scholarly journals Use of Dantrolene and Ativan to Treat Overlapping Diagnosis NMS Versus Malignant Catatonia Case Report

2021 ◽  
Author(s):  
Dynela Garcia-Baran ◽  
Sam Collier ◽  
Alejandro Ortiz
Keyword(s):  
Case Report ◽  
Hospital Stay ◽  
Neuroleptic Malignant Syndrome ◽  
Second Generation ◽  
Treatment Guidelines ◽  
Manic Episode ◽  
Type I ◽  
Second Generation Antipsychotics ◽  
Simultaneous Intervention ◽  
Malignant Catatonia

Abstract We present a case report of a patient who developed symptoms resembling malignant catatonia and neuroleptic malignant syndrome. Suspicion of neuroleptic malignant syndrome arose after treatment over his course of hospital stay with three different second-generation antipsychotics for a first-time bipolar type I manic episode. After a hospital stay of 5 days, the patient developed symptoms that could be interpreted as malignant catatonia or neuroleptic malignant syndrome. Administration of antipsychotics was immediately ceased, and the patient was transferred to the ICU where he was treated with dantrolene and higher dosages of Ativan. The patient improved after simultaneous intervention for both possible diagnoses. After approximately one month, quetiapine, one of the second generation antipsychotics previously prescribed, was restarted with good results and no reoccurrence of NMS or malignant catatonia. This case illustrates the potential dilemma faced when differentiation between the two obscure diagnoses is necessary. Diagnosis is typically established through clinical observation and monitoring of symptom evolution after the administration of neuroleptics. The treatment algorithms for each diagnosis vary as can the respective outcomes. Our case also highlights the dearth of research available on distinguishing neuropathologic psychiatric disorders from pathophysiologic psychomotor syndromes. It also focuses on the need for sound diagnostic scoring scales that will clarify the diagnostic picture as well as treatment guidelines to ensure best outcomes.

scholarly journals Second-Generation Antipsychotics and Neuroleptic Malignant Syndrome: Systematic Review and Case Report Analysis

Drugs in R&D ◽  
2015 ◽  
Vol 15 (1) ◽  
pp. 45-62 ◽  
Author(s):  
Martino Belvederi Murri ◽  
Argentina Guaglianone ◽  
Michele Bugliani ◽  
Pietro Calcagno ◽  
Matteo Respino ◽  
...  
Keyword(s):  
Systematic Review ◽  
Case Report ◽  
Neuroleptic Malignant Syndrome ◽  
Second Generation ◽  
Second Generation Antipsychotics ◽  
Report Analysis

Five-year Course of Bipolar Disorder Following Treatment of First Manic Episode with Risperidone Versus Olanzapine: A Retrospective Review

2017 ◽  
Vol 41 (S1) ◽  
pp. S206-S206
Author(s):  
K. Kulkarni ◽  
G. Devasthali ◽  
A. Purty ◽  
M. Kesavan ◽  
J. Reddy ◽  
...  
Keyword(s):  
Treatment Guidelines ◽  
Retrospective Chart Review ◽  
Mood Stabilizer ◽  
Manic Episode ◽  
Complete Recovery ◽  
Mood Stabilizers ◽  
First Episode ◽  
Second Generation Antipsychotics ◽  
Icd 10 ◽  
Competing Interest

ObjectiveContemporary treatment guidelines recommend use of second-generation antipsychotics (SGAs) either as mono therapy or in combination with mood stabilizers as first-line treatment. While these drugs have been established to have superior efficacy compared to placebo, there is very less data comparing these antipsychotics with one another. We sought to study differences in the five-year outcome of first episode of mania (FEM) treated with olanzapine or risperidone, either alone or in combination with mood stabilizer.MethodsWe conducted a retrospective chart review of patients diagnosed with FEM (ICD-10) in the year 2008 (n = 88) at our centre. We selected the data of patients prescribed either olanzapine or risperidone for the purpose of this analysis. We extracted data about time to recovery and recurrence after FEM, total episodes, drug compliance and response, and number of follow-up visits from 2008 to 2013. The study was approved by the Institute Ethics Committee.ResultsA total of 88 patients received diagnosis of FEM in the year 2008, of which 50 (56.8%) received risperidone and 35 (39.8%) received olanzapine. The two groups were comparable in socio-demographic and clinical symptomatology of FEM (all P > 0.08). Complete recovery was significantly more in the olanzapine group than the risperidone group (χ2 = 4.84, P < 0.05).ConclusionOur study indicates that risperidone and olanzapine, either alone or in combination with mood stabilizers have a similar impact on the five-year course of BD following a first manic episode. However, olanzapine is associated with more complete recovery from FEM than risperidone.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Early introduction of clozapine after neuroleptic malignant syndrome may prevent malignant catatonia: A case report

2017 ◽  
Vol 27 (1) ◽  
pp. 91-92 ◽  
Author(s):  
G. van Rooijen ◽  
M. Strypet ◽  
A. Maat ◽  
D.S Scheepens ◽  
M.S. Oudijn ◽  
...  
Keyword(s):  
Case Report ◽  
Neuroleptic Malignant Syndrome ◽  
Early Introduction ◽  
Malignant Catatonia

Neuroleptic Malignant Syndrome: A Pilot Study on Psychiatric Inpatients in Iran

2019 ◽  
Vol 8 (3) ◽  
pp. 207-212
Author(s):  
Saeed S. Shafti ◽  
Alireza Memarie ◽  
Masomeh Rezaie ◽  
Masomeh Hamidi
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
First Generation ◽  
Second Generation ◽  
Psychiatric Patients ◽  
Statistical Significance ◽  
P Value ◽  
Antipsychotic Treatment ◽  
Second Generation Antipsychotics ◽  
Significant Difference ◽  
Male Patients

Background: Neuroleptic malignant syndrome is a life-threatening complication that can occur anytime during antipsychotic treatment. Objective: The present assessment has probed the incidence and clinical profile of neuroleptic malignant syndrome among a sample of non-western psychiatric patients and compared with the available data in the literature with regard to prevalence and other associated clinical physiognomies. Methods: As a retrospective, record-based evaluation, all cases with diagnosis of neuroleptic malignant syndrome during the last sixty-two months, after ruling out other imaginable differential diagnoses, like encephalitis, meningitis and serotonin syndrome, entered the present investigation. Clinical diagnosis, was in essence also based on the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. The assessment of independent variables was analyzed by ‘Compression of proportions’. Statistical significance is, defined as p value ≤0.05. Results: Among 19814 psychiatric patients, during a sixty-two months’ period, eighteen cases received the diagnosis of neuroleptic malignant syndrome. The most prevalent symptom was fever, which was observed in 100% of cases. Also, there was no significant difference between the first generation versus second-generation antipsychotics. Neuroleptic malignant syndrome was meaningfully more prevalent among male patients suffering from schizophrenia. Similarly, it was significantly more widespread amid 18-65 years old agegroup. Conclusion: While no significant difference was found between first-generation as opposed to second-generation antipsychotics, neuroleptic malignant syndrome was significantly more prevalent among young and male patients suffering from schizophrenia.

scholarly journals Comparison of neuroleptic malignant syndrome induced by first- and second-generation antipsychotics

2012 ◽  
Vol 201 (1) ◽  
pp. 52-56 ◽  
Author(s):  
Julian N. Trollor ◽  
Xiaohua Chen ◽  
Kate Chitty ◽  
Perminder S. Sachdev
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Clinical Characteristics ◽  
Antipsychotic Drugs ◽  
Second Generation ◽  
Clinical Profile ◽  
Clinical Presentations ◽  
Second Generation Antipsychotics ◽  
Extrapyramidal Signs ◽  
Second Generation Antipsychotic ◽  
First And Second Generation

BackgroundReports of neuroleptic malignant syndrome (NMS) induced by second-generation antipsychotic drugs highlight a propensity for atypical clinical presentations.AimsTo systematically compare the clinical profile of NMS induced by first- (1G-NMS) and second-generation antipsychotic drugs (2G-NMS).MethodThe Australian Adverse Drug Reaction Advisory Committee (ADRAC) database was searched to identify individuals with NMS reported between April 1994 and September 2010. The clinical characteristics of 208 people with NMS induced by monotherapy with first- or second-generation antipsychotic drugs, as well as presenting features of NMS, were compared.ResultsThe individuals with 2G-NMS were younger and more likely to have a psychotic disorder diagnosis. The features of NMS in the two groups were very similar, except that people with 2G-NMS were less likely to present with rigidity or extrapyramidal signs compared with those with 1G-NMS. This difference was due to the lower rates of rigidity in those with clozapine-induced NMS. Mortality was considerably lower for those with 2G-NMS (3.0%) compared with 1G-NMS (16.3%), and the former were more likely to have received supportive treatment.ConclusionsThe clinical profile of 2G-NMS is largely similar to 1G-NMS, with clozapine-induced NMS being differentiated by the relative lack of rigidity as a feature. Mortality is lower for 2G-NMS.

scholarly journals Epidemiology and Treatment Guidelines of Negative Symptoms in Schizo-phrenia in Central and Eastern Europe: A Literature Review

2015 ◽  
Vol 11 (1) ◽  
pp. 158-165 ◽  
Author(s):  
Monika Szkultecka-Dębek ◽  
Jacek Walczak ◽  
Joanna Augustyńska ◽  
Katarzyna Miernik ◽  
Jarosław Stelmachowski ◽  
...  
Keyword(s):  
Clinical Guidelines ◽  
Negative Symptoms ◽  
Second Generation ◽  
Treatment Guidelines ◽  
Unmet Need ◽  
Mental Illnesses ◽  
First Episode ◽  
Standardized Mortality Ratio ◽  
Second Generation Antipsychotics ◽  
Eastern European Countries

Aim: To gather and review data describing the epidemiology of schizophrenia and clinical guidelines for schizophrenia therapy in seven Central and Eastern European countries, with a focus on negative symptoms.Methods:A literature search was conducted which included publications from 1995 to 2012 that were indexed in key databases.Results:Reports of mean annual incidence of schizophrenia varied greatly, from 0.04 to 0.58 per 1,000 population. Lifetime prevalence varied from 0.4% to 1.4%. One study reported that at least one negative symptom was present in 57.6% of patients with schizophrenia and in 50–90% of individuals experiencing their first episode of schizophrenia. Primary negative symptoms were observed in 10–30% of patients. Mortality in patients with schizophrenia was greater than in the general population, with a standardized mortality ratio of 2.58–4.30. Reasons for higher risk of mortality in the schizophrenia population included increased suicide risk, effect of schizophrenia on lifestyle and environment, and presence of comorbidities. Clinical guidelines overall supported the use of second-generation antipsychotics in managing negative symptoms of schizophrenia, although improved therapeutic approaches are needed.Conclusion:Schizophrenia is one of the most common mental illnesses and poses a considerable burden on patients and healthcare resources alike. Negative symptoms are present in many patients and there is an unmet need to improve treatment offerings for negative symptoms beyond the use of second-generation antipsychotics and overall patient outcomes.

A comparison of risperidone and olanzapine in the acute treatment of persistent delusional disorder: Data from a retrospective chart review

2016 ◽  
Vol 33 (S1) ◽  
pp. S544-S544
Author(s):  
K. Kulkarni ◽  
R. Arasappa ◽  
K. Prasad ◽  
A. Zutshi ◽  
P. Chand ◽  
...  
Keyword(s):  
Chart Review ◽  
Second Generation ◽  
Treatment Guidelines ◽  
Treatment Options ◽  
Specific Treatment ◽  
Retrospective Chart Review ◽  
Delusional Disorder ◽  
Response To Treatment ◽  
Second Generation Antipsychotics ◽  
Competing Interest

IntroductionThere is a lack of pharmacological trials studying drug response in Persistent Delusional Disorder (PDD) to guide clinical practice. Available reviews of retrospective data indicate good response to second-generation antipsychotics, but even such data from India is sparse.Objectives and aimsWe aimed to compare the response of acute PDD to risperidone and olanzapine in our retrospective review.MethodsWe conducted a retrospective chart review of patients diagnosed with PDD (ICD-10) from 2000 to 2014 (n = 455) at our Center. We selected the data of patients prescribed either olanzapine or risperidone for the purpose of this analysis. We extracted data about dose, drug compliance and response, adverse effects, number of follow-up visits and hospitalizations. The study was approved by the Institute Ethics Committee.ResultsA total of 280/455 (61%) were prescribed risperidone and 86/455 (19%) olanzapine. The remaining (n = 89; 20%) had received other antipsychotics. The two groups were comparable in socio-demographic and clinical characteristics of PDD. Compliance was good and comparable in both groups (> 80%, P = 0.2). Response to treatment was comparable in both groups (85% partial response and > 52% good response, all P > 0.3). Olanzapine was effective at lower mean chlorpromazine equivalents than risperidone (240 vs. 391, P < 0.05).ConclusionOur study indicates a good response to both risperidone and olanzapine, if compliance to treatment can be ensured. In the absence of specific treatment guidelines for PDD, second-generation antipsychotics like risperidone and olanzapine offer good treatment options for this infrequently encountered and difficult to treat psychiatric disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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