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.

Anesthetic management of electroconvulsive therapy in a patient with a known history of neuroleptic malignant syndrome

2007 ◽  
Vol 21 (4) ◽  
pp. 527-528 ◽  
Author(s):  
Naoko Kato ◽  
Yusuke Asakura ◽  
Misako Mizutani ◽  
Nobuhisa Kandatsu ◽  
Yoshihiro Fujiwara ◽  
...  
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Electroconvulsive Therapy ◽  
Anesthetic Management ◽  
History Of

scholarly journals Lithium Toxicity and Neurologic Effects: Probable Neuroleptic Malignant Syndrome Resulting from Lithium Toxicity

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Osamede Edokpolo ◽  
Madiha Fyyaz
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Pharmacokinetic Interaction ◽  
Electrolyte Imbalance ◽  
Lithium Toxicity ◽  
Cerebral Infarcts ◽  
Lithium Level ◽  
Case Presentation ◽  
Gait Abnormality ◽  
Autonomic Instability ◽  
History Of

Introduction. We present the case of a patient who developed lithium toxicity with normal therapeutic levels, as a result of pharmacokinetic interaction with Valsartan, and probable Neuroleptic Malignant Syndrome from the ensuing lithium toxicity.Case Presentation. A 59-year old black male with bipolar disorder maintained on lithium and fluphenazine therapy presented with a 2 week history of worsening confusion, tremor, and gait abnormality. He recently had his dose of Valsartan increased. At presentation, patient had signs of autonomic instability, he was confused, dehydrated, and had rigidity of upper extremities. Significant labs on admission were lithium level-1.2, elevated CK-6008, leukocytosis WBC-22, and renal impairment; Creatinine-4.1, BUN-35, HCO3-20.1, and blood glucose 145. CT/MRI brain showed old cerebral infarcts, and there was no evidence of an infective process. Lithium and fluphenazine were discontinued, his lithium levels gradually decreased, and he improved with supportive treatment including rehydration and correction of electrolyte imbalance.Conclusions. This case illustrates that lithium toxicity can occur within therapeutic levels, and the neurotoxic effect of lithium can include Neuroleptic Malignant Syndrome. Clinicians should be aware of the risk associated with drug interactions with lithium.

scholarly journals Postpartum psychosis – case report on effective treatment of electroconvulsive therapy in a patient with a history of neuroleptic malignant syndrome

2019 ◽  
Vol 35 (1) ◽  
pp. 75-80
Author(s):  
Bogdan W. Stefanowski ◽  
Anna Z. Antosik-Wójcinska ◽  
Julia Jeschke ◽  
Monika Dominiak ◽  
Łukasz Święcicki
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Electroconvulsive Therapy ◽  
Muscle Relaxation ◽  
Postpartum Psychosis ◽  
Complete Disappearance ◽  
Electroconvulsive Treatment ◽  
Anaesthetic Agents ◽  
Increased Risk ◽  
History Of

In this paper, we present a case of a 31-year-old patient with postpartum psychosis of an unusual course. In patients with antipsychotics, there have been significant complications of treatment in the form of a neuroleptic malignant syndrome. Because of the complications of pharmacological treatment, it was decided to withdraw antipsychotics and to use electroconvulsive therapy. Propofol was used for the anaesthesia of the patient; cisatracurium was used for muscle relaxation. In case of neuroleptic malignant syndrome, succinylcholine is contraindicated because of the increased risk of malignant hyperthermia. Due to the use of long-term anaesthetic agents, the patient required temporary intubation and respiratory support. A total of 8 ECT procedures were performed, complete disappearance of positive symptoms was achieved. After electroconvulsive treatment, aripiprazole 5 mg/d was administered, no significant complications were observed. The patient was discharged home with full mental status.

History of vascular reactivity models and their involvement in hypertension pathogenesis

VASA ◽  
2017 ◽  
Vol 46 (6) ◽  
pp. 431-439 ◽  
Author(s):  
Ana Gabriela Conceição-Vertamatti ◽  
Filipy Borghi ◽  
Fernando Canova ◽  
Dora Maria Grassi-Kassisse
Keyword(s):  
Blood Pressure ◽  
Adrenergic Receptors ◽  
Vascular Reactivity ◽  
Multifactorial Disease ◽  
Pharmacological Treatments ◽  
Beta Adrenergic Receptors ◽  
Vascular Area ◽  
History Of ◽  
Record Blood Pressure ◽  
Advance Knowledge

Abstract. Hypertension is a silent and multifactorial disease. Over two centuries ago, the first device to record blood pressure was developed, making it possible to determine normotension and to establish criteria for hypertension. Since then, several studies have contributed to advance knowledge in this area, promoting significant advances in pharmacological treatments and, as a result, increasing survival of hypertensive people. The main models developed for the study of hypertension and the main findings in the vascular area are included in this review. We considered aspects related to vascular reactivity, changes in the population, and action of beta adrenergic receptors in the pathogenesis of hypertension.

scholarly journals How Fear of COVID-19 Can Affect Treatment Choices for Anaplastic Large Cell Lymphomas ALK+ Therapy: A Case Report

Healthcare ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 135
Author(s):  
Antonello Sica ◽  
Caterina Sagnelli ◽  
Beniamino Casale ◽  
Gino Svanera ◽  
Massimiliano Creta ◽  
...  
Keyword(s):  
Cell Lymphoma ◽  
Large Cell ◽  
Brentuximab Vedotin ◽  
Caucasian Woman ◽  
Hematopoietic Stem ◽  
Drug Regulatory Agency ◽  
Clinical Center ◽  
History Of ◽  
Chemotherapy Patients ◽  
Pet Scans

Background: The t (2; 5) chromosomal rearrangement of the ALK gene with nucleophosmin 1 gene (NPM1), resulting in an NPM1–ALK fusion, was first demonstrated in 1994 in anaplastic large cell lymphoma, (ALCL), a T-cell lymphoma responsive to cyclophosphamide, abriblastine, vincristine and prednisone in approximately 80% of cases; refractory cases usually respond favorably to brentuximab vedotin. These treatments are regarded as a bridge to allogeneic hematopoietic stem cell transplantation (allo-SCT). Nowadays, transplant procedures and the monitoring of chemotherapy patients proceed very slowly because the SARS-CoV-2 pandemic has heavily clogged the hospitals in all countries. Results: A 40-year-old Caucasian woman was first seen at our clinical center in June 2020. She had ALCL ALK+, a history of failure to two previous therapeutic lines and was in complete remission after 12 courses of brentuximab, still pending allo-SCT after two failed donor selections. Facing a new therapeutic failure, we requested and obtained authorization from the Italian drug regulatory agency to administer 250 mg of crizotinib twice a day, a drug incomprehensibly not registered for ALCL ALK +. Conclusions: The response to crizotinib was optimal since no adverse event occurred, and CT-PET scans persisted negative; this drug has proved to be a valid bridge to allo-SCT.

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.

Parkinson disease psychosis – A case report

2016 ◽  
Vol 33 (S1) ◽  
pp. S147-S147
Author(s):  
M.D.C. Ferreira ◽  
S. Varanda ◽  
G. Carneiro ◽  
B. Santos ◽  
Á. Machado
Keyword(s):  
Impulse Control ◽  
Disease Duration ◽  
Motor Symptoms ◽  
Agonist Therapy ◽  
Clozapine Treatment ◽  
Dopamine Agonist Therapy ◽  
Severe Motor ◽  
History Of ◽  
Competing Interest ◽  
Motor Effects

IntroductionPsychosis is one of the most prevalent non-motor complications in Parkinson's disease (PD). Risk factors for PD psychosis are advancing age, longer disease duration, severe motor symptoms, presence of dementia, sleep disorders, depression and autonomic dysfunction. Treatment is challenging in this setting because antipsychotic medications are known to worse motor symptoms.ObjectivesTo highlight the therapeutic difficulties in PD-related psychosis.MethodsCase description and literature review.ResultsWe report a case of a 74-year-old woman with a 9-year history of PD, who presented a complex psychotic disorder consisting in auditory, olfactory and visual (gulliverian and lilliputian) hallucinations, persecutory and sexual delusions. Additionally, the patient presented euthymic mood, without evidence of cognitive impairment or impulse-control disorder. These symptoms began after dopamine agonist therapy (ropinirole 4 mg/day). Other medical conditions that could justify these symptoms were excluded. Initially, ropinirole was removed, but without psychotic remission. Then, she was treated with antipsychotic medication (clozapine 25 mg/day) with full psychotic remission and without significant worsening of motor symptoms.ConclusionsClozapine treatment is frequently delayed, mainly for fear of its side effects, particularly agranulocytosis. However, this antipsychotic drug presents many benefits regarding the management of PD-related psychosis, namely few motor effects and even improvement of motor fluctuations.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Seksueel onaangepast gedrag bij een patiënt met dementie: literatuurreview en casusrapport

2021 ◽  
Author(s):  
C. SEAUX ◽  
K. GOEDSEELS ◽  
J. DE LEPELEIRE
Keyword(s):  
Case Studies ◽  
Randomised Controlled Trials ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Controlled Trials ◽  
Pharmacological Treatments ◽  
Pharmacological Interventions ◽  
Drug Of Choice ◽  
Cochrane Database ◽  
History Of ◽  
Randomised Controlled

Sexually inappropriate behaviour in a patient with dementia: literature review and case report In this paper, the medical history of a 75-year-old man with dementia and sexually inappropriate behaviour (SIB) is described. An overview of the literature regarding the approach and treatment of SIB in persons with dementia was performed. PubMed, Web of Science and the Cochrane database were consulted, and thirteen articles selected. There are no randomised controlled trials available. The literature is limited to case studies and reviews of case studies. Non-pharmacological treatments are perceived to be the first step, although they are rarely studied. There is no consensus regarding a pharmacological approach. However, all studies suggest the paradigm of “start low and go slow”. A variety of drugs have been described. When starting a pharmacological treatment, it is recommended to keep in mind comorbidities and possible side-effects. Selective serotonin reuptake inhibitors (SSRIs) seem to be the preferred first line treatment if the behaviour is not too harmful. If the behaviour is intrusive, anti-androgens seem to be the drug of choice. Further research is needed: a consensus regarding the definition and the development of a screening tool could support randomised controlled trials concerning pharmacological and non-pharmacological interventions. Research concerning ethical dilemmas should, however, not be neglected.

scholarly journals Neuroleptic malignant syndrome

2011 ◽  
Vol 69 (5) ◽  
pp. 751-755 ◽  
Author(s):  
Mariana Moscovich ◽  
Felipe T.M. Nóvak ◽  
Artur F. Fernandes ◽  
Tatiana Bruch ◽  
Tabita Tomelin ◽  
...  
Keyword(s):  
Adverse Event ◽  
Neuroleptic Malignant Syndrome ◽  
Fatal Outcome ◽  
Signs And Symptoms ◽  
Complete Recovery ◽  
Past Medical History ◽  
History Of ◽  
High Doses ◽  
Symptoms And Signs ◽  
Gathering Data

Neuroleptic malignant syndrome (NMS) is a potentially fatal adverse event associated with the use of antipsychotics (AP). The objective of this study was to investigate the profile of cases of NMS and to compare our findings with those published in similar settings. A series of 18 consecutive patients with an established diagnosis of NMS was analyzed, gathering data on demography, symptoms and signs. Two thirds of all cases involved woman with a past medical history of psychiatric disorder receiving relatively high doses of AP. The signs and symptoms of NMS episodes were similar to those reported in other series and only one case had a fatal outcome, the remaining presenting complete recovery. As expected, more than two thirds of our cases were using classic AP (68%), however the clinical profile of these in comparison with those taking newer agent was similar. Newer AP also carry the potential for NMS.

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