Malignant catatonia and neuroleptic malignant syndrome: How different/similar are they?

2016 ◽  
Vol 33 (S1) ◽  
pp. S640-S640 ◽  
Author(s):  
P. Sales ◽  
M. Bernardo ◽  
A. Lopes ◽  
E. Trigo
Keyword(s):  
Supportive Care ◽  
Neuroleptic Malignant Syndrome ◽  
Specific Treatment ◽  
Hemodynamic Instability ◽  
Psychotic Symptoms ◽  
Muscle Rigidity ◽  
Life Threatening ◽  
History Of ◽  
Competing Interest ◽  
Malignant Catatonia

IntroductionCatatonia is a neuropsychiatric syndrome that appears in medical, neurological or psychiatric conditions. There are presentation variants: “malignant catatonia” (MC) subtype shares many characteristics with the neuroleptic malignant syndrome (NMS), possibly reflecting common pathophysiology.Objectives/methodsWe present a clinical vignette and review the literature available on online databases about MC/NMS.ResultsWe present a man, 41-years-old, black ethnicity, with no relevant medical history. He had two previous episodes compatible with brief psychosis, the last one in 2013, and a history of adverse reactions to low doses of antipsychotics. Since the last episode he was asymptomatic on olanzapine 2.5 mg id. He acutely presented to the Emergency Room with mutism, negativism, immobility and delusional speech, similar to the previous episodes mentioned and was admitted to a psychiatric infirmary, where his clinical condition worsened, showing muscle rigidity, hemodynamic instability, leukocytosis, rhabdomyolysis and fever. Supportive care was provided, olanzapine was suspended and electroconvulsive therapy (ECT) was initiated. After two months, he was discharged with no psychotic symptoms. He is still under ECT and no antipsychotic medication was reintroduced.Discussion/conclusionMany studies suggest that clinical or laboratory tests do not distinguish MC from NMS and that they are the same entity. These two conditions are life-threatening and key to treatment is a high suspicion level. There is no specific treatment; supportive care and stopping involved medications are the most widely used measures. ECT is a useful alternative to medication.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Hyperthermia and neuroleptic malignant syndrome-Case report

2017 ◽  
Vol 41 (S1) ◽  
pp. s829-s830
Author(s):  
K. Puljić ◽  
M. Herceg ◽  
V. Jukić
Keyword(s):  
Malignant Hyperthermia ◽  
Neuroleptic Malignant Syndrome ◽  
Altered Mental Status ◽  
Muscle Rigidity ◽  
Idiosyncratic Reaction ◽  
Malignant Neuroleptic Syndrome ◽  
Neuroleptic Syndrome ◽  
Threatening Condition ◽  
Life Threatening ◽  
Competing Interest

Neuroleptic malignant syndrome (NMS) is a rare, but life-threatening, idiosyncratic reaction to neuroleptic medications that is characterized by fever, muscular rigidity, altered mental status, and autonomic dysfunction. NMS often occurs shortly after the initiation of neuroleptic treatment, or after dose increases. Malignant hyperthermia (MH) or malignant hyperpyrexia is a rare life-threatening condition that is usually triggered by exposure to certain drugs. The 46-years-old female patient was diagnosed schizophrenia at the age of 22. Currently, she is hospitalized due to psychotic decompensation. The patient was admitted with following daily dose therapy of: haloperidol 15 mg, biperiden 4 mg and diazepam 15 mg. During this hospitalization she developes muscle rigidity, tremor, hyperthermia, and laboratory results showed increase of enzimes CPK and LDH, so we started treatment of suspected malignant neuroleptic syndrome. After a treatment and recovery with complete withdrawal of all presented symptoms, our patient developed a malignant hypertermia that was resistant to all applicated medications. Our dilemma is whether presented symptoms of malignant hyperthermia are related to malignant neuroleptic syndrome or not?Disclosure of interestThe authors have not supplied their declaration of competing interest.

Neuroleptic malignant syndrome: A rare, life-threatening and not fully understood condition

2017 ◽  
Vol 41 (S1) ◽  
pp. S562-S562
Author(s):  
P. Cabral Barata ◽  
J.C. Melo ◽  
T. Maia
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Current Knowledge ◽  
Neurological Deficits ◽  
Muscle Rigidity ◽  
Scientific Publications ◽  
Idiosyncratic Reaction ◽  
Life Saving ◽  
Increased Risk ◽  
Life Threatening ◽  
Competing Interest

IntroductionNeuroleptic Malignant Syndrome (NMS) is a rare life-threatening idiosyncratic reaction associated with the use of neuroleptics. It is characterized by delirium, muscular rigidity, fever and autonomic nervous system dysregulation. Its diagnosis represents a significant challenge for clinicians and many aspects regarding its epidemiology, etiopathology and nosology remain controversial.ObjectivesSummarize current knowledge to facilitate NMS diagnosis and allow a fast onset of therapeutic and life-saving interventions.MethodsNon-systematic review of the literature–scientific publications from Pubmed and a Psychiatry Textbook.ResultsNMS typically develops during the first week after the neuroleptic is introduced, although it may also appear after years of treatment. Its incidence is of 0.02 to 3% in patients taking antipsychotics; the mean age of its patients is 50 years. Typical symptoms are muscle rigidity and temperature greater than 38hC in a patient on antipsychotic; however, recent reports indicate that these core symptoms may not always be present. Several risk factors have also been identified and must be addressed. NMS may be fatal in 10 to 20% of cases or may produce residual sequelae, like cognitive dysfunction or neurological deficits. NMS must be managed by aggressive use of supportive measures, as well as specific interventions. It recurs in 30% of patients, which can be diminished by specific measures.DiscussionNMS requires timely and accurate diagnosis and treatment. Antipsychotics should be used cautiously in patients at increased risk. When recognizing this condition, prompt withdrawal of the offending agent is the most important step. Wise approaches can diminish morbidity, mortality and recurrence.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Comorbid depression and ulcerative colitis – is there a connection?

2017 ◽  
Vol 41 (S1) ◽  
pp. S534-S534
Author(s):  
A. Melada ◽  
I. Krišto-Mađura ◽  
A. Vidović
Keyword(s):  
Ulcerative Colitis ◽  
Psychiatric Treatment ◽  
Psychiatric Symptoms ◽  
Specific Treatment ◽  
Unknown Etiology ◽  
Suicidal Thoughts ◽  
Symptoms Of Depression ◽  
Bidirectional Communication ◽  
History Of ◽  
Competing Interest

Ulcerative colitis (UC) is a subset disorder of inflammatory bowel disease (IBD) with chronic course and symptoms such as fatigue, gastrointestinal pain, fever, etc. IBD is associated with psychological manifestations including depression and anxiety. There is an increased number of studies trying to link these comorbidities. The gut-brain axis is regulated by intestinal microbiota and this bidirectional communication including immune, neural, endocrine and metabolic mechanisms may bring us closer to the answer. The following case concerns a 56-year-old patient with history of major depressive disorder who was in continuous psychiatric care and treated with antidepressants. Several years after the beginning of psychiatric treatment, he was hospitalized for diagnostic examination due to subfebrility of unknown etiology, but with no final somatic diagnosis. After two years he was referred to our department and at administration the patient showed symptoms of depression, anxiety, lack of motivation and suicidal thoughts and tendencies. Subfebrility was still present at that time. His psychopharmacotherapy was revised and there was a slight improvement in mood and behaviour. During outpatient follow-ups the symptoms of depression were still prominent and remission was not achieved even with modulation of antidepressant pharmacotherapy. The following year the patient was diagnosed with UC and started specific treatment after he presented with diarrhea in addition to subfebrility. Subsequently his mood improved, suicidal thoughts were diminished and ultimately remission was achieved. This case suggests that only after UC was being treated the psychiatric symptoms also withdrew which implicates that inflammatory mediators were involved in pathogenesis of depression.Disclosure of interestThe authors have not supplied their declaration of competing interest.

A broken heart

2017 ◽  
Vol 41 (S1) ◽  
pp. S422-S423
Author(s):  
M.J. Gordillo Montaño ◽  
S. Ramos Perdigues ◽  
S. Latorre ◽  
M. de Amuedo Rincon ◽  
P. Torres Llorens ◽  
...  
Keyword(s):  
Heart Function ◽  
Mood Stabilizer ◽  
Psychotic Symptoms ◽  
Emotional States ◽  
Cardiac Syndrome ◽  
History Of ◽  
Competing Interest ◽  
High Doses ◽  
Depressive Episodes ◽  
The Impact

IntroductionWithin the various cultures and throughout the centuries has observed the relationship between emotional states and heart function, colloquially calling him “heartbroken”. Also in the medical literature are references to cardiac alterations induced by stress.ObjectiveTakotsubo is a rare cardiac syndrome that occurs most frequently in postmenopausal women after an acute episode of severe physical or emotional stress. In the text that concerns us, we describe a case related to an exacerbation of psychiatric illness, an episode maniform.MethodWoman 71 years old with a history of bipolar I disorder diagnosed at age 20. Throughout her life, she suffered several depressive episodes as both manic episodes with psychotic symptoms. Carbamazepine treatment performed and venlafaxine. He previously performed treatment with lithium, which had to be suspended due to the impact on thyroid hormones and renal function, and is currently in pre-dialysis situation.She requires significant adjustment treatment, not only removal of antidepressants, but introduction of high doses of antipsychotic and mood stabilizer change of partial responders. In the transcurso income, abrupt change in the physical condition of the patient suffers loss of consciousness, respiratory distress, drop in blood pressure, confusion, making involving several specialists. EEG was performed with abnormal activity, cranial CT, where no changes were observed, and after finally being Echocardiography and coronary angiography performed when diagnosed Takotsubo.Results/conclusionsIn this case and with the available literature, we can conclude that the state of acute mania should be added to the list of psychosocial/stressors that can trigger this condition.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Risperidone-Induced Neuroleptic Malignant Syndrome: A Case Report and Review

1996 ◽  
Vol 41 (1) ◽  
pp. 52-54 ◽  
Author(s):  
Gb Meterissian
Keyword(s):  
Case Report ◽  
Side Effects ◽  
Neuroleptic Malignant Syndrome ◽  
Clinical Features ◽  
Prior History ◽  
Extrapyramidal Side Effects ◽  
Life Threatening ◽  
History Of ◽  
Life Threatening Complication ◽  
The One

Objectives: 1. To report the case of a 53-year-old patient who developed neuroleptic malignant syndrome (NMS) — a rare but potentially life-threatening complication of neuroleptic therapy — 4 days after treatment with risperidone was initiated. 2. To review previously reported cases of NMS associated with risperidone. Methods: A computerized search of several databases, including MEDLINE, was conducted to find all previously reported cases of NMS with risperidone. Results: Five reported cases of risperidone-induced NMS were found in the literature. All cases including the one reported here displayed typical clinical features of NMS and all 6 patients had a prior history of extrapyramidal side effects and/or NMS. Age and duration of exposure to risperidone did not seem to be of significance. Conclusions: These cases illustrate that clinicians should be on the lookout for risperidone-induced NMS.

An approach to neuroleptic malignant syndrome from a clinical case

2016 ◽  
Vol 33 (S1) ◽  
pp. S631-S632 ◽  
Author(s):  
A. Gomez Peinado ◽  
P. Cano Ruiz ◽  
M.D. Sanchez Garcia ◽  
S. Cañas Fraile ◽  
M. Gonzalez Cano ◽  
...  
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Clinical Case ◽  
Medical Complication ◽  
Neuroleptic Treatment ◽  
Autonomic Nervous System Dysfunction ◽  
Electrolyte Disturbances ◽  
Starting Point ◽  
Threatening Condition ◽  
Life Threatening ◽  
Competing Interest

IntroductionNeuroleptic malignant syndrome (NMS) takes place in patients in treatment with neuroleptics and it is potentially lethal, being important an early diagnostic and therapeutic approach.ObjectivesTo analyze from a clinical case the clinical and epidemiological features, and therapeutical approach to NMS.MethodReview of some articles in Mental Health journals and analysis of the following clinical case: 68-year-old woman with bipolar disorder, hospitalized in manic phase. Usual treatment: lithium, trazodone, quetiapine and asenapine. During the admission to hospital, the patient started presenting hyperthermia, sweating, electrolyte disturbances, limb rigidity, and elevation of CPK levels. The suspicion was NMS, so neuroleptics were stopped and fluids and dantrolene were initiated, with favorable evolution.ResultsThe discharge diagnosis was NMS. Neuroleptics were gradually reintroduced under vigilance. The patient is stable and has not had new complications. NMS is an uncommon (0.02% to 3% among patients taking neuroleptic agents), but life-threatening condition. Its symptoms are hyperthermia, autonomic nervous system dysfunction, limb rigidity, altered consciousness… The attendant infections, consume of lithium, dehydration, iron deficiency and sharp changes in neuroleptic treatment are predisposing factors. The withdrawal of neuroleptics is the key of the treatment. Benzodiazepines can improve the prognosis, and electroconvulsive therapy can be necessary if there is no response to previous measures.ConclusionsNeuroleptic malignant syndrome is a life-threatening medical complication we should try to avoid by a correct and careful use of neuroleptics. Additionally, it is important the early treatment, taking withdrawal of neuroleptics as the key starting point.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Gestchwind syndrome and epileptic psychosis, beyond the schizophrenia frontier

2016 ◽  
Vol 33 (S1) ◽  
pp. S639-S639
Author(s):  
V. Rodriguez ◽  
C. Gómez ◽  
C. Gomis ◽  
L. González ◽  
E. Tercelán ◽  
...  
Keyword(s):  
Correct Diagnosis ◽  
Personal History ◽  
Psychotic Symptoms ◽  
Delusional Ideation ◽  
Religious Feeling ◽  
Cognitive Disturbances ◽  
History Of ◽  
False Diagnosis ◽  
Competing Interest ◽  
Clonic Convulsions

During late 19th and early 20th century neuropsychiatrists began to identify common behavioral and cognitive disturbances in epilepsy, but it is not until 1973 that Norman Gestchwind described the basics of what we know as Gestchwind syndrome. This syndrome includes the triada of hyper-religiosity, hypergraphia and hypo/hypersexuality and it was mainly associated with temporal lobe epilepsy. Moreover, it is well known the association between epilepsy and psychotic symptoms, the so-called schizophrenia-like syndrome, which can lead us to a false diagnosis of schizophrenia. We report a 44-year-old man who was brought to the hospital with delusional ideation of prosecution and reference in his work environment with important behavioral disruption, as well as delusional ideation of religious content. He had a diagnosis of schizophrenia since he was 18-years-old and personal history of generalized tonic-clonic convulsions in his twenties. During the admission, he recovered ad integrum very rapidly with low doses of risperidone, but referred recurrence of déjà vu episodes. After reviewing his patobiography and past medical history, we identified the presence of hypergraphia, hypersexuality and a profound religious feeling, fulfilling the criteria for Gestchwind syndrome, in the context of which was later diagnosed as chronic epileptic psychosis. It is very important a careful approach to the patobiography and personal history. Also, we should include classic differential diagnosis such as Gestchwind syndrome, as they can lead us finally to the correct diagnosis, which in this case meant not only a different treatment but also a better prognosis.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Antipsychotics-induced leukopenia and neutropenia: A case report and review of literature

2016 ◽  
Vol 33 (S1) ◽  
pp. S546-S546 ◽  
Author(s):  
H. Maatallah ◽  
H. Ben Ammar ◽  
M. Said ◽  
A. Aissa
Keyword(s):  
Case Report ◽  
Side Effects ◽  
Atypical Antipsychotics ◽  
Antipsychotic Drugs ◽  
Psychotic Symptoms ◽  
Review Of Literature ◽  
Blood Cell Count ◽  
Life Threatening ◽  
Dsm Iv ◽  
Competing Interest

IntroductionAntipsychotic drugs effectively control psychotic symptoms, but may cause important side effects, significantly increasing morbidity and mortality. Hematologic abnormalities are frequent and may be life-threatening in some patients. Many prospective investigations confirmed neutropenia as a frequent occurrence with virtually all atypical antipsychotics.Objective and methodsDefine epidemiological, clinical and therapeutic characteristics of antipsychotics – induced leukopenia and neutropenia through a case report and a review of literature.Case reportPatient 28 years old native of Tunis, with family history: brother who suffer of undifferentiated schizophrenia. Since the age of 16 years he has been followed for disorganized schizophrenia (DSM IV). He was initially put under Haldol Decanoate (2 months), fluphenazine (2 months), amisulpride (3 months), sulpride (2 months), olanzapine (3 months), Rispreridone (1 month), aripiprazole (5 months) leukopenia/neutropenia is occurring during treatment with each molecule and which promptly resolved after discontinuation. Reduced white blood cell count has also been reported after addition of lithium. Actually an ECT is proposed for this patient.ConclusionThis case report shows the importance of hematological monitoring during the course of typical or atypical treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Recognition and Treatment of the Catatonic Syndrome

1997 ◽  
Vol 12 (3) ◽  
pp. 135-147 ◽  
Author(s):  
Gregory Fricchione ◽  
George Bush ◽  
Manish Fozdar ◽  
Andrew Francis ◽  
Max Fink
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Mental Disorders ◽  
Neuroleptic Malignant Syndrome ◽  
Differential Diagnoses ◽  
Suggested Approach ◽  
Syndrome Diagnosis ◽  
History Of ◽  
Catatonic Syndrome ◽  
Malignant Catatonia

We define the catatonic syndrome and review the history of the concept of catatonia, including its recent acceptance as a syndrome. Diagnosis of the catatonic syndrome, with its associated extensive differential diagnoses related to systemic and mental disorders, is addressed. Catatonia is related to variants of the syndrome, such as lethal (malignant) catatonia and the neuroleptic malignant syndrome (NMS). Medical sequelae of these conditions are outlined. The literature on the treatment of the catatonic syndrome is reviewed, and a suggested approach to treatment and management of catatonic patients in the intensive care unit is provided. An hypothesis regarding the neuropathophysiological basis for the syndrome is also offered.

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.

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