The COVID-19 pandemic is associated with different types of stressors: fear of infection, financial burden, and social isolation. Additionally, COVID-19 infection seems to increase the risk for neuropsychiatric symptoms including psychosis. We present a case of a 52-year-old male with no previous psychiatric history who developed severe paranoia leading to a suicide attempt. He was successfully treated with a combination of milieu treatment, pharmacotherapy, and electroconvulsive therapy. We add to the nascent literature that COVID-19, as other coronaviruses, can increase the risk for severe psychosis and suicidal behavior.

Objective: The authors report three cases of neuroleptic malignant syndrome (NMS) induced by atypical antipsychotics (olanzapine and clozapine) which showed classic features of NMS including muscular rigidity and prominent fever. Method: Case reports. Results: A 66-year-old man with dementia and alcohol abuse developed NMS while on olanzapine for agitation and combativeness. A 62-year-old man with schizophrenia developed NMS 6 days after starting clozapine. A 43-year-old man with bipolar disorder developed NMS 14 days after starting clozapine. All three cases showed classic features of NMS including muscular rigidity and fever. Resolution of fever and muscular rigidity occurred within 72 hours with discontinuation of neuroleptics, supportive care, and lorazepam. The NMS rating scale refl ected daily clinical improvement. Conclusion: Classic NMS characterized by muscular rigidity and prominent fever may occur with atypical neuroleptics. Our cases suggest recovery from NMS associated with atypical neuroleptics may be hastened by lorazepam, as was previously reported for NMS from typical neuroleptics. Also, the NMS rating scale was sensitive to clinical improvement. Keywords: atypical antipsychotics, neuroleptic malignant syndrome, lorazepam, catatonia, rating scale IntroductionNeuroleptic malignant syndrome (NMS) is a rare but potentially life-threatening adverse reaction to antipsychotic drugs and other dopamine-modulating agents (Caroff and Mann 1993). The syndrome is characterized by motor, behavioral, autonomic, and laboratory abnormalities (Caroff et al 1993;Francis et al 2000). Several clinical and research diagnostic criteria for NMS are available. Most require muscular rigidity and fever (Caroff et al 1993; APA 1994) but some permit a diagnosis without rigidity (eg, Levenson 1985).Almost all typical neuroleptics have been associated with NMS (Caroff et al 1993). Some workers predicted that atypical neuroleptics would not cause NMS since intense dopaminergic blockade is one hypothesized basis for NMS. However, numerous cases of apparent NMS related to atypical neuroleptics have been reported (Caroff et al , 2003, and most of these are associated with muscular rigidity and fever. In one review, however, 20% of reported cases of clozapine-related NMS lacked muscle rigidity as part of clinical picture .We report three cases of NMS related to atypical neuroleptics (olanzapine and clozapine). All had classic features of NMS, including fever and muscle rigidity and met both APA (1994) and Caroff-Mann (1993) 236Yacoub and Francis benefi cial in hastening recovery. In all three cases, the NMS rating scale showed improvement in all four clinical domains (motor, behavioral, autonomic, and laboratory). NMS rating scaleThe NMS rating scale (Yacoub et al 2004; Appendix) includes 23 items encompassing motor, behavioral, autonomic, and laboratory domains of NMS. In conjunction with the present report, reliability was determined using records from 10 well-defi ned cases of NMS (Francis et al 2000). All cases met APA (1...

Recurrent self-limited hyperthermia following ECT for catatonia in a young man with cerebral palsy. Psychosomatics. 2012;53:474-477. Majeske MF, Garakani A, Maloutas E, et al.Transient febrile reaction after electroconvulsive therapy (ECT) in a young adult with intellectual disability and bipolar disorder.

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