The Aftercare of the Patient with the Neuroleptic Malignant Syndrome

1985 ◽  
Vol 146 (3) ◽  
pp. 317-318 ◽  
Author(s):  
Dov Aizenberg ◽  
Arieh Shalev ◽  
Hanan Munitz
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Autonomic Dysfunction ◽  
Neuroleptic Drugs ◽  
Anti Psychotic ◽  
Idiosyncratic Reaction ◽  
Muscular Rigidity ◽  
Level Of Consciousness

SummaryThe neuroleptic malignant syndrome (NMS) is an idiosyncratic reaction to neuroleptic drugs, made up of hyperthermia, muscular rigidity, disturbance of level of consciousness and autonomic dysfunction. It is potentially lethal and should be kept in mind whilst using anti-psychotic drugs; as most patients treated by them require further anti-psychotic treatment, the clinician faces the problem of treating those patients after a NMS episode, yet reports in the literature have generally neglected the problem of late management. A patient suffering from a psychosis and NMS is presented, and a rationale for management offered.

scholarly journals Low dosage of aripiprazole induced neuroleptic malignant syndrome after interaction with other neuroleptic drugs

2013 ◽  
pp. 206-208 ◽  
Author(s):  
Albino Petrone ◽  
Michela Quartieri ◽  
Cinzia Falcone ◽  
Elina Suffredini ◽  
Marta Brandani ◽  
...  
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Antipsychotic Drugs ◽  
Clinical Syndrome ◽  
Neuroleptic Drugs ◽  
Status Change ◽  
Clinical Database ◽  
Mental Status Change ◽  
2Nd Generation ◽  
Symptom Complex ◽  
Low Dosage

Aripiprazole is a 2nd generation antipsychotic medication, atypical neuroleptic used for treatment of schizophrenia improving symptoms such as hallucinations, delusions, and disorganized thinking. A potentially fatal symptom complex sometimes referred to as neuroleptic malignant syndrome (NMS) has been reported in association with administration of antipsychotic drugs, including aripiprazole. Rare cases of NMS occurred during aripiprazole treatment in the worldwide clinical database. The disease is characterized by a distinctive clinical syndrome of mental status change, rigidity, fever, and dysautonomia. We report on a 63-year old woman with depression syndrome who developed neuroleptic malignant syndrome after twelve days of aripripazole 5 mg per day. Our case is added to the small number already described and suggests the need for caution when aripripazole is added to increase the effect of other antipsychotics.

3. The Obscure Autopsy and Neuroleptic Malignant Syndrome

1997 ◽  
Vol 37 (1) ◽  
pp. 79-81 ◽  
Author(s):  
J W Lowe Td Mb Bs Mrcp (Uk) Frc Path
Keyword(s):  
Differential Diagnosis ◽  
Neuroleptic Malignant Syndrome ◽  
Neuroleptic Drugs ◽  
Detailed Assessment

The technique of immunocytochemistry was used to identify myoglobin in kidney, confirming a diagnosis of neuroleptic malignant syndrome following an otherwise obscure autopsy in a decomposed body. The features of neuroleptic malignant syndrome are reviewed with a differential diagnosis of myoglobin renal casts. The report emphasizes a thorough and detailed assessment of deaths which occur during treatment with neuroleptic drugs.

scholarly journals Neuroleptic-induced acute respiratory distress syndrome

2003 ◽  
Vol 121 (3) ◽  
pp. 121-124 ◽  
Author(s):  
Francisco Garcia Soriano ◽  
Elcio dos Santos Oliveira Vianna ◽  
Irineu Tadeu Velasco
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Neuroleptic Malignant Syndrome ◽  
Distress Syndrome ◽  
Muscle Relaxation ◽  
Respiratory Function Tests ◽  
Anesthesia Induction ◽  
Neuroleptic Drugs ◽  
Chest X Ray

CONTEXT: A case of neuroleptic malignant syndrome and acute respiratory distress syndrome is presented and discussed with emphasis on the role of muscle relaxation, creatine kinase, and respiratory function tests. CASE REPORT: A 41-year-old man presented right otalgia and peripheral facial paralysis. A computed tomography scan of the skull showed a hyperdense area, 2 cm in diameter, in the pathway of the anterior intercommunicating cerebral artery. Preoperative examination revealed: pH 7.4, PaCO2 40 torr, PaO2 80 torr (room air), Hb 13.8 g/dl, blood urea nitrogen 3.2 mmol/l, and creatinine 90 mmol/l. The chest x-ray was normal. The patient had not eaten during the 12-hour period prior to anesthesia induction. Intravenous halothane, fentanyl 0.5 mg and droperidol 25 mg were used for anesthesia. After the first six hours, the PaO2 was 65 torr (normal PaCO2) with FiO2 50% (PaO2/FiO2 130), and remained at this level until the end of the operation 4 hours later, maintaining PaCO2 at 35 torr. A thrombosed aneurysm was detected and resected, and the ends of the artery were closed with clips. No vasospasm was present. This case illustrates that neuroleptic drugs can cause neuroleptic malignant syndrome associated with acute respiratory distress syndrome. Neuroleptic malignant syndrome is a disease that is difficult to diagnose. Acute respiratory distress syndrome is another manifestation of neuroleptic malignant syndrome that has not been recognized in previous reports: it may be produced by neuroleptic drugs independent of the manifestation of neuroleptic malignant syndrome. Some considerations regarding the cause and effect relationship between acute respiratory distress syndrome and neuroleptic drugs are discussed. Intensive care unit physicians should consider the possibility that patients receiving neuroleptic drugs could develop respiratory failure in the absence of other factors that might explain the syndrome.

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

Neuroleptic Malignant Syndrome in Striatonigral Degeneration

1988 ◽  
Vol 153 (2) ◽  
pp. 254-255 ◽  
Author(s):  
W. R. G. Gibb
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Heat Production ◽  
Striatal Dopamine ◽  
Striatonigral Degeneration ◽  
Muscular Rigidity

A case of probable neuroleptic malignant syndrome (NMS) complicating l-dopa withdrawal in striatonigral degeneration is described. This case suggests that the hyperthermia of NMS is due to peripheral heat production associated with severe muscular rigidity secondary to withdrawal of striatal dopamine drive, rather than being centrally mediated by the hypothalamus, which is not involved in striatonigral degeneration.

Therapy of Syndrome Malin

1983 ◽  
Vol 17 (9) ◽  
pp. 639-640 ◽  
Author(s):  
Christopher S. Conner
Keyword(s):  
Malignant Hyperthermia ◽  
Neuroleptic Malignant Syndrome ◽  
Autonomic Dysfunction ◽  
Specific Treatment ◽  
Extrapyramidal Symptoms ◽  
Dopaminergic Agonists ◽  
The Past ◽  
Initiation Of Therapy

Syndrome malin refers to neuroleptic malignant syndrome (NMS), a combination of extrapyramidal symptoms, hyperthermia, autonomic dysfunction, hypertension, and coma, which has been reported primarily with haloperidol administration, but also with fluphenazine, thiothixene, and thioridazine. NMS is much more severe than typical extrapyramidal reactions to neuroleptic agents and can result in fatality. The syndrome is not dose related and can begin within hours of initiation of therapy or after months of treatment. Treatment of NMS has been mainly supportive in the past. Recent reports have suggested benefits from the use of bromocriptine and amantadine (dopaminergic agonists), based on a possible etiology of neuroleptic-induced dopaminergic blockade. Dantrolene also has been utilized successfully in NMS on the hypothesis that the syndrome is similar to anesthetic-induced malignant hyperthermia. These agents provide a more specific treatment for this potentially lethal syndrome.

scholarly journals Metoclopramide-Induced Neuroleptic Malignant Syndrome: A Review Study

2020 ◽  
Vol 14 (3) ◽  
Author(s):  
Ideh Ghafour ◽  
Forouzan Elyasi
Keyword(s):  
Side Effects ◽  
Neuroleptic Malignant Syndrome ◽  
Psychiatric Symptoms ◽  
Previous History ◽  
Muscle Rigidity ◽  
Drug Induced ◽  
Idiosyncratic Reaction ◽  
History Of ◽  
And Gender ◽  
Age Range

Context: Neuroleptic malignant syndrome (NMS) has been introduced as a rare but lethal and idiosyncratic reaction to neuroleptics/antipsychotics. The most obvious risk of this syndrome is the use of neuroleptics, especially high-potency ones. Metoclopramide is also known as an anti-nausea medication administered before surgery to manage digestive problems. Evidence Acquisition: Formerly, it had been assumed that metoclopramide was a type of chlorobenzamide that was not in the phenothiazine group but free of extrapyramidal side effects (EPSs). The sequential reports of complications indicate that metoclopramide can cause EPSs and drug-induced motor side effects. A total number of 5044 articles were obtained after the initial search. Then, two researchers independently screened out their titles, and abstracts and 20 articles were finally selected based on the inclusion criteria. Results: Of the 20 articles reporting metoclopramide-induced NMS, treatments had been successful in 16 (80%) cases, but it had led to death in four (20%) patients. There were 11 and 8 male and female patients, respectively, and gender was not mentioned for a patient in one article. The age range of the patients was from six months to 84 years, and the mean age was 50.92 years. Conclusions: Although NMS following metoclopramide intake is reported very rarely, it should be considered for any psychiatric symptoms with unexpected mental changes, muscle rigidity, and fever after being treated with metoclopramide. The neuroleptic malignant syndrome can occur following multiple doses or just one dose of metoclopramide. Also, metoclopramide use in patients affected with kidney failure is accompanied by a higher risk of NMS. A previous history of NMS, a recent episode of catatonia, and severe agitation are all taken into account as risk factors in this domain.

scholarly journals Neuroleptic Malignant Syndrome (NMS) on Clozapine with a Potential Atypical Interaction with Paliperidone

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
Paras Agarwal ◽  
Adanegbe Omoruyi ◽  
Kiara Gascon Perai ◽  
Kerenza MacDaid ◽  
Andrea Burton
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
First Generation ◽  
Idiosyncratic Reaction ◽  
Statistical Manual ◽  
Diagnostic Uncertainty ◽  
Diagnostic And Statistical Manual ◽  
Core Symptom ◽  
Second Generation Antipsychotics ◽  
Criteria For Diagnosis ◽  
Minor Criteria

Neuroleptic Malignant Syndrome (NMS) associated with the use of first-generation antipsychotics is a widely known phenomenon. This idiosyncratic reaction is less significant with the use of second-generation antipsychotics, and only a few cases in the literature exist, describing this reaction with clozapine use. While being titrated on clozapine, the patient developed major and minor criteria features of NMS as per the Diagnostic and Statistical Manual of Mental Disorders, Fifth edition (DSM-5) criteria except for fever, a core symptom which created diagnostic uncertainty. Initially, clozapine was temporarily discontinued due to his deteriorating mental and physical state. A rechallenge was considered at a much lower dose, but due to a rapid increase in his creatinine kinase (CK) levels within a 12-hour timeframe, clozapine was permanently stopped. The evidence further suggests that the presentation of NMS for patients on this medication may be different to the classical presentation, and other criteria for diagnosis are suggested, which may lower the threshold for investigating NMS for patients on clozapine.

scholarly journals S216. CASE REPORT OF TREATMENT OF NEUROLEPTIC MALIGNANT SYNDROME IN CHILD ADOLESCENT

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S120-S121 ◽  
Author(s):  
Moon Doo Kim ◽  
Beomwoo Nam ◽  
Se-Hoon Shim ◽  
Eun-Sung Lim ◽  
Sung-Yong Park ◽  
...  
Keyword(s):  
Risk Factors ◽  
Case Report ◽  
Mental Disorders ◽  
Neuroleptic Malignant Syndrome ◽  
Paralytic Ileus ◽  
Symptom Control ◽  
Sudden Change ◽  
Clinical Syndrome ◽  
Psychotic Symptoms ◽  
Idiosyncratic Reaction

Abstract Background Neuroleptic Malignant Syndrome is a rare clinical syndrome occurring due to idiosyncratic reaction after use of neuroleptics. We report a case of neuroleptic malignant syndrome in an adolescent patient with schizophrenia after treatment with antipsychotics. Methods Case report. Results A 15-year-old male Schizophrenic patient was admitted to the psychiatric closed ward due to worsening of psychotic symptoms on July of 2017. Pineal cystoma and pituitary microadenoma were detected incidentally on MRI, and consultation with the department of pediatrics recommended close observation. After treatment with 6mg of risperidone in combination with 300 mg of quetiapine, psychotic symptoms improved enough to be discharged. Since March 25th of 2019, due to manifestation of paralytic ileus from worsening of underlying constipation, all the oral medications were stopped along with NPO for treatment; in addition, IM injection of haloperidol was only allowed for the symptom control. The day before the onset of neuroleptic malignant syndrome, IM injection of 15 mg of haloperidol and 10 mg of lorazepam resulted in vomiting, headache, fever of 39℃, systemic tremor and stiffness, confusion in consciousness, tachycardia and sweating. On April 1st of 2019, with suspicion of neuroleptic malignant syndrome, the patient was transferred to ICU at our institution. Blood work-up performed on day of admission at ICU indicated CPK 2836 IU/L and myoglobulin 337.2 ng/ml, and CPK, after peaking at 4493 IU/L, continuously decreased and was normalized by the 18th day at ICU. Diazepam (IV), dantrolene, domperidone, L-Dopa/benserazideand and cold blanket were applied because the patient continuously screamed due to fever, stiffness, tremor, and psychotic symptoms. Even though confusion improved after 3 days, nausea and vomiting persisted for 8 days. Tremor, stiffness, and fever were stabilized after 3 days. Tachycardia improved after 17 days. Recovery of hematologic abnormalities such as increased CPK and myoglobulin and leukocytosis were followed by stabilization of tremor, stiffness, and high fever on the 18th day. The patient was transferred out of ICU after 18 days, and symptoms were all stabilized after treatment with clozapine. Discussion Evaluation of risk factors of NMS in patients requiring neuroleptics is most critical in order for prompt differentials and early intervention. Known risk factors are 1) male, 2) combination of more than two antipsychotic, 3) history of previous EPS symptoms or NMS, 4) psychiatric disorders such as severe agitation, mood disorder, or delirium, 5) recent initiation or increasing dose of antipsychotics, 6) IM injection of antipsychotics, 7) poor physical conditions like dehydration, infection, malnutrition, brain tumor, encephalitis, or AIDS, 8) use of zuclopenthixol acetat (clopixol acuphase), and 9) substance abuse. In this case, because the patient had 6 of the risk factors described above, which are biological vulnerabilities due to pineal cystoma and pituitary micro adenoma, dehydration and malnutrition caused by paralytic ileus, and sudden change in IM antipsychotics and dosage, it was critical to consider more carefully in medication injection and changes in dosage. Once diagnosed with NMS, immediate hydration and efforts to lower body temperature are critical to prevent complications like acute renal failure, and use of dantrolene, bromocriptine, and benzodiazepine is helpful in shortening the treatment period. In cases of NMS in patients who cannot terminate use of neuroleptics due to underlying mental disorders, ECT is an effective method to treat both NMS and mental disorders. Safety and efficacy of ECT have been already proven, and it is highly recommended when needed.

scholarly journals the Malignant Neuroleptic Syndrome: Etiopathogenesis, Diagnosis and Clinics

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
V. Adomaitiene ◽  
A. Kulak ◽  
O. Anciulyte
Keyword(s):  
Clinical Signs ◽  
Altered Mental Status ◽  
Muscular Contraction ◽  
Idiosyncratic Reaction ◽  
Malignant Neuroleptic Syndrome ◽  
Muscular Rigidity ◽  
Pathological Conditions ◽  
Lead Pipe ◽  
Neuroleptic Syndrome

MNS is a rare, acute or chronic idiosyncratic reaction to a neuroleptic medication. the syndrome is characterised by fever, muscular rigidity, altered mental status and autonomic dysfunction. MNS is caused by neuroleptics, dopamine antagonistic medications, combination of MAO and antidepresants.The main groups of theories, explaining MNS are reviewed. There is a genetic predisposition and association between MNS and human DRD2 gene A1 and A2 alleles polymorphism. There were attempts to prove MNS and serotoninergic syndrome as different forms of malignant hypertermia. Dopaminergic activity inhibition increases quantity of calcium in the sarcoplasmic reticulum, therefore muscular contraction increases and it leads to clinical MNS signs. There are theories of neuromediators interaction (changes in HVA, adrenaline, MHPG, 5-HIAA levels in cerebrospinal fluid detected during MNS), increased sympathetic activity, malignant hyperthermia, and direct toxic effect of neuroleptic medications to sceletal muscules in vitro.The main risk factors and clinical signs of MNS are summarised. MNS develops suddenly during few hours from the start of treatment with neuroleptics, in rare cases - during first 4 weeks. Usually MNS starts during first 24-72 hours. Classic MNS signs are muscular rigidity (“lead pipe”), hypertermia, elevation of CPK.MNS diagnosis is determined based on anamnesis, clinical signs, laboratorical findings and differentiation which is based by excluding other pathological conditions.

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