scholarly journals Neuroleptic malignant syndrome: a guide for psychiatrists

2020 ◽  
pp. 1-10
Author(s):  
Ovais Wadoo ◽  
Sami Ouanes ◽  
Mudasir Firdosi
Keyword(s):  
Adverse Reaction ◽  
Differential Diagnosis ◽  
Neuroleptic Malignant Syndrome ◽  
Clinical Presentation ◽  
Acute Hospital ◽  
Medical Emergency ◽  
Muscle Rigidity ◽  
Autonomic Instability ◽  
State Changes ◽  
Symptom Overlap

SUMMARY Neuroleptic malignant syndrome (NMS) is a rare and potentially fatal adverse reaction to drugs. In psychiatric practice, it is mainly associated with antipsychotics. The classic presentation is that of hyperpyrexia, muscle rigidity, mental state changes and autonomic instability. Subtle forms are difficult to recognise owing to symptom overlap with other conditions. This article discusses the clinical presentation of the syndrome, its differential diagnosis and use of supportive care, medication and electroconvulsive therapy in its treatment. It also explores prevention of NMS and reinstatement of treatment after an episode. It is stressed that all but the mildest forms of NMS should be considered a medical emergency that is properly managed in an acute hospital.

Neuroleptic Malignant Syndrome – A medical emergency in a psychiatric patient

2018 ◽  
Vol 6 (2) ◽  
pp. 108-110
Author(s):  
Rajib Ahsan Sumon ◽  
Eshita Majumder
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Complete Resolution ◽  
Antipsychotic Drugs ◽  
Medical Emergency ◽  
Muscle Rigidity ◽  
Atypical Antipsychotic Drug ◽  
Presumptive Diagnosis ◽  
Idiosyncratic Reaction ◽  
High Fatality Rate ◽  
Work Up

With an estimated incidence of 0.02 to 3.23%1, neuroleptic malignant syndrome (NMS) is a rare idiosyncratic reaction to antipsychotic drugs; having a relatively high fatality rate of about 10%2. Here, we are reporting, a 38 years old female schizoaffective patient, presented with fever, muscle rigidity and altered sensorium who had started tablet risperidone(an atypical antipsychotic drug) 11 days prior to hospital admission. After initial sepsis work up and neuroimaging, infective causes and acute cerebrovascular incidents were ruled out and a presumptive diagnosis of NMS was made. Immediate discontinuation of suspected causative agent, along with the provision of supportive care leads to complete resolution of all the symptoms in our patient.Bangladesh Crit Care J September 2018; 6(2): 108-110

scholarly journals A Case of Neuroleptic Malignant Syndrome in a Profoundly Intellectually Disabled Patient with Successful Reintroduction of Antipsychotic Therapy with Quetiapine

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Kamal Patel ◽  
Brandon Lilly ◽  
Oluwadamilare Ajayi ◽  
Kelly Melvin
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
First Generation ◽  
Early Recognition ◽  
Rare Condition ◽  
Signs And Symptoms ◽  
Antipsychotic Agent ◽  
Muscle Rigidity ◽  
Status Change ◽  
Antipsychotic Therapy ◽  
Autonomic Instability

Neuroleptic Malignant Syndrome (NMS) is a rare condition clinically characterized by muscle rigidity, hyperthermia, autonomic instability, and acute mental status change. NMS is most often associated with use of high-potency first-generation antipsychotic medications; though, other neuroleptics have been implicated as well. NMS can be fatal with estimated mortality rates as high as 20%. Patients experiencing certain severe complications, including renal failure, have been associated with mortality as high as 50%, stressing the need for early recognition and treatment. Here we present the case of a 54-year-old male that initially presented with symptoms suspicious for sepsis, but who eventually developed a clinical picture consistent with NMS. We describe the diagnostic and treatment process leading to symptom remission. We then discuss our decision to reintroduce an atypical antipsychotic agent, quetiapine. This case illustrates the importance of early recognition of the signs and symptoms of NMS and the need to initiate treatment promptly in order to prevent complications, including death. This case also highlights the decision to resume antipsychotic pharmacotherapy after adequate resolution of NMS, demonstrating that it can be done so safely if started at low doses coupled with intensive monitoring of the patient.

scholarly journals Neuroleptic Malignant Syndrome Associated with Rhabdomyolysis Induced by Antipsychotic Agents: A Rare Occurrence

2021 ◽  
Vol 2 (4) ◽  
pp. 4-6
Author(s):  
Supriya D. Malhotra ◽  
Ankit R. Mistry ◽  
Sapna D Gupta
Keyword(s):  
Emergency Department ◽  
Neuroleptic Malignant Syndrome ◽  
Atypical Antipsychotics ◽  
Distress Syndrome ◽  
Antipsychotic Agents ◽  
Medical Emergency ◽  
Muscle Rigidity ◽  
Rare Occurrence ◽  
Altered Mental State ◽  
Psychotropic Agents

Neuroleptic Malignant Syndrome (NMS) is a medical emergency of infrequent presentation in Emergency department, which is associated with the use of psychotropic agents, classical and atypical antipsychotics. We report a case involving a 56-year-old male patient diagnosed with schizophrenia and depression for 30 years, who had been receiving Amisulpride, Trifluoperazine, Clozapine, and Amitryptiline as part of his treatment. This patient presented with symptoms of NMS with fever, muscle rigidity, altered mental state, elevated CPK, Urea, and S. Creatinine levels. NMS may be responsible for serious rhabdomyolysis, acute respiratory distress syndrome, and disseminated intravascular coagulation. We hypothesize the occurrence of acute renal failure precipitated by NMS. His treatment included the withdrawal of all psychotropic agents, Bromocriptine, and other supportive measures.

Successful clozapine rechallenge following clozapine-induced neuroleptic malignant syndrome

2015 ◽  
Vol 5 (2) ◽  
pp. 88-90 ◽  
Author(s):  
Clint Ross
Keyword(s):  
Adverse Effect ◽  
Neuroleptic Malignant Syndrome ◽  
Mental Status ◽  
Signs And Symptoms ◽  
Altered Mental Status ◽  
Muscle Rigidity ◽  
Treatment Resistant ◽  
Autonomic Instability ◽  
Life Threatening ◽  
Potential Risks

Abstract Neuroleptic malignant syndrome (NMS) is a potential life-threatening adverse effect of antipsychotics. Characteristic signs and symptoms of NMS include hyperthermia, muscle rigidity, altered mental status, and autonomic instability. Treatment of NMS includes discontinuation of any antipsychotic or other potentially offending agents. This report describes the details of a patient diagnosed with NMS induced by clozapine with subsequent successful rechallenge. Given limited therapeutic options for patients with treatment-resistant schizophrenia, clinicians should be cognizant of potential risks but aware of the possibility of successful rechallenge with clozapine.

scholarly journals Diagnostic uncertainty in a case of neuroleptic malignant syndrome

CJEM ◽  
2005 ◽  
Vol 7 (04) ◽  
pp. 266-272 ◽  
Author(s):  
Dallas P. Seitz
Keyword(s):  
Differential Diagnosis ◽  
Diagnostic Criteria ◽  
Neuroleptic Malignant Syndrome ◽  
Muscle Rigidity ◽  
Atypical Presentation ◽  
Diagnostic Uncertainty ◽  
Threatening Condition ◽  
Life Threatening ◽  
Psychiatric Conditions ◽  
Delays In Diagnosis

ABSTRACTNeuroleptic malignant syndrome (NMS) is a potentially life-threatening condition that has been associated with antipsychotic use. Most diagnostic criteria include fever and muscle rigidity, although NMS may present without either. Diagnostic uncertainty in such cases may result in delays in diagnosis and management, leading to adverse consequences for these patients. The differential diagnosis of NMS is broad and includes a number of neurological, medical and psychiatric conditions as well as substance and medication-induced disorders. A case is described that illustrates an atypical presentation of NMS and demonstrates some of the challenges in its diagnosis. Limitations of current NMS criteria are also examined, and suggestions for future criteria are presented.

scholarly journals Neuroleptic Malignant Syndrome Associated with Haloperidol

2020 ◽  
Vol 32 (2) ◽  
pp. 62-63
Author(s):  
Md Fajlul Kabir Bhuiyan
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Schizophrenic Patient ◽  
Mental State ◽  
Temporal Relationship ◽  
High Fever ◽  
Muscle Rigidity ◽  
Good Recovery ◽  
Prompt Treatment ◽  
Old Adult ◽  
State Changes

A 42-year-old adult schizophrenic patient developed high fever (106 degree Fahrenheit), mental state changes and muscle rigidity after treatment with parenteral haloperidol. Neuroleptic malignant syndrome (NMS) associated with haloperidol was suspected. Other differentials were excluded. Haloperidol was discontinued and prompt treatment with bromocriptine and lorazepam was started resulting in a good recovery. Because of the temporal relationship between the patient's improvement with the discontinuation of haloperidol and treatment with lorazepam and bromocriptine, the diagnosis was believed to be haloperidol-induced NMS. TAJ 2019; 32(2): 62-63

scholarly journals A Patient with Hemoptysis and Renal Failure

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
Pranavkumar Dalal ◽  
Gautam Phadke ◽  
Amandeep Gill ◽  
Kurtis Tarwater ◽  
Madhukar Misra ◽  
...  
Keyword(s):  
Renal Failure ◽  
Differential Diagnosis ◽  
Kidney Biopsy ◽  
Clinical Presentation ◽  
Organ Damage ◽  
Medical Emergency ◽  
Diagnosis Delay ◽  
End Organ Damage ◽  
Tissue Diagnosis ◽  
Pulmonary Renal Syndrome

Pulmonary-renal syndrome is a medical emergency; etiology of which has broad differential diagnosis. Delay in both diagnosis and initiation of management may result in end-organ damage. Management decisions may have to be empiric till a rapid, definitive tissue diagnosis is established. We present such a case where prompt recognition and immediate treatment was initiated, although the patient sustained irreversible end-organ damage. The case also highlights the need to interpret the kidney biopsy data (namely, immunofluroscence findings) in the context of clinical presentation.

scholarly journals Neuroleptic malignant syndrome due to risperidone misdiagnosed as status epilepticus

2011 ◽  
Vol 3 (3) ◽  
pp. 19 ◽  
Author(s):  
Ali Ertug Arslankoylu ◽  
Meryem Ozlem Kutuk ◽  
Cetin Okuyaz ◽  
Fevziye Toros
Keyword(s):  
Status Epilepticus ◽  
Emergency Room ◽  
Neuroleptic Malignant Syndrome ◽  
Neuroleptic Drug ◽  
High Dose ◽  
Muscle Rigidity ◽  
Neuroleptic Treatment ◽  
The Past ◽  
Autonomic Instability ◽  
Risperidone Treatment

Neuroleptic malignant syndrome (NMS) is a rare but potentially fatal disease characterized by fever, muscle rigidity, delirium and autonomic instability. Here we report a child, with NMS due to the risperidone misdiagnosed as status epilepticus. Nine year old boy, who had been under high dose risperidone treatment for 8 weeks, admitted to the emergency room because of the contractions (evaluated as status epilepticus) persisting for 7 hours. Since there was neuroleptic treatment in the past medical history and, unconsciousness, muscular rigidity, diaphoresis, hypertermi and, hypotension in physical examination, leucocytosis and elevated creatininphosphokinase levels in laboratory tests, the patient was evaluated as NMS and discharged without any complications. We reported this case to point out that; NMS may be misdiagnosed as status epilepticus in children when EEG monitoring is unavailable. When a child admitted to the emergency room because of suspicious convulsion neuroleptic drug use must surely be asked.

scholarly journals OSAHS in adolescents: clinical presentation and differential diagnosis

2018 ◽  
Vol 21 (1) ◽  
pp. 106
Author(s):  
N. Beydon
Keyword(s):  
Obstructive Sleep Apnea ◽  
Differential Diagnosis ◽  
Sleep Apnea ◽  
Clinical Presentation ◽  
Transitional Period ◽  
Alternative Diagnosis ◽  
Obstructive Sleep ◽  
Hypopnea Syndrome

Adolescent experiment widespread changes as he/ she goes through this transitional period from childhood to adulthood. Sleep is no exception to this changeover with, as consequences, modifications of the clinical pre- sentation of subjects with Obstructive Sleep Apnea- Hypopnea Syndrome (OSAHS) and potential different alternative diagnosis.

scholarly journals Myelodysplastic Syndrome Clinically Presenting with the “Classic TTP Pentad”

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Santiago Fabián Moscoso Martínez ◽  
Evelyn Carolina Polanco Jácome ◽  
Elizabeth Guevara ◽  
Vijay Mattoo
Keyword(s):  
Myelodysplastic Syndrome ◽  
Clinical Presentation ◽  
Renal Involvement ◽  
Medical Emergency ◽  
Complete Blood Cell Count ◽  
Blood Cell Count ◽  
Thrombocytopenic Purpura ◽  
Life Saving ◽  
Threatening Condition ◽  
Life Threatening

The clinical presentation of myelodysplastic syndrome (MDS) is not specific. Many patients can be asymptomatic and can be detected only due to an abnormal complete blood cell count (CBC) on routine exam or for other reasons while others can be symptomatic as a consequence of underlying cytopenias. Thrombotic thrombocytopenic purpura (TTP) usually is suspected under the evidence of microangiopathic hemolytic anemia (MAHA) and thrombocytopenia and because it is a life-threatening condition (medical emergency) immediate initiation of plasmapheresis could be life-saving. The following case illustrates an unusual presentation of MDS in a patient who came in to the emergency room with the classic TTP “pentad” of fever, renal involvement, MAHA, mental status changes, and thrombocytopenia. We will focus our discussion in the clinical presentation of this case.

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