Neuroleptic malignant syndrome

Caroff, Stanley N.; Mann, Stephan C.; Campbell, E. Cabrina

doi:10.1097/00012995-200108000-00001

Cited by 57 publications

(84 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However NMS has been reported with all the atypical antipsychotics including clozapine and quetiapine in monotherapy (Ananth et al, 2004). The condition is twice as common in men as in women and 80% of cases occur in patients under the age of 40 years (Caroff, 1980). The incidence is often quoted as 0.2% (Caroff and Mann, 1993) but it seems that this is decreasing.…”

Section: Clinical Featuresmentioning

confidence: 99%

“…The condition is twice as common in men as in women and 80% of cases occur in patients under the age of 40 years (Caroff, 1980). The incidence is often quoted as 0.2% (Caroff and Mann, 1993) but it seems that this is decreasing. This may reflect the use of lower doses of antipsychotics, less antipsychotic polypharmacy and the introduction of the atypical antipsychotics.…”

Section: Clinical Featuresmentioning

confidence: 99%

See 1 more Smart Citation

Neurological complications of psychiatric drugs: clinical features and management

Haddad

Dursun

2007

Hum. Psychopharmacol. Clin. Exp.

190

106

View full text Add to dashboard Cite

This paper reviews the main neurological complications of psychiatric drugs, in particular antipsychotics and antidepressants. Extrapyramidal syndromes include acute dystonia, parkinsonism, akathisia, tardive dyskinesia and tardive dystonia. Extrapyramidal symptoms (EPS) are less frequent with atypical than with conventional antipsychotics but remain common in clinical practice partly due to lack of screening by health professionals. Neuroleptic malignant syndrome (NMS) consists of severe muscle rigidity, pyrexia, change in conscious level and autonomic disturbance but partial forms also occur. NMS is particularly associated with the initiation and rapid increase in dose of high-potency antipsychotics but it has been reported with all the atypical antipsychotics and rarely with other drugs including antidepressants. Serotonin toxicity comprises altered mental state (agitation, excitement, confusion), neuromuscular hyperactivity (tremor, clonus, myoclonus, hyperreflexia) and autonomic hyperactivity and occurs on a spectrum. Severe cases, termed serotonin syndrome, usually follow the co-prescription of drugs that increase serotonergic transmission by different pathways, for example a monoamine oxidase inhibitor (MAOI) and a selective serotonin reuptake inhibitor (SSRI). Most antipsychotics and antidepressants lower the seizure threshold and can cause seizures; the risk is greater with clozapine than with other atypical antipsychotics and greater with tricyclic antidepressants (TCAs) than with SSRIs. In randomised controlled trials in elderly patients with dementia atypical antipsychotics are associated with a higher risk of stroke and death than placebo. Cohort studies suggest that conventional drugs carry at least the same risk. Cessation of treatment with antipsychotics and antidepressants can lead to a wide range of discontinuation symptoms which include movement disorders and other neurological symptoms. Clinicians need to be familiar with strategies to reduce the risk of these adverse events and to manage them when they arise. Their occurrence needs to be balanced against the benefits of psychiatric drugs in terms of efficacy and improved quality of life in a range of disorders.

show abstract

Section: Clinical Featuresmentioning

confidence: 99%

Section: Clinical Featuresmentioning

confidence: 99%

Neurological complications of psychiatric drugs: clinical features and management

Haddad

Dursun

2007

Hum. Psychopharmacol. Clin. Exp.

190

106

View full text Add to dashboard Cite

show abstract

“…In the majority of cases, NMS occurs within 2 weeks of neuroleptic initiation, and virtually all cases occur within 1 month after the last change in medications. In 16% of cases, symptoms may occur acutely, within 24 hours of neuroleptic administration [23]. While NMS was initially described after the use of older, "typical" antipsychotics like haloperidol, it has been associated with the atypical antipsychotics including clozapine, olanzapine, quetiapine, risperidone and ziprasidone [24,25].…”

Section: Does This Patient Have Nms?mentioning

confidence: 99%

“…Regardless, the study is highly suggestive of the benefit of any of these agents in NMS, even though it is unable to provide insight into which agents work better or the optimal combination. In cases of NMS from dopaminergic agent withdrawal, multiple case reports describe improvement of symptoms with reinstitution of the discontinued medication [23,40].…”

Section: What Drugs and Other Therapies Are Used To Treat Nms?mentioning

confidence: 99%

Case files of the Program in Medical Toxicology at Brown University: Amantadine withdrawal and the neuroleptic malignant syndrome

Brantley¹,

Cohn²,

Babu³

2009

J. Med. Toxicol.

View full text Add to dashboard Cite

A sixty-one-year old woman with a history of depression and idiopathic dystonia presented to the emergency department (ED) with fever, nausea, muscle rigidity, and redness in her extremities. The patient had seen various specialists for her dystonia during the preceding year and had tried multiple medication regimens, including benztropine and tizanidine. The patient described her home medications as tizanidine 2 mg three times daily, diazepam 2.5 mg daily, escitalopram 100 mg daily, rosuvastatin 10 mg daily and bupropion 300 mg nightly.At ED presentation her vital signs were: temperature 37.5°C (99.5F), blood pressure 157/76 mmHg, heart rate 105 beats per minute, respirations 24 per minute, and oxygen saturation of 100% on room air. Her physical examination was significant for diaphoresis, tachycardia, diffuse flushing, tremors in her upper and lower extremities, muscle rigidity, and hyperreflexia in the upper and lower extremities. The tremors were low amplitude and worse with intention, while the rigidity had cogwheeling features and was more notable in her lower extremities. Initial laboratory evaluation was significant for a creatine phosphokinase (CPK) of 1146 IU/L. Her electrocardiogram showed sinus tachycardia with normal QRS and QT intervals, and no evidence of acute ischemia.Two months earlier, the patient's neurologist had started her on amantadine 100 mg twice daily for dystonia. Three days prior to ED presentation, the patient abruptly stopped taking her amantadine on the advice of a pharmacist, secondary to bilateral lowerextremity edema. The following day, the patient presented to her primary care physician complaining of nausea, tremors, and diffuse flushing. The physician treated her for an allergic reaction with oral steroids and diphenhydramine. The patient's symptoms worsened over the next day with increasing tremors and rigidity, low-grade fever, nausea, and flushing, which prompted her presentation to the ED.

show abstract

“…NMS is classically associated with the use of high-potency antipsychotics (AP), such as butyrophenones and phenothiazines, but has also been described with newer agents, commonly described as "atypical" AP (risperidone, olanzapine, quetiapine), other D2-receptor antagonists (metoclopramide) and following withdrawal of anti dopaminergic agents [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] . Although the precise pathophysiologic mechanism underlying NMS remains unknown, a reduction in dopaminergic activity in the brain probably by dopamine D2 receptor blockade in the striatum and hypothal-amus is generally assumed as a potential cause 4,20 .…”

mentioning

confidence: 99%

Neuroleptic malignant syndrome

Moscovich

Novak

Fernandes

et al. 2011

Arq. Neuro-Psiquiatr.

View full text Add to dashboard Cite

Neuroleptic malignant syndrome (NMS) is a potentially fatal adverse event associated with the use of antipsychotics (AP). The objective of this study was to investigate the profile of cases of NMS and to compare our findings with those published in similar settings. A series of 18 consecutive patients with an established diagnosis of NMS was analyzed, gathering data on demography, symptoms and signs. Two thirds of all cases involved woman with a past medical history of psychiatric disorder receiving relatively high doses of AP. The signs and symptoms of NMS episodes were similar to those reported in other series and only one case had a fatal outcome, the remaining presenting complete recovery. As expected, more than two thirds of our cases were using classic AP (68%), however the clinical profile of these in comparison with those taking newer agent was similar. Newer AP also carry the potential for NMS. Key words: atypical antipsychotics, typical antipsychotics, neuroleptic malignant syndrome.Síndrome neuroléptica maligna RESUMO A síndrome neuroléptica maligna (SNM) é um evento adverso potencialmente fatal associado ao uso de antipsicóticos (AP). O objetivo deste estudo foi investigar as características clínicas de cases da SNM e comparar nossos resultados com os publicados na literatura. Uma série de 18 pacientes com diagnóstico confirmado de SNM foram analisados, associando dados demográficos, apresentação clínica, diagnóstico e tratamento. Dois terços dos casos envolveram mulheres com antecedentes psiquiátricos que recebeceram doses relativamente altas de AP. Os sinais e sintomas foram semelhantes àqueles já relatados na literatura e a maioria dos pacientes teve uma recuperação completa, exceto por um caso com desfecho fatal. Houve predomínio de pacientes que usam medicamentos neurolépticos clássicos (68%), porém não houve diferença nas manifestações destes casos em relação àqueles que usavam AP novos. AP mais novos também têm o potencial de causar SNM. Palavras-Chave: neurolépticos atípicos, neurolépticos típicos, síndrome neuroléptica maligna.

show abstract

Neuroleptic malignant syndrome

Cited by 57 publications

References 14 publications

Neurological complications of psychiatric drugs: clinical features and management

Neurological complications of psychiatric drugs: clinical features and management

Case files of the Program in Medical Toxicology at Brown University: Amantadine withdrawal and the neuroleptic malignant syndrome

Neuroleptic malignant syndrome

Contact Info

Product

Resources

About