Tatalaksana Neuroleptik Malignant Syndrome di Intensif Care Unit Dengan Impending Organ Failure

Neuroleptic Malignant Syndrome adalah sebuah sindrom khas dan merupakan komplikasi pengobatan antipsikotik yang mengancam jiwa. Neuroleptic Malignant Syndrome memberikan gambaran klinis seperti rigiditas, hipertermia, dan perubahan status mental. Morbiditas dan mortalitas pada Neuroleptic Malignant Syndrome sering akibat sekunder dari komplikasi jantung, paru-paru dan ginjal sehingga diperlukan perawatan intensif. Penatalaksanaan Neuroleptic Malignant Syndrome adalah menghentikan semua antipsikotik dan melakukan terapi suportif. Prognosis pasien Neuroleptic Malignant Syndrome akan mengalami perbaikan gejala dalam waktu dua minggu dan beberapa pasien sembuh tanpa gejala sisa neurologis. Telah dilakukan perawatan terhadap pasien perempuan usia 21 tahun dengan Neuroleptic Malignant Syndrome. Selama di ICU pasien mengalami demam, kekakuan otot, tremor dan mioglobinuria. Perawatan yang dilakukan berupa monitoring pernafasan, monitoring hemodinamik, dan terapi supportif. Selama perawatan di ICU kondisi pasien cenderung membaik dan kembali ke bangsal setelah perawatan hari ke sebelas. Tujuan penulisan laporan kasus ini adalah mengetahui pentingnya tatalaksana yang tepat pada pasien Neuroleptic Malignant Syndrome sehingga dapat menghindari kerusakan organ yang berat dan irreversible di ICU.

Neuroleptic Malignant Syndrome in an Elderly Patient with Bipolar Disorder

Neuroleptic malignant syndrome (NMS) is a well-known and potentially fatal complication of antipsychotic use. The elderly population, with multiple risk factors, are more vulnerable to this condition. We described a case of an 80-yearold man with bipolar disorder, previously on oral extended-release sodium valproate, aripiprazole and long-acting injectable paliperidone, who developed NMS. He presented with generalised muscle rigidity, fever, fluctuating blood pressure and elevated creatinine kinase during his hospitalisation for a manic episode. Contributing factors included old age, underlying vascular Parkinsonism, electrolyte imbalance, intercurrent lung infection with acute exacerbation of chronic obstructive pulmonary disease, hyperactive delirium, and repeated administration of parenteral typical antipsychotic. Antipsychotics were withheld promptly, and the patient was treated with dantrolene, bromocriptine and amantadine. His symptoms resolved after a week. He subsequently remained well with oral extended-release sodium valproate alone. Relevant clinical points are discussed. Clinical vigilance, close interdisciplinary cooperation, and prompt interventions are keys to successful to management of NMS in elderly patients.

Neuroleptic malignant syndrome: case report

Neuroleptic malignant syndrome (NMS) is an infrequent, but potentially life-threatening neurologic emergency associated with the use of neuroleptic or antipsychotic drugs. A 43 years old male with a history of trigeminal neuralgia developed Neuroleptic malignant syndrome while receiving Carbamazepine and Amitryptylline. Treatment is mainly supportive and includes withdrawal of the neuroleptic medication and, possibly, administration of drugs such as dantrolene and bromocriptine. Complications of NMS include acute renal failure and acute respiratory failure. The possible etiologies, triggering factors and treatment are discussed with reference to existing literature.

Neuroleptic Malignant Syndrome in Children with Autism Spectrum Disorder (ASD): A Case Report and Brief Review of Recent Literature

Neuroleptic malignant syndrome (NMS) is a rare, life-threatening, idiosyncratic adverse reaction to antipsychotic drugs. Despite the increasing rates in the prescription of antipsychotics in pediatric patients with autism spectrum disorder (ASD), little is known about the occurrence and hallmarks of NMS in this specific population. NMS appears to be part of the larger catatonia domain, based on the frequent relationship between ASD and catatonia, on the shared, when not overlapping, clinical features with malignant catatonia, and on the effectiveness of catatonia treatments on the NMS/MC symptoms. The intrinsic difficulties of exploring NMS in ASD in controlled studies accounts for the subsequent lack of available information. Based on recent reports and on our case report, clinical features of NMS in the pediatric ASD population appear to be the same as the non-ASD population. Further studies are needed to confirm these results.

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

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.