018 ◽  
Author(s):  
Quintí Foguet-Boreu ◽  
Montse Coll-Negre ◽  
Montse Serra-Millàs ◽  
Miquel Cavalleria-Verdaguer
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Electroconvulsive Therapy ◽  
Potential Role ◽  
Caucasian Woman ◽  
Concomitant Treatment ◽  
Pharmacological Treatments ◽  
Severe Motor ◽  
Autonomic Instability ◽  
History Of ◽  
Psychotic Features

Neuroleptic malignant syndrome (NMS) is a severe motor syndrome occurring as a consequence of neuroleptic treatment. We present a case of a 67-year-old Caucasian woman with a history of a major depressive disorder with psychotic features. During her third hospital admission, symptoms of autonomic instability, hyperpyrexia, severe extrapyramidal side effects, and delirium appeared, suggesting NMS due to concomitant treatment with risperidone and quetiapine, among other drugs. Despite several consecutive pharmacological treatments (lorazepam, bromocriptine and amantadine) and prompt initiation of electroconvulsive therapy (ECT), clinical improvement was observed only after combining bupropion with ECT. The symptoms that had motivated the admission gradually remitted and the patient was discharged home. Bupropion increases dopaminergic activity in both the nucleus accumbens and the prefrontal cortex. Therefore, from a physiopathological standpoint, bupropion has a potential role in treating NMS. However, there is scarce evidence supporting this approach and therefore future cases should be carefully considered.

Mortality of Neuroleptic Malignant Syndrome Induced by Typical and Atypical Antipsychotic Drugs

2011 ◽  
Vol 73 (04) ◽  
pp. 427-430 ◽  
Author(s):  
Mitsuhiro Nakamura ◽  
Hideo Yasunaga ◽  
Hiroaki Miyata ◽  
Takafumi Shimada ◽  
Hiromasa Horiguchi ◽  
...  
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Atypical Antipsychotic ◽  
Antipsychotic Drugs ◽  
Atypical Antipsychotic Drugs

Withdrawal Reactions Associated with Venlafaxine

1998 ◽  
Vol 32 (2) ◽  
pp. 291-294 ◽  
Author(s):  
Gordon Parker ◽  
Jenny Blennerhassett
Keyword(s):  
Single Dose ◽  
Side Effects ◽  
Clinical Picture ◽  
Withdrawal Syndrome ◽  
Withdrawal Symptoms ◽  
Selective Serotonin ◽  
Short Acting ◽  
Severe Withdrawal ◽  
Uptake Inhibitors

Objective: The aim of this paper is to describe discontinuation syndromes associated with abrupt and tapered withdrawal of venlafaxine, and to document that withdrawal symptoms may occur after missing a single dose. Clinical picture: We report on two patients prescribed venlafaxine. One developed a broad range of serious side effects after reaching a dose of 300 mg a day, and a severe withdrawal syndrome (including hallucinations) during a slow taper regime. The second had severe discontinuation symptoms during and aborting a slow taper regime, and described withdrawal responses after missing a single dose of venlafaxine. Conclusions: As for the short-acting selective serotonin re-uptake inhibitors, severe discontinuation reactions may occur with venlafaxine, seemingly marked most distinctly by headache, nausea, fatigue, dizziness and dysphoria, and may make cessation of the drug extremely difficult. Two strategies for addressing the concern are considered.

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