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 Antipsychotic prescribing practice among child psychiatrists and community paediatricians

2010 ◽  
Vol 34 (4) ◽  
pp. 126-129 ◽  
Author(s):  
John Otasowie ◽  
Rachel Duffy ◽  
Jenny Freeman ◽  
Chris Hollis
Keyword(s):  
Children And Adolescents ◽  
Atypical Antipsychotic ◽  
Developmental Disorders ◽  
Child And Adolescent ◽  
Typical Antipsychotic ◽  
Antipsychotic Therapy ◽  
Routine Monitoring ◽  
Prescribing Practice ◽  
Antipsychotic Prescribing ◽  
Child Psychiatrists

Aims and methodAll child and adolescent psychiatrists and community paediatricians in the former Trent Region were surveyed about their antipsychotic prescribing practice during 1 year, including monitoring, and whether they would like consensus guidelines on prescribing and monitoring of antipsychotics in children and adolescents.ResultsThe majority (88%) of child psychiatrists and 33% of paediatricians had prescribed atypical antipsychotics, most commonly risperidone. Only two psychiatrists had prescribed a typical antipsychotic and no paediatrician had done so. Challenging behaviour in developmental disorders was the most common indication for atypicals. Both child psychiatrists and paediatricians prescribed atypicals for non-psychotic developmental disorders, whereas prescribing for psychosis occurred almost exclusively among psychiatrists. Height, weight and blood pressure were routinely monitored, but waist circumference was rarely measured and there was wide variation in the monitoring of other parameters such as blood glucose, prolactin and extrapyramidal side-effects. Three-quarters of the participants felt there was a need for guidance on prescribing and monitoring atypical antipsychotic therapy.Clinical implicationsThe greater prescription of antipsychotics by child and adolescent psychiatrists may reflect differences in case-load and training. Routine monitoring of adverse effects is inconsistent among prescribers. The survey highlights the need for training and guidance on prescribing and monitoring of atypical antipsychotic use in children and adolescents.

Cerebrospinal fluid monoamine metabolism in a case of neuroleptic malignant syndrome improved by electroconvulsive therapy

1996 ◽  
Vol 39 (5) ◽  
pp. 383-384 ◽  
Author(s):  
Koichi Nisijima ◽  
Katumi Oyafuso ◽  
Tatuhiro Shimada ◽  
Hitoshi Hosino ◽  
Takeo Ishiguro
Keyword(s):  
Cerebrospinal Fluid ◽  
Neuroleptic Malignant Syndrome ◽  
Electroconvulsive Therapy ◽  
Monoamine Metabolism

scholarly journals Side effects of antipsychotic agents: Neuroleptic malignant syndrome

2010 ◽  
Vol 63 (9-10) ◽  
pp. 705-708 ◽  
Author(s):  
Mina Cvjetkovic-Bosnjak ◽  
Branislava Soldatovic-Stajic
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Atypical Antipsychotics ◽  
Signs And Symptoms ◽  
Antipsychotic Agents ◽  
Psychotic Symptoms ◽  
Symptomatic Therapy ◽  
Idiosyncratic Reaction ◽  
Hypothalamic Nuclei ◽  
Life Threatening ◽  
Possible Cause

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.

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.

Chapter 10: Diagnosis

2019 ◽  
Author(s):  
Gerhard Dobler
Keyword(s):  
Cerebrospinal Fluid ◽  
Viral Encephalitis ◽  
Clinical Symptoms ◽  
Serological Tests ◽  
Specific Antibodies ◽  
Cross Reactions ◽  
Neuro Imaging ◽  
Tbev Infection

• TBE appears with non-characteristic clinical symptoms, which cannot be distinguished from oth-er forms of viral encephalitis or other diseases. • Cerebrospinal fluid and neuro-imaging may give some evidence of TBE, but ultimately cannot confirm the diagnosis. • Thus, proving the diagnosis “TBE” necessarily requires confirmation of TBEV-infection by detec-tion of the virus or by demonstration of specific antibodies from serum and/or cerebrospinal fluid. • During the phase of clinic symptoms from the CNS, the TBEV can only rarely be detected in the cerebrospinal fluid of patients. • Most routinely used serological tests for diagnosing TBE (ELISA, HI, IFA) show cross reactions resulting from either Infection with other flaviviruses or with other flavivirus vaccines.

Chapter 10: Diagnosis

2020 ◽  
Keyword(s):  
Cerebrospinal Fluid ◽  
Viral Encephalitis ◽  
Clinical Symptoms ◽  
Serological Tests ◽  
Specific Antibodies ◽  
Cross Reactions ◽  
Neuro Imaging ◽  
Tbev Infection

TBE appears with non-characteristic clinical symptoms, which cannot be distinguished from other forms of viral encephalitis or other diseases. Cerebrospinal fluid and neuro-imaging may give some evidence of TBE, but ultimately cannot confirm the diagnosis. Thus, proving the diagnosis “TBE” necessarily requires confirmation of TBEV-infection by detection of the virus or by demonstration of specific antibodies from serum and/or cerebrospinal fluid. During the phase of clinic symptoms from the CNS, the TBEV can only rarely be detected in the cerebrospinal fluid of patients. Most routinely used serological tests for diagnosing TBE (ELISA, HI, IFA) show cross reactions resulting from either infection with other flaviviruses or with other flavivirus vaccines.

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.

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