Malignant Catatonia Versus Neuroleptic Malignant Syndrome

Desai, Saral; Hirachan, Tinu; Toma, Anca E; Gerolemou, Adela

doi:10.7759/cureus.15818

Cited by 6 publications

(13 citation statements)

References 10 publications

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“…However, the patient presented with an elevated serum creatinine phosphokinase, a non-specific marker that can result from muscle injuries accompanying immobility due to the catatonic state. The absence of fever and autonomic instability ruled out neuroleptic malignant syndrome (NMS), considered an iatrogenic subtype of malignant catatonia by some researchers [17,19]. Although NMS remains a differential diagnosis in patients with catatonia due to shared clinical features, it requires distinct treatment strategies [17][18][19].…”

Section: Discussionmentioning

confidence: 99%

“…The absence of fever and autonomic instability ruled out neuroleptic malignant syndrome (NMS), considered an iatrogenic subtype of malignant catatonia by some researchers [17,19]. Although NMS remains a differential diagnosis in patients with catatonia due to shared clinical features, it requires distinct treatment strategies [17][18][19].…”

Section: Discussionmentioning

confidence: 99%

“…Catatonia can lead to medical complications associated with high morbidity and mortality [ 19 ]. Despite improved recognition and treatment, malignant catatonia has a mortality rate of approximately 9-10% [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

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Rebound Catatonia Associated With Injectable Paliperidone

Johnson¹,

Orji²,

Johnson³

et al. 2023

Cureus

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Paliperidone is an atypical antipsychotic medication commonly used to treat schizophrenia, schizoaffective disorder, and bipolar disorder. It is a metabolite of risperidone and has a similar mechanism of action, primarily blocking dopamine 2 receptors (D2 receptors) in the brain. Paliperidone has various adverse effects, including extrapyramidal symptoms, weight gain, and metabolic disturbances. Catatonia is rare but severe side effects can occur in the context of an underlying psychiatric, neurologic, or general medical condition. Paradoxically, antipsychotics for treating schizophrenia or bipolar spectrum disorders can precipitate or worsen catatonic symptoms. The report suggests that 17-19% of all cases diagnosed as catatonia due to other medical conditions are medication-induced. Catatonia is a neuropsychiatric syndrome that presents as a cluster of psychomotor signs and symptoms resulting in movement and behavior aberrations. Various symptoms, including mutism, stupor, rigidity, and abnormal movements, characterize catatonia. Catatonia is a potentially life-threatening condition requiring prompt recognition and management. Here, we present a case of a patient with catatonia associated with long-acting injectable paliperidone intramuscular therapy in a patient with schizophrenia.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Rebound Catatonia Associated With Injectable Paliperidone

Johnson¹,

Orji²,

Johnson³

et al. 2023

Cureus

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“…NMS and MC however are similar and, therefore, generally cannot be differentiated on clinical features alone. Consideration of temporal association with medications and response to treatment were the guiding force for the final determination of the diagnosis [ 14 ]. The patient was only given 0.5 mg of lorazepam twice a day; this is significantly lower than the dose generally used for catatonic patients, and lorazepam is generally not very effective in malignant catatonia, even at the doses used for retarded or excited catatonia [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Neuroleptic Malignant Syndrome Status Post Anoxic Brain Injury: A Case Presentation of Heightened Susceptibility in the Brain Injury Population

Cocuzzo¹,

Fisher²,

Villalba³

2023

Cureus

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Neuroleptic malignant syndrome (NMS), a potentially life-threatening neurological emergency characterized by muscle rigidity, altered mental status (AMS), autonomic instability, and hyperthermia, is most commonly precipitated by high-potency first-generation antipsychotics due to central dopamine receptor blockade. There is a heightened risk of NMS in animals with ischemic brain injury (IBI) or traumatic brain injury (TBI) due to the resulting death of dopaminergic neurons from injury and the dopamine receptor blockade elicited upon recovery. To the best of our knowledge, this will be the first documented case of a critically ill patient, with a history of prior exposure to antipsychotics, who suffered an anoxic brain injury with subsequent development of NMS after the initiation of haloperidol for the treatment of acute agitation. Further investigation is necessary to expand upon the existing literature suggesting the role of alternative agents, including amantadine, due to its impact on dopaminergic transmission, as well as dopamine and glutamine release. Furthermore, NMS can be difficult to diagnose due to variable clinical presentation and lack of absolute diagnostic criteria, which is further compounded with central nervous system (CNS) injury, where neurological abnormalities and AMS may be attributed to the injury, rather than a medication effect, especially in the early period. This case highlights the significance of prompt recognition with appropriate treatment of NMS in vulnerable and susceptible patients suffering from brain injury.

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“…One of the dominant mechanisms of NMS is the blockade of D2 dopamine receptors in the hypothalamus and brainstem regulatory systems, which leads to hyperthermia. In addition, D2 dopamine receptors in the striatum are involved in muscle rigidity, while those in the midbrain and cortical pathways are involved in changes in the mental state [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Muscle magnetic resonance imaging abnormality in neuroleptic malignant syndrome: a case report

Kakinuma¹,

Amano²,

Ishida³

et al. 2022

BMC Neurol

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Background Neuroleptic malignant syndrome (NMS) is a rare and occasionally fatal undesirable reaction to dopamine antagonists, and its phenotype is diverse owing to causative drugs. Classically, elevation of serum creatine kinase is described in NMS. Some reports have described muscular pathological findings; however, muscle magnetic resonance imaging (MRI) has not been reported previously. Case presentation A 63-year-old woman with a history of schizophrenia presented to our hospital with a high fever, excessive sweating, muscle weakness, and elevated serum creatine kinase levels. Muscle MRI revealed T2 high-intensity lesions in several muscles with gadolinium enhancement, and the pathology of the muscle biopsy showed a very mild presence of muscle fiber necrosis and regeneration with type 2c fibers without inflammation. Her symptoms resolved by treatment with levodopa/carbidopa, dantrolene. Finally, the patient was diagnosed with NMS. Conclusions This is the first report of muscle MRI abnormalities in a patient with NMS. Muscle MRI abnormalities in NMS may be associated with non-inflammatory myopathic changes. The cause of creatine kinase elevation cannot be explained by abnormal strong muscle contraction nor inflammation.

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Malignant Catatonia Versus Neuroleptic Malignant Syndrome

Cited by 6 publications

References 10 publications

Rebound Catatonia Associated With Injectable Paliperidone

Rebound Catatonia Associated With Injectable Paliperidone

Neuroleptic Malignant Syndrome Status Post Anoxic Brain Injury: A Case Presentation of Heightened Susceptibility in the Brain Injury Population

Muscle magnetic resonance imaging abnormality in neuroleptic malignant syndrome: a case report

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