Risk Factors For Neuroleptic Malignant Syndrome Research Articles

Neuroleptic Malignant Syndrome Concurrent with COVID-19 Infection: A Case Report.

Neuroleptic malignant syndrome (NMS), which most often occurs after the use of antipsychotics, is a rare but life-threatening condition. In this article, a 56-year-old male patient with a diagnosis of bipolar affective disorder (BPD) who developed NMS after a COVID-19 infection will be presented. The patient had been brought to the emergency room with high fever, fatigue, and slowness of movements that had been going on for two days. The examination revealed tachycardia, tachypnea, lethargy and rigidity. Upon further investigation the COVID-19 test came out positive and the serum levels of creatine kinase were considerably high. He was admitted to the psychiatric ward with diagnoses of COVID-19 infection and NMS. COVID-19 infection might have been a risk factor for NMS in this patient. Especially in patients who are taking antipsychotic drugs, if COVID-19 is present, the risk of NMS should be taken into consideration. Keyword: COVID-19, Neuroleptic Malignant Syndrome, Risperidone, Antipsikotik, Enfeksiyon.

Catatonia: Clinical Aspects and Neurobiological Correlates

Catatonia is a neuropsychiatric syndrome that can occur due to medical or psychiatric disorder. This review synthesizes over 20 years of original research and comprehensive review articles with attention to the most recent findings. Though catatonia is common and highly treatable, there have been few research studies investigating the syndrome. Pooled case reports suggest that catatonia due to an underlying general medical condition and catatonia due to a psychiatric illness can be treated similarly and that the catatonic symptoms and the underlying illness must be addressed in both types. Benzodiazepines and ECT continue to be mainstays of treatment. Evidence is mounting for the use of NMDA antagonists in catatonia refractory to lorazepam.

Risperidone-Induced Neuroleptic Malignant Syndrome in Neurodegenerative Disease

Risperidone-Induced Neuroleptic Malignant Syndrome in Neurodegenerative Disease

Neuroleptic Malignant Syndrome

Neuroleptic Malignant Syndrome

A case of neuroleptic malignant syndrome induced by olanzapine in postpartum period

Neuroleptic malignant syndrome (NMS) is a life-threatening medical complication that occurs as a result of dopaminergic receptor blockage in nigrostriatal pathways. This syndrome is mainly accepted to be an idiosyncratic reaction for antipsychotic medications. Incidence of NMS induced by olanzapine - an atypical antipsychotic - is extremely rare. However, there has been contradiction on postpartum period as a risk factor for NMS. This case is of interest due to the fact that it happens on postpartum period and is induced by olanzapine. We aimed in this study to evaluate the successfully cured case of neuroleptic malignant syndrome induced by olanzapine in postpartum period with the literature view.

Possible neuroleptic malignant syndrome related to concomitant treatment with paroxetine and alprazolam

A 74-year-old man with depressive symptoms was admitted to a psychiatric hospital due to insomnia, loss of appetite, exhaustion, and agitation. Medical treatment was initiated at a daily dose of 20 mg paroxetine and 1.2 mg alprazolam. On the 10th day of paroxetine and alprazolam treatment, the patient exhibited marked psychomotor retardation, disorientation, and severe muscle rigidity with tremors. The patient had a fever (38.2 °C), fluctuating blood pressure (between 165/90 and 130/70 mg mm Hg), and severe extrapyramidal symptoms. Laboratory tests showed an elevation of creatine phosphokinase (2218 IU/L), aspartate aminotransferase (134 IU/L), alanine aminotransferase (78 IU/L), and BUN (27.9 mg/ml) levels. The patient received bromocriptine and diazepam to treat his symptoms. 7 days later, the fever disappeared and the patient's serum CPK levels were normalized (175 IU/L). This patient presented with symptoms of neuroleptic malignant syndrome (NMS), thus demonstrating that NMS-like symptoms can occur after combined paroxetine and alprazolam treatment. The adverse drug reaction score obtained by the Naranjo algorithm was 6 in our case, indicating a probable relationship between the patient's NMS-like adverse symptoms and the combined treatment used in this case. The involvement of physiologic and environmental aspects specific to this patient was suspected. Several risk factors for NMS should be noted in elderly depressive patients whose symptoms often include dehydration, agitation, malnutrition, and exhaustion. Careful therapeutic intervention is necessary in cases involving elderly patients who suffer from depression.

Neuroleptic malignant syndrome in cancer treatment

Neuroleptic malignant syndrome (NMS) is a life-threatening reaction to neuroleptics. Several prospective studies have reported NMS occurrence rates ranging from 0.07% to 2.2% of patients receiving neuroleptics. However, few occurrences of NMS have been reported in cancer patients despite frequent complications of cancer and its treatment by mental disorders managed with neuroleptic drugs. Exhaustion, dehydration, and malnutrition are considered risk factors for NMS, and cancer patients represent a high risk group for NMS. We describe a patient with metastatic chondrosarcoma who had received frequent neuroleptic injections prior to brain surgery and developed NMS in the intensive care unit immediately after surgery. The patient showed delirium, hyperpyrexia, tachycardia, diaphoresis, and extrapyramidal symptoms. After a diagnosis of NMS was made, supportive care and careful monitoring were carried out, and the patient recovered over an interval of 11 days. Clinical NMS studies have been conducted mainly in psychiatric units, but NMS can occur wherever psychotropic drugs are administered. NMS can be difficult to diagnose due to multiple complicating factors in cancer treatment, but the diagnosis is highly important given the risk of death. Recognition of prodromal NMS symptoms can facilitate actions to decrease morbidity and mortality. It is suggested that special attention to cancer patients undergoing psychopharmacologic treatment is required in clinical oncologic practice.

Clozapine-Induced Neuroleptic Malignant Syndrome and Subdural Hematoma

Clozapine-Induced Neuroleptic Malignant Syndrome and Subdural Hematoma

NMS and HIV

Back to table of contents Previous article Next article LetterFull AccessNMS and HIVEwald Horwath, M.D., and Francine Cournos, M.D.Ewald HorwathSearch for more papers by this author, M.D., and Francine CournosSearch for more papers by this author, M.D.Published Online:1 Apr 1999https://doi.org/10.1176/ps.50.4.564AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: In their excellent review of neuroleptic malignant syndrome (NMS) published in the September 1998 issue, Pelonero and associates (1) called attention to the role of poorly controlled or treatment-resistant extrapyramidal symptoms as risk factors for NMS. We would like to amplify this point and call attention to the association between HIV infection and increased sensitivity to extrapyramidal symptoms. Several authors have reported on cases of NMS in patients with AIDS, leading us to wonder whether advanced HIV infection may be a risk factor for NMS.Breitbart and associates (2) reported three cases of NMS in patients with AIDS dementia who were treated with neuroleptics. Rosebush and Stewart (3) reported on 24 cases of NMS occurring in 20 patients, one of whom was a 31-year-old man with AIDS. Swenson and associates (4) reported a case of AIDS and dementia in a man who developed severe extrapyramidal symptoms with many features of NMS while being treated with a phenothiazine, prochlorperazine, as an antiemetic. Vogel-Scibilia and colleagues (5) identified an episode of NMS in a literature review of 13 cases of HIV infection presenting as psychosis, of whom seven were treated with neuroleptics.These case reports call attention to the possible role of HIV infection as a risk factor for NMS. Several of these authors observe that HIV infection of the central nervous system may increase a patient's susceptibility to extrapyramidal symptoms. If increased sensitivity to extrapyramidal symptoms is a risk factor for NMS, as Pelonero and associates suggest, then it follows that HIV infection may predispose to NMS.Of note, five of the six cases of NMS reported by the authors cited above occurred in patients with AIDS, and most involved the use of standard, as opposed to atypical, antipsychotics. Some authors have suggested that the increased sensitivity to extrapyramidal symptoms may be a direct effect of HIV on the basal ganglia. At the very least, clinical caution is indicated when using standard antipsychotics in the treatment of patients with advanced HIV infection or AIDS.Dr. Horwath is associate clinical professor of psychiatry and Dr. Cournos is professor of clinical psychiatry at Columbia University College of Physicians and Surgeons in New York City.

Neuroleptic malignant syndrome in elderly patients.

Neuroleptic malignant syndrome (NMS) is a potentially lethal disorder that can occur in patients on neuroleptic medication.1 The main features of the syndrome are extrapyramidal symptoms and elevated temperature. Other common findings are autonomic instability, confusion, incontinence, diaphoresis, and agitation. Common laboratory abnormalities include leukocytosis and elevated creatine phosphokinase. It is commonly thought that NMS occurs predominantly in young patients2 and that it is generally underrecognized and unreported in the elderly.3 Despite these common views, a literature search of NMS revealed 18 cases of NMS occurring in patients 60 years old and over (Table 1).3–16 Of these, 14 were being treated with neuroleptics. Three cases occurred in patients with Parkinson's disease (PD) who had stopped antiparkinsonian medications, and in one patient with PD who developed NMS while continuing medication. Calling this syndrome NMS may be incorrect, as these patients were not receiving neuroleptic therapy; nevertheless the syndrome appears in an identical way. Furthermore, the occurrence of NMS in these patients lends support to the hypothesis that the underlying pathophysiology of NMS is hypodopaminergic functioning.14 The most common neuroleptic agent in these cases was haloperidol, a potent dopamine-receptor blocker. Although haloperidol is commonly implicated in cases of NMS,1 it is unclear whether this effect is related to its potent dopamine-blocking action or to the frequency of haloperidol use in this age group. Certainly haloperidol is often used in an elderly population because it has relatively fewer toxic effects on the cardiovascular system than other neuroleptic drugs. The patients in this series were receiving relatively large doses of neuroleptic drugs for this age group. This is consistent with the idea that high doses of neuroleptic drugs are a risk factor for NMS, though NMS may occur at a relatively low dosage. In the literature NMS has been reported in patients in various psychiatric diagnostic categories, including two patients with Alzheimer's disease. Early recognition of NMS symptoms in the elderly is critical. Morbidity and mortality in NMS are related to the development of cardiac problems, pneumonia, pulmonary emboli, and renal failure.17 Renal failure may occur secondary to myoglobinuria. As older patients frequently have preexisting medical illnesses involving these systems, they are more likely to suffer the devastating effects of this disorder. In this series, two cases resulted in death. The most important factor in treatment is the early recognition of the incipient syndrome and prompt discontinuation of neuroleptic medication. Supportive care must be instituted with careful monitoring of nutrition and fluid balance, and prevention of prolonged immobility. If NMS persists, more specific treatments are available. The benzodiazepines, bromocriptine, amantadine, and dantrolene have all been used with some success,18 but carefully controlled trials have not been done to determine their efficacy. All of these agents must be used with care as they all have potentially deleterious side effects. In summary, clinicians treating elderly patients with neuroleptics and antiparkinsonian medication should be carefully mindful of the possibility of the development of NMS. Early recognition of this potentially lethal syndrome is crucial.