Carbamazepine and Forme Fruste Neuroleptic Malignant Syndrome

1990 ◽  
Vol 157 (3) ◽  
pp. 437-438 ◽  
Author(s):  
Tim Dalkin ◽  
Alan S. Lee
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Altered Consciousness ◽  
Autonomic Instability

A woman developed rigidity, autonomic instability and altered consciousness after taking an overdose of trifluoperazine and carbamazepine. A diagnosis of NMS was made despite the absence of fever, as carbamazepine might modify the presentation of NMS.

An Iatrogenic Catatonia

2016 ◽  
Author(s):  
Robertus M. A. de Bie
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Creatine Phosphokinase ◽  
D2 Receptor ◽  
Disease Course ◽  
Atypical Neuroleptics ◽  
Altered Consciousness ◽  
Creatine Phosphokinase Level ◽  
Autonomic Instability ◽  
Increasing Temperature ◽  
Degrees Of Severity

Neuroleptic malignant syndrome is an iatrogenic movement disorders emergency characterized by rigidity, altered consciousness, and autonomic instability of varying degrees of severity. In severe cases this can be a fatal syndrome, so recognition and withdrawal of potentially causative medications is the priority. Management is otherwise supportive, and some patients will require admission to an intensive care unit. Creatine phosphokinase can be used to monitor the disease course; a decreasing creatine phosphokinase level with an increasing temperature may indicate an infection. The incidence of neuroleptic malignant syndrome has declined considerably with the increased use of atypical neuroleptics with greater D2 receptor blockade compared to older agents.

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.

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.

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

scholarly journals Neuroleptic malignant syndrome with abnormally elevated cardiac troponin I: a case report

2020 ◽  
Vol 48 (11) ◽  
pp. 030006052096834 ◽  
Author(s):  
Qiang Wang ◽  
Jiabo Shi ◽  
Peng Zhao ◽  
Qiuyun Cao ◽  
Zhijian Yao
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Cardiac Troponin I ◽  
Major Depressive ◽  
Cardiology Department ◽  
Autonomic Instability ◽  
Life Threatening ◽  
Physical Examinations ◽  
The Relationship

Neuroleptic malignant syndrome (NMS) is a life-threatening neurological emergency that is primarily characterized by altered consciousness, hyperpyrexia, muscular rigidity, and autonomic instability. Here, we describe a unique case of NMS. A 54-year-old woman with major depressive disorder (MDD) was admitted to our hospital to relieve painful emotions; her laboratory tests and physical examinations were unremarkable. Her medication regime was as follows: day 1, quetiapine (200 mg), clonazepam (2 mg), and zopiclone (7.5 mg); day 2, olanzapine (5 mg) and sertraline (100 mg); day 3, olanzapine (15 mg), sertraline (100 mg), zopiclone (7.5 mg), and clonazepam (2 mg); day 4, olanzapine (15 mg) and haloperidol (5 mg); and day 5, sertraline (50 mg) and olanzapine (5 mg). The patient then developed NMS, and a series of tests showed further abnormalities. Unusually, her cardiac troponin I (TNI) was abnormally elevated as her NMS symptoms worsened, but gradually decreased after she was transferred to the cardiology department for treatment. The increased TNI was suspected to be related to the NMS. Here, we provide several potential explanations for the relationship between TNI and NMS. Based on the present case, it may be important to measure and monitor TNI concentrations in NMS patients.

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 Malignant Syndrome: Two Cases without Muscle Rigidity

1996 ◽  
Vol 30 (3) ◽  
pp. 415-418 ◽  
Author(s):  
Michael M.C. Wong
Keyword(s):  
Skeletal Muscle ◽  
Neuroleptic Malignant Syndrome ◽  
Clinical Picture ◽  
The Other ◽  
Clinical Severity ◽  
Muscle Rigidity ◽  
Supportive Treatment ◽  
Altered Consciousness ◽  
Nervous Systems ◽  
Autonomic Nervous

Objective: Two patients with neuroleptic malignant syndrome without muscle rigidity are described. Clinical picture: Both patients developed fever and altered consciousness while taking neuroleptic but did not develop muscle rigidity; the symptoms subsided when the neuroleptic was stopped but recurred when it was given again. Treatment: The neuroleptic was stopped; one patient received supportive treatment and the other received bromocriptine. Outcome: One patient died while the other survived. Conclusion: The pathophysiology is proposed as a combination of involvement of the central thermoregulatory, neuroregulatory and autonomic nervous systems, and the peripheral skeletal muscle. It supports the concept of a spectrum of clinical severity of neuroleptic malignant syndrome.

scholarly journals Case Report: Neuroleptic malignant syndrome in a HIV-positive patient

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 1382
Author(s):  
Sibi Joseph ◽  
Jerry George ◽  
Mongezi Tau ◽  
Lourdes de Fatima Ibanez-Valdes ◽  
Thozama Dubula ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Neuroleptic Malignant Syndrome ◽  
Medical Literature ◽  
Hiv Positive ◽  
Altered Consciousness ◽  
Blood Tests ◽  
The Family ◽  
Show Evidence ◽  
Upper Limb Movements ◽  
Comprehensive History

We report a 29-year-old, HIV-positive woman being treated with antipsychotic medication for psychosis (Clopixol 200mg intramuscularly monthly, Risperidone 2mg orally daily Haloperidol 2.5mg twice a day), who presented with neuroleptic malignant syndrome. She was also receiving lorazepam and sodium valproate. The patient was referred to our department as she had developed involuntary upper limb movements and simple permanent focal seizure on the lower part of the left hemiface. Clinically the patient had altered consciousness, autonomic dysfunction, and rigidity. Her blood tests showed elevated creatine kinase (1467U/L) but no leucocytosis. We did a thorough workup for other causes of such a presentation. A comprehensive history was taken from the family to exclude other medications used. Her cerebrospinal fluid results were average. Blood tests did not show evidence of infection or other abnormalities. Computed tomography brain was normal. The patient died a few days after the beginning of the attack, which we have also observed  in other HIV-female patients. As far as we know, it is the first report about this comorbidity reported in the medical literature.

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: 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.

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