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.

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.

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.

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.

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.

Neuroleptic Malignant Syndrome and Serotonin Syndrome

2019 ◽  
Author(s):  
Richard Sanders ◽  
Richard Krysiak
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Dopamine Agonists ◽  
Serotonin Syndrome ◽  
Clinical Symptoms ◽  
Altered Mental Status ◽  
Muscle Relaxants ◽  
Autonomic Instability ◽  
Life Threatening ◽  
Dopamine Circuits ◽  
Pharmacologic Treatments

Serotonin syndrome (SS) and neuroleptic malignant syndrome (NMS) are iatrogenic life-threatening conditions with similar clinical symptoms. Altered mental status, rigidity, and autonomic instability are common in both serotonin overload and toxic dopamine antagonism. It is paramount that providers understand the key differences between these two pathologies, as pharmacologic treatments can exacerbate the condition if SS is mistaken for NMS or vice versa. Hyperreflexia, clonus, diarrhea, and vomiting suggest the excessive activity of serotonin circuits in SS, whereas prominent rigidity and hyporeflexia suggest the underactivity of dopamine circuits in NMS. Supportive care and discontinuing the offending agent(s) are keys to treating both syndromes, but serotonin antagonists (eg, cyproheptadine) could be helpful in SS, whereas NMS may sometimes benefit from muscle relaxants (eg, dantrolene) and dopamine agonists (eg, bromocriptine). Following recovery, decisions about further use of an inciting agent (or similar agents) require reconsideration of risks, benefits, and alternatives, based on newly realized hazards. It is usually important to wait at least 2 weeks before rechallenge with any drugs resembling the inciting agents. This review contains 1 figure, 5 tables, and 29 references. Key Words: bromocriptine, cyproheptadine, dantrolene, Hunter criteria, neuroleptic malignant syndrome, parkinsonism, serotonin 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

Risperidone-Induced Neuroleptic Malignant Syndrome

1996 ◽  
Vol 30 (7-8) ◽  
pp. 775-778 ◽  
Author(s):  
Roopali Sharma ◽  
Brian Trappler ◽  
Yiu Kee Ng ◽  
Cavin P Leeman
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Medical Records ◽  
Altered Mental Status ◽  
Resident Physician ◽  
Muscle Rigidity ◽  
Data Synthesis ◽  
Unsuccessful Treatment ◽  
Data Source ◽  
Prolonged Hospital ◽  
Supportive Management

OBJECTIVE: To describe a patient with neuroleptic malignant syndrome (NMS) induced by risperidone, an atypical antipsychotic, and to review the available literature related to risperidone-associated NMS. DATA SOURCE: Case report information was obtained from the resident physician and medical records. MEDLINE and Index Medicus were searched to obtain literature published between 1960 and 1995. DATA SYNTHESIS: We report an adolescent boy who developed NMS after treatment with risperidone. Risperidone therapy was started after unsuccessful treatment and development of extrapyramidal adverse effects with haloperidol. The patient demonstrated the classic tetrad of fever, generalized skeletal muscle rigidity, altered mental status, and autonomic dysfunction. Risperidone was discontinued and the patient recovered after a prolonged hospital course with supportive management. CONCLUSIONS: Clinicians are cautioned about the possibility of NMS with risperidone.

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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