scholarly journals A Case of Neuroleptic Malignant Syndrome in a Profoundly Intellectually Disabled Patient with Successful Reintroduction of Antipsychotic Therapy with Quetiapine

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Kamal Patel ◽  
Brandon Lilly ◽  
Oluwadamilare Ajayi ◽  
Kelly Melvin
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
First Generation ◽  
Early Recognition ◽  
Rare Condition ◽  
Signs And Symptoms ◽  
Antipsychotic Agent ◽  
Muscle Rigidity ◽  
Status Change ◽  
Antipsychotic Therapy ◽  
Autonomic Instability

Neuroleptic Malignant Syndrome (NMS) is a rare condition clinically characterized by muscle rigidity, hyperthermia, autonomic instability, and acute mental status change. NMS is most often associated with use of high-potency first-generation antipsychotic medications; though, other neuroleptics have been implicated as well. NMS can be fatal with estimated mortality rates as high as 20%. Patients experiencing certain severe complications, including renal failure, have been associated with mortality as high as 50%, stressing the need for early recognition and treatment. Here we present the case of a 54-year-old male that initially presented with symptoms suspicious for sepsis, but who eventually developed a clinical picture consistent with NMS. We describe the diagnostic and treatment process leading to symptom remission. We then discuss our decision to reintroduce an atypical antipsychotic agent, quetiapine. This case illustrates the importance of early recognition of the signs and symptoms of NMS and the need to initiate treatment promptly in order to prevent complications, including death. This case also highlights the decision to resume antipsychotic pharmacotherapy after adequate resolution of NMS, demonstrating that it can be done so safely if started at low doses coupled with intensive monitoring of the patient.

Neuroleptic Rechallenge after Neuroleptic Malignant Syndrome: Case Report and Literature Review

1988 ◽  
Vol 22 (6) ◽  
pp. 475-480 ◽  
Author(s):  
Amy J. Wells ◽  
Roger W. Sommi ◽  
M. Lynn Crismon
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Signs And Symptoms ◽  
Antipsychotic Agent ◽  
Antipsychotic Agents ◽  
Psychotic Symptoms ◽  
Muscle Rigidity ◽  
Close Monitoring ◽  
Altered Level ◽  
Time Period ◽  
Level Of Consciousness

Neuroleptic malignant syndrome (NMS) is associated with essentially all of the currently available antipsychotic agents. The signs and symptoms associated with the syndrome are hyperpyrexia, defined by body temperature > 38°C; extreme muscle rigidity, with or without elevated creatine Phosphokinase or hyperreflexia; and other symptoms such as altered level of consciousness and/or autonomic dysfunction as manifested by labile blood pressure, tachycardia, tachypnea, urinary or fecal incontinence, pallor, or diaphoresis. This potentially fatal syndrome complicates the treatment of patients with recurrent psychotic symptoms because of the possibility for recurrence of the NMS. A case of recurrent NMS is presented in which the patient was rechallenged with an antipsychotic agent. In addition, 41 reported cases of antipsychotic rechallenge after NMS are reviewed. The results of the review suggest that neuroleptic rechallenge following NMS is associated with an acceptable risk of recurrence in most patients. However, close monitoring for NMS and careful selection of patients for antipsychotic rechallenge is mandatory. A minimal time period of five days before rechallenge may also reduce the risk of recurrent NMS. Recurrence was not associated with patient age or gender, nor the antipsychotic agent used.

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 Neuroleptic Malignant Syndrome or Catatonia? A Case Report

2020 ◽  
Vol 6 (3) ◽  
pp. 190-193
Author(s):  
Sebastian Rodriguez ◽  
Keith A. Dufendach ◽  
Robert M. Weinreib
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Marked Improvement ◽  
Early Recognition ◽  
Signs And Symptoms ◽  
Clinical Syndrome ◽  
Review Of The Literature ◽  
Case Presentation ◽  
Life Saving ◽  
Intravenous Diazepam ◽  
Autonomic Instability

AbstractIntroductionA review of the literature has shown that there are many similarities in the presentation of neuroleptic malignant syndrome (NMS) and catatonia. Attempts to reconcile the differences have been made by suggesting that NMS and catatonia may represent different presentations of the same illness or that they lie within the same spectrum of a poorly understood clinical syndrome. The described case is of a patient who presented with NMS and catatonia which was difficult to diagnose, but which responded to treatment with intravenous diazepam.Case presentationThe case concerns a 22-year-old male admitted for pulmonary hypertension to an intensive care unit (ICU). Three days following admission, he developed a high fever that did not respond to antibiotics. The patient then developed rigidity, nocturnal agitation, decreased responsiveness, and somnolence. Without the use of bromocriptine (Novartis, Basel, Switzerland) or dantrolene (Par Pharmaceuticals, Chestnut Ridge, USA) discontinuation of neuroleptics combined with intravenous diazepam (Pfizer, NY, USA) led to a very rapid response and marked improvement in the case.ConclusionsEarly recognition and management of NMS and MC in a complex, gravely ill patient, may be accomplished in the ICU despite obfuscation of traditional signs and symptoms of the NMS and MC syndrome. Such interventions can have life-saving effects on patients in danger of fatal autonomic instability.

On the Early Recognition of Neuroleptic Malignant Syndrome

1986 ◽  
Vol 15 (4) ◽  
pp. 299-310 ◽  
Author(s):  
Terri Clark ◽  
Jambur Ananth ◽  
Stephen Dubin
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Clinical Picture ◽  
Early Recognition ◽  
Neuroleptic Drug ◽  
Altered Consciousness ◽  
Fatal Complication ◽  
Laboratory Findings ◽  
Autonomic Instability ◽  
Elevated Creatinine

Neuroleptic Malignant Syndrome, a serious and sometimes fatal complication, has been reported to occur in some patients with the administration of neuroleptic medications. Clinically it is manifested by four groups of symptoms which include muscular hypertonicity, autonomic instability, altered consciousness, and hyperthermia. Laboratory findings such as elevated creatinine phosphokinase and leukocytosis are also seen. While it is true that the incidence of the full blown clinical picture of this syndrome is rare, the authors report that only muscular hypertonicity and autonomic instability have occurred frequently in their setting leading to discontinuation of neuroleptics. Such abortive cases may go undetected. If properly diagnosed, the occurrence of this syndrome is not as rare as the published reports indicate. Second, it is reported that rechallenge with neuroleptics may not induce Neuroleptic Malignant Syndrome again. The authors noted recurrence of fever after rechallenge with a different neuroleptic drug. This article describes the method of early recognition and prevention of morbidity as well as mortality.

Neuroleptic malignant syndrome

2011 ◽  
Vol 26 (S2) ◽  
pp. 1235-1235
Author(s):  
A. Cruz
Keyword(s):  
Risk Factors ◽  
Neuroleptic Malignant Syndrome ◽  
Rare Complication ◽  
Clinical Signs ◽  
Specific Treatment ◽  
Signs And Symptoms ◽  
Clinical History ◽  
Altered Mental Status ◽  
Antipsychotic Therapy ◽  
Mesh Terms

IntroductionNeuroleptic malignant syndrome (NMS) is a rare and potentially fatal idiosyncratic drug reaction usually defined as a complication of treatment with antipsychotics. It is manifested by altered mental status, hyperpyrexia, rigidity and autonomic instability. This syndrome occurs in response to administration of drugs that induce dopamine blockage.ObjectivesStudy the risk factors, diagnosis, treatment and complications of NMS, by performing a literature review.AimsSummarize the main aspects of NMS that may have importance in usual clinical practice.MethodsPubMed was used to identify NMS articles published after 2000, associated with the MeSH terms “neuroleptic malignant syndrome” and “antipsychotic agents”.ResultsNMS is not dose-related and its aetiology is still unknown. There are many risk factors associated with the syndrome, such as demographic, individual, genetic and environmental factors and medication. In order to evaluate the medical situation, an accurate clinical history and physical examination should be fulfilled. NMS is also characterized by changes in laboratory investigation. There are no patognomonic findings, thus other different diagnosis should be considered. Specific treatment remains controversial. Treatment should be individualized for each patient, regarding characteristics, duration and severity of the clinical signs and symptoms. Resolution is usually verified in one to two weeks. Though there are cases in which the symptoms persist and comorbid process may occur.ConclusionsAlthough NMS is a rare complication of antipsychotic therapy, early diagnosis and treatment is essential to improve prognosis.

scholarly journals Paliperidone Inducing Concomitantly Syndrome of Inappropriate Antidiuretic Hormone, Neuroleptic Malignant Syndrome, and Rhabdomyolysis

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Jaspinder Kaur ◽  
Dileep Kumar ◽  
Mostafa Alfishawy ◽  
Ricardo Lopez ◽  
Issac Sachmechi
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Antidiuretic Hormone ◽  
Health Care Providers ◽  
Creatine Phosphokinase ◽  
Liver Enzymes ◽  
Antipsychotic Agent ◽  
Muscle Rigidity ◽  
Care Providers ◽  
High Grade Fever ◽  
Life Threatening

Paliperidone, an active metabolite of risperidone, is a new atypical antipsychotic agent. Syndrome of inappropriate antidiuretic hormone (SIADH), neuroleptic malignant syndrome (NMS), and rhabdomyolysis are the uncommon side effects of psychotropic drugs.We report a case of 35-year-old male with schizoaffective disorder who was admitted for acute-on-chronic exacerbation of his psychotic disorder for which intramuscular paliperidone 234 mg injection was given. Two days later, the patient developed hyponatremic seizures secondary to SIADH which was treated with hypertonic saline. On the third day, he developed high grade fever and severe muscle rigidity with raised creatine phosphokinase (CPK) and liver enzymes levels. He was treated with dantrolene 100 mg, bromocriptine 2.5 mg, and lorazepam 2 mg. Our patient required management of the three rare conditions following treatment with paliperidone. This case highlights the need for health care providers to be aware of the rare, potentially life threatening but preventable hyponatremia, NMS, and rhabdomyolysis as a possible adverse effect of paliperidone.

scholarly journals Neuroleptic malignant syndrome: a guide for psychiatrists

2020 ◽  
pp. 1-10
Author(s):  
Ovais Wadoo ◽  
Sami Ouanes ◽  
Mudasir Firdosi
Keyword(s):  
Adverse Reaction ◽  
Differential Diagnosis ◽  
Neuroleptic Malignant Syndrome ◽  
Clinical Presentation ◽  
Acute Hospital ◽  
Medical Emergency ◽  
Muscle Rigidity ◽  
Autonomic Instability ◽  
State Changes ◽  
Symptom Overlap

SUMMARY Neuroleptic malignant syndrome (NMS) is a rare and potentially fatal adverse reaction to drugs. In psychiatric practice, it is mainly associated with antipsychotics. The classic presentation is that of hyperpyrexia, muscle rigidity, mental state changes and autonomic instability. Subtle forms are difficult to recognise owing to symptom overlap with other conditions. This article discusses the clinical presentation of the syndrome, its differential diagnosis and use of supportive care, medication and electroconvulsive therapy in its treatment. It also explores prevention of NMS and reinstatement of treatment after an episode. It is stressed that all but the mildest forms of NMS should be considered a medical emergency that is properly managed in an acute hospital.

Acute basagranTM poisoning mimicking neuroleptic malignant syndrome

1999 ◽  
Vol 18 (8) ◽  
pp. 493-494 ◽  
Author(s):  
T-J Lin ◽  
D-Z Hung ◽  
W-H Hu ◽  
D-Y Yang ◽  
T-C Wu
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Sinus Tachycardia ◽  
Signs And Symptoms ◽  
Muscle Rigidity ◽  
Clinical Presentations ◽  
Surgical History ◽  
Commit Suicide

A 27-year-old robust man, without any medical and surgical history, attempted to commit suicide by consumption of 300 cc (44.1%, 132.3 g) basagranTM, a readily available herbicide. This poisoning resulted in vomiting, fever, sweating, pipe-like muscle rigidity, sinus tachycardia, drowsiness, leukocytosis, rhabdomyolysis and hepatorenal damage. Emperical treatment with bromocriptine was temporally associated with resolution of above signs and symptoms. His clinical presentations and the effect of bromocriptine may be indicative that basagranTm poisoning mimicks neuroleptic malignant syndrome.

scholarly journals Case Report: Ziprasidone induced neuroleptic malignant syndrome

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 124 ◽  
Author(s):  
Yub Raj Sedhai ◽  
Alok Atreya ◽  
Prabin Phuyal ◽  
Soney Basnyat ◽  
Sagar Pokhrel
Keyword(s):  
Acute Kidney Injury ◽  
Neuroleptic Malignant Syndrome ◽  
Ventricular Arrhythmias ◽  
First Generation ◽  
Kidney Injury ◽  
Antipsychotic Agents ◽  
Significant Morbidity ◽  
Autonomic Instability ◽  
Neurologic Emergency ◽  
Muscle Hypertonia

Neuroleptic malignant syndrome (NMS) is a well-recognized neurologic emergency. It presents with classic features including hyperthermia, autonomic instability, muscle hypertonia, and mental status changes. The syndrome is potentially fatal and is associated with significant morbidity due to complications such as rhabdomyolysis, acute kidney injury, and ventricular arrhythmias due to the trans-cellular electrolyte shift. NMS is conventionally associated with the first-generation antipsychotic agents, however, has been described with the use of atypical and novel antipsychotics including Ziprasidone. A case of NMS with Ziprasidone use at the therapeutic dose is reported here.

scholarly journals Neuroleptic malignant syndrome due to risperidone misdiagnosed as status epilepticus

2011 ◽  
Vol 3 (3) ◽  
pp. 19 ◽  
Author(s):  
Ali Ertug Arslankoylu ◽  
Meryem Ozlem Kutuk ◽  
Cetin Okuyaz ◽  
Fevziye Toros
Keyword(s):  
Status Epilepticus ◽  
Emergency Room ◽  
Neuroleptic Malignant Syndrome ◽  
Neuroleptic Drug ◽  
High Dose ◽  
Muscle Rigidity ◽  
Neuroleptic Treatment ◽  
The Past ◽  
Autonomic Instability ◽  
Risperidone Treatment

Neuroleptic malignant syndrome (NMS) is a rare but potentially fatal disease characterized by fever, muscle rigidity, delirium and autonomic instability. Here we report a child, with NMS due to the risperidone misdiagnosed as status epilepticus. Nine year old boy, who had been under high dose risperidone treatment for 8 weeks, admitted to the emergency room because of the contractions (evaluated as status epilepticus) persisting for 7 hours. Since there was neuroleptic treatment in the past medical history and, unconsciousness, muscular rigidity, diaphoresis, hypertermi and, hypotension in physical examination, leucocytosis and elevated creatininphosphokinase levels in laboratory tests, the patient was evaluated as NMS and discharged without any complications. We reported this case to point out that; NMS may be misdiagnosed as status epilepticus in children when EEG monitoring is unavailable. When a child admitted to the emergency room because of suspicious convulsion neuroleptic drug use must surely be asked.

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