Published: Jun 26, 2020
  
 
     
 
Keywords:
neuroleptic malignant syndrome
  
     
 
   
 
 
 
 
 
 
 
 
 
 
 

 

 
   
 
 
 
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    Home / Archives / Vol. 16 No. 1 (2020): ่January-Jane / Research Article  
 
   
 

Neuroleptic malignant syndrome:A review and report of six cases
   
 
   
   
     
 

Published: Jun 26, 2020
Keywords:
neuroleptic malignant syndrome

Main Article Content

Sarinthip Sirisuwannarat
Department ofpsychiatry,CharoenkrungPracharakHospitalMedical Service Department, Bangkok Metropolitan Administration.

Abstract

Introduction:The typical symptoms and signs of neuroleptic malignant syndrome (NMS) consist of fever, muscle rigidity, alteration of consciousness(i.e. confusion, agitation,aggression), autonomic nervous system disturbances (i.e. hypertension, tachycardia, tachypnea, profuse sweating and urine incontinence), abnormal blood test such as elevated serum creatine phosphokinase (CPK) level and leukocytosis. The mortality among NMS cases is in the 10-55% range depending on the severity of the symptoms and time of therapeutic approach.


Objective: To study in-depth about the clinical features,course,causative agent andtreatment ofthe patients who developed NMS. To provide an earlier diagnosis and treatment that can reduce the morbidity and mortality rate from NMS.


Materials and Methods:This study is a descriptive research.The author encountered six patients who were diagnosed NMS in CharoenkrungPracharakHospital between 2014 to 2017. All clinical records were studied in detail.


Results: The author reported six cases with clinical features of NMS. Three of them had been on antipsychotic drug for many years. One patient had the symptoms after abrupt withdrawal of antiparkinsonian drugs. One patient with underlying alcohol dependence and he had delirium tremens, developed NMS from haloperidol 5 mg intramuscular within 24 hours. One patient developed NMS from antidepressant drug. Two patients died from NMS. Four patients recovered from supportive treatment plus with specific medications [bromocriptine, benzodiazepine and anticholinergic drug (trihexyphenidyl)]. One patient restarts the same antiparkinsonian drug. All of the patients were rehydration, corrected electrolytes imbalance and stop the causative agent that induced NMS.


Conclusions: NMScan occasionally occurredin the patient using high risk drug.It requires timely and accurate diagnosis and treatment because of its life-threatening complications. The principles for treatment are to stop the offending drugor restart antiparkinsonian drug if the mechanism is from abrupt withdrawal of antiparkinsonian drug,then give the supportive and specific treatment.Administration of bromocriptine, dantrolene, benzodiazepine andelectroconvulsive therapy (ECT)proved life-saving.

  
     
     
 
    How to Cite  
     
  Sirisuwannarat, S. (2020). Neuroleptic malignant syndrome:A review and report of six cases. Journal of Charoenkrung Pracharak Hospital, 16(1), 1–24. Retrieved from https://he02.tci-thaijo.org/index.php/JCP/article/view/242730  
     

 
 
     
     
 
    Issue  
     
  Vol. 16 No. 1 (2020): ่January-Jane  

 
 
     
     
 
    Section  
     
  Research  article  

 
 
     
     
     
 

References

1. Delay J, Pichot P, Lempiere T, Blissalde B, Peigne F. Le neuroleptiquemajeur non phenothiazinique et non reserpinique, l’haloperidol, dans le traitement es psychoses. (A non-phenothiazine and non-reserpine major neuroleptic, haloperidol, in the treatment of psychoses) in French. Ann Med Psychol 1960;18:145-52.
2. กุลธิดา เมธาวศิน. ความรู้เบื้องต้นเกี่ยวกับการเคลื่อนไหวผิดปกติ.วารสารประสาทวิทยาศาสตร์ ภาคตะวันออกเฉียงเหนือ 2555; 7(4): 51-78.
3. Pelonero AL, Levenson JL, Pandurangi AK. Neuroleptic malignant syndrome: a review. Psychiatr Serv 1998;49(9):1163-72.
4. Su YP, Chang CK, Hayes RD, Harrison S, Lee W, Broadbent M, et al. Retrospective chart review on exposure to psychotropic medications associated with neuroleptic malignant syndrome. Acta PsychiatrScand 2014; 130:52-60.
5. Berman BD. Neuroleptic malignant syndrome: a review for neurohospitalists. Neurohospitalist 2011;1:41-7.
6. Bhanushali MJ, Tuite PJ. The evaluation and management of patients with Neuroleptic malignant syndrome. Neurologic Clin 2004;22(2):389-411.
7. Reilly TH, Kirk MA. Atypical antipsychotics and newer antidepressants.Emerg Med Clin North Am2007;25(2):477-97.
8. Adnet P, Lestavel P, Krivosic-Horber R. Neuroleptic malignant syndrome. Br J Anaesth2000;85(5):129-35.
9. Patil BS, Subramanym AA, Singh SL, Kamath RM. Low serum iron as a possible risk factor for neuroleptic malignant syndrome. Int J Appl Basic Med Res 2014; 4: 117-8.
10. HallRC,ApplebyB,HallRC.Atypicalneuroleptic malignantsyndromepresentingasfeverofunknownoriginintheelderly.SouthMedJ2005;98: 114-7.
11. Neuroleptic malignant syndrome. Diagnostic and statistical manual of mental disorders. 4thed. Washington, DC: American Psychiatric Association; 1994. p.739-42.
12. Fricchione G, Mann SC, Caroff SN. Catatonia, lethal catatonia, and neuroleptic malignant syndrome. Psychiatr Ann 2000; 30(5):347-55.
13. Lazarus A. Differentiating neuroleptic-related heatstroke from neuroleptic malignant syndrome. Psychosomatics1989; 30(4):454-6.
14. Martin TG. Serotonin syndrome. Ann Emerg Med 1996; 28(5):520-6.
15. Birmes P, Coppin D, Schmitt L, Lauque D. Serotonin syndrome: a brief review. Can Med Assoc J 2003;168(11):1439-42.
16. Christian A, Ellis F, Halsall P. Is there a relationship between masseteric muscle spasm and malignant hyperpyrexia?. Br J Anaesth 1989;62:540-4.
17. Strawn JR, Keck PE, Caroff SN. Neuroleptic malignant syndrome. Am J Psychiatry 2007;164(5):870-6.
18. Lenlerpetersen P, Hansen BD, Hasselstrom L. A rapidly progressing lethal case of neuroleptic malignant syndrome. Intensive Care Med 1990;16(4):267-8.
19. Levenson JL. Neuroleptic malignant syndrome. Am J Psychiatry 1985;142(3):1137-45.
20. Nierenberg D, Disch M, Manheimer E, Patterson J, Jonathan R, Gerard Set al. Facilitating prompt diagnosis and treatment of the neuroleptic malignant syndrome. Clin Pharm Ther 1991; 50: 580-6.
21. Gupta S, Nihalani ND. Neuroleptic malignant syndrome: a primary care perspective. Prim Care Companion. J Clin Psychiatry 2004; 6: 191-4.
22. Ananth J, Aduri K, Parameswaran S, Gunatilake S. Neuroleptic malignant syndrome: risk factors, pathophysiology, and treatment. Acta Neuropsychiatrica 2004; 16: 219-28.
23. Mann SC, Caroff SN, Keck PE Jr, Lazarus A. Neuroleptic malignant syndrome related conditions. 2nded. Washington, DC: American Psychiatric Publishing; 2003.
24. Ananth J, Parameswaran S, Gunatilake S, BurgoyneK, Sidhom T. Neuroleptic malignant syndrome and atypical antipsychotic drugs. J Clin Psychiatry 2004; 65: 464-70.
25. Tanii H, Fujita K, Okazaki Y. Neuroleptic malignant syndrome related to a switch to perospirone and anticholinergic withdrawal. Am J Psychiatry 2006;163: 547-8.
26. Matsumoto R, Kitabayashi Y, Nakatomi Y, Tsuchida H, Fukui K. Neuroleptic malignant syndrome induced by quetiapine and fluvoxamine. Am J Psychiatry 2005; 162: 812.
27. ทวนธน บุญลือ, จิตติพล ตันติวิท. Neuroleptic malignant syndrome จากการได้รับยา paliperidone long acting injection ร่วมกับoral risperidone และ intramuscular Haloperidol. วารสารประสาทวิทยา 2015;31(2):41-52.
28. Borovicka MC, Bond LC, Gaughan KM. Ziprasidone- and lithium-induced neuroleptic malignant syndrome. Ann Pharmacother 2006;40:139-42.
29. Berardi D, Amore M, Keck PJ, Troia M, Dell’Atti M. Clinical and pharmacologic risk factors for neuroleptic malignant syndrome: a case-control study. Biol Psychiatry 1998;44:748-54.
30. Keck PE, Pope HG, Cohen BM, McElroy SL, Nierenberg AA. Risk-factors for neuroleptic malignant syndrome-a case control study. Arch Gen Psychiatry 1989;46(6):914-8.
31. Kontaxakis VP, Havaki-Kontaxaki BJ, Stamouli SS, Christodoulou GN. Toxic interaction between risperidone and clozapine: a case report. Prog Neuropsychopharmacol Biol Psychiatry 2002;26:407-9.
32. Tantiphlachiva K. Neuroleptic malignant syndrome: afive-year review. Journal of Psychiatric association of Thailand 1999;44(3):189-200.
33. Wae-alee D, Tanchaiswad W. Neuroleptic malignant syndrome: a review of 12 cases. Journal of the psychiatrist association of Thailand1996;41(2):89-109.
34. Kasantikul D, Kanchanatawan B. Neuroleptic malignant syndrome: a review and report of 6 cases. J Med Assoc Thai 2006;89(12):2155-60.
35. Isbister GK, Bowe SJ, Dawson A, Whyte IM. Relative toxicity of selective serotonin reuptake inhibitors (SSRIs) in overdose. J Toxicol Clin Toxicol 2004; 42: 277-85.
36. Kuno S, Mizuta E, Yamasaki S. Neuroleptic malignant syndrome in parkinsonian patients:risk factors. Eur Neurol 1997; 38(2):56-9.
37. GrannerMA, WootenGF.Neurolepticmalignantsyndromeor parkinsonismhyperpyrexia syndrome. Sem Neurol.1991; 11(3):228-35.
38. DavisJM,CaroffSN, MannSC.Treatmentofneuroleptic malignantsyndrome. PsychiatrAnn2000;30(3):325-31.
39. LurdesTse, Alasdair M, Vanessa S, Fidel V. Neuroleptic malignant syndrome: a review from a clinically oriented perspective. Current Neuropharmacology 2015; 13:395-406.
40. Rosebush PI, Stewart T, Mazurek MF. The treatment of neuroleptic malignant syndrome. are dantrolene and bromocriptine useful adjuncts to supportive care?. Br J Psychiatry 1991;159:709-12.
41. Rosenberg MR, Green M. Neuroleptic malignant syndrome. review of response to therapy. Arch. Intern Med 1989; 149(9): 1927-31.
42. Scheftner WA,Shulman RB. Treatment choice in neuroleptic malignant syndrome. ConvulsTher1992; 8(4): 267-79.
43. McCarronMM,BoettgerML, PeckJJ. Acaseofneuroleptic malignant syndrome successfully treated with amantadine.JClinPsychiatry1982;43(9):381-2.
44. HendersonVW,WootenGF. Neurolepticmalignantsyndrome-apathogeneticrolefordopaminereceptorblockade.Neurology1981;31(2):132-7.
45. FrancisA,KochM,ChandragiriS,RizviS,PetridesG. Islorazepama treatment for neuroleptic malignantsyndrome?.CNS Spectr2000;5(7):54-7.