Neuroleptic malignant syndrome and delirious mania as malignant catatonia in autism: prompt relief with electroconvulsive therapy

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.

Download Full-text

Diagnostic, Treatment, and System Challenges in the Management of Recurrent Neuroleptic Malignant Syndrome on a General Medical Service

Case Reports in Psychiatry ◽

10.1155/2018/4016087 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5

Author(s):

Karan Verma ◽

Vivek Jayadeva ◽

Raymond Serrano ◽

Karthik Sivashanker

Keyword(s):

Neuroleptic Malignant Syndrome ◽

Electroconvulsive Therapy ◽

Medical Service ◽

Clinical Course ◽

General Medical Service ◽

Psychiatric Ward ◽

High Morbidity ◽

Intervention Protocol ◽

Delayed Recognition ◽

Malignant Catatonia

Neuroleptic malignant syndrome (NMS), an iatrogenic form of malignant catatonia, carries high morbidity and mortality rates especially in the context of delayed recognition and standard intervention protocol of lorazepam trial. However, there is limited guidance available through literature for further management if benzodiazepine treatment is ineffective and electroconvulsive therapy (ECT) is not readily accessible. This case report describes a multimodal approach to address the diagnostic, treatment, and logistical system challenges in an acute medical hospital through the case of a 69-year-old man with schizophrenia who represented from a psychiatric ward with neuroleptic malignant syndrome. We educated our inpatient colleagues for timely recognition of hyperexcited subtype of catatonia to avoid iatrogenic progression to neuroleptic malignant syndrome and our medical colleagues on the clinical course of catatonic symptoms to avoid any further disagreements and delays in treatment. We advocated for timely electroconvulsive therapy in the setting of limited access and utilized creative pharmacologic strategies such as N-methyl-D-aspartate (NMDA) receptor antagonists and longer acting benzodiazepines while managing medical complications.

Download Full-text

Role of electroconvulsive therapy in neuroleptic malignant syndrome (NMS)

Acta Psychiatrica Scandinavica ◽

10.1111/j.1600-0447.1987.tb02927.x ◽

1987 ◽

Vol 76 (5) ◽

pp. 603-604 ◽

Cited By ~ 6

Author(s):

Adityanjee

Keyword(s):

Neuroleptic Malignant Syndrome ◽

Electroconvulsive Therapy

Download Full-text

Neuroleptic malignant syndrome: a case responding to electroconvulsive therapy plus bupropion

Clinics and Practice ◽

10.4081/cp.2018.1044 ◽

2018 ◽

Cited By ~ 3

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.

Download Full-text