Neuroleptic malignant syndrome cases in a Moroccan intensive care unit: a retrospective analysis and literature review

Abstract

Background: Neuroleptic malignant syndrome (NMS) is a rare but potentially life-threatening neuropsychiatric emergency. The aim of our study was to update our bedside procedures by investigating NMS cases managed in the intensive care unit (ICU).Methods: This retrospective study included all NMS patients admitted to our hospital between January 2012 and December 2019. The variables analyzed included demographics, diagnosis, therapeutics, and outcomes.Results: This study included 20 patients, with an average age of 36.6 years. The male to female ratio was 1:4. No patient had a history of NMS, and 60% of the patients had schizophrenia. First-generation neuroleptics (NLs) were the most commonly prescribed drugs (80%). The mean time between the introduction of NLs and onset of symptoms was 7.6 days. Rigidity was observed in 90% of the patients, hyperthermia and neuropsychic syndrome in 65%, and dysautonomia in 50%. The creatine phosphokinase level in all patients was four times the normal value. Mechanical ventilation was required in 20% of the patients and hemodialysis in one patient. None of the patients received specific therapy. The mean duration of ICU stay was 10 days. The mortality rate was 10%,, mainly associated with renal failure. The analysis of the predictors of mortality was limited by the size of our cohort.Conclusion: NMS is a rare condition requiring multidisciplinary implementation of contextualized and updated procedures. Early detection and supportive treatment could improve the prognosis in resource-limited settings, where specific treatments are not available. Predictive risk factors should be investigated in larger multicenter cohorts.

Antipsychotic-associated neuroleptic malignant syndrome (NMS) in schizophrenia patients: a narrative review

“…Although NMS incidence is rare, it is a potentially fatal adverse drug reaction of antipsychotics which can range in severity from mild to life-threatening. 25 Antipsychotics are the main therapy for schizophrenia. The common property of effective antipsychotics is D 2 receptor blockade.…”

“…These antipsuchotics are less frequently associated with NMS, less severe and less potential fatal condition. 25 Clinicians should avoid parenteral administration, rapid titration, and high doses of antipsychotics due to their association with a higher risk for developing NMS. It is recommended to consider the use of antipsychotics with caution.…”

“…The antipsychotic should be stopped immediately if fever, rigidity, or labile blood pressure occur. 25 Studies concerning the association between antipsychotics and NMS incidence are limited due to the rare NMS incidence. In addition, antipsychotics have a NMS risk causing difficulties in comparing the specific types of antipsychotics that may cause the NMS.…”