Neuroleptic malignant syndrome induced by atypical antipsychotics

Abstract

A review of the English literature confirms that neuroleptic malignant syndrome (NMS) occurs with both traditional and atypical antipsychotic medications. Published reports of NMS induced by the traditional antipsychotics have given the practitioner valuable information on the prevention and treatment of this adverse effect. Case reports have also been published concerning NMS and clozapine, risperidone, olanzapine and quetiapine. By evaluating the case reports of atypical antipsychotic-induced NMS, valuable information may be obtained concerning similarities or differences from that induced by the traditional antipsychotics. The case reports of NMS with atypical antipsychotics were evaluated for diagnosis, age/sex of patient, risk factors, antipsychotic doses and duration of use, symptoms of NMS, and clinical course.

Ileus as a Sign of Neuroleptic Malignant Syndrome: A Case Report and Review of the Literature

“…This syndrome is generally characterized by rigidity, tremor, fever, dysregulated hyperactivity of the sympathetic nervous system, mental status change, leukocytosis, and elevated creatinine kinase (CK). However, several case reports and reviews (4)(5)(6)(7) suggested that NMS may be induced by second-generation antipsychotics, atypically. Preliminary studies indicated that NMS is induced by second-generation antipsychotics with a lower incidence, milder clinical severity and fatal prognosis, and occurs less than NMSs induced by first-generation antipsychotics (8).…”

Suspected Neuroleptic Malignant Syndrome During Quetiapine-Clozapine Cross-Titration

“…First-generation antipsychotics (ie, haloperidol, fluphenazine, chlorpromazine) are some of the common medications that have been associated with NMS; however, NMS has also been reported with second-generation antipsychotic agents such as risperidone, olanzapine, clozapine, quetiapine, ziprasidone, and aripiprazole. [1][2][3][4][5][6][7][8][9][10][11][12][13] The risk of developing NMS is considered greatest in the first 2 weeks after initiating therapy and has also been associated with rapid dose escalation. 14,15 Early recognition, diagnosis, and treatment are keys in preventing NMS-related death.…”

“…15 Other symptoms commonly reported include mental status changes (confusion), hyperthermia (temperature between 38 C and 40 C [100.4 F-104 F]), diaphoresis, catatonia, signs of autonomic dysfunction (ie, hypertension, tachycardia, and urinary incontinence), and abnormal laboratory measures of elevated creatinine phosphokinase (CPK) and leukocytes. 14,15,[17][18][19] With the differential diagnosis being complicated, the establishment of timeline associations with medication and onset of clinical symptom presentation is of importance. There are several key differentiating features for 1 University of Missouri-Kansas City, Kansas City NMS from other disorders.…”

“…14,15,[17][18][19] With the differential diagnosis being complicated, the establishment of timeline associations with medication and onset of clinical symptom presentation is of importance. There are several key differentiating features for 1 University of Missouri-Kansas City, Kansas City NMS from other disorders. Diaphoresis typically does not occur with dehydration or heat stroke.…”

“…18 Some of the pharmacologic agents that have been shown to reduce the severity of symptoms of NMS include the dopaminergic agents, amantadine and bromocriptine, or the skeletal muscle relaxant, dantrolene sodium. 14,[17][18][19] Once properly identified and treated, NMS typically resolves over a course of 7 to 10 days. Rechallenging patients who have experienced NMS with antipsychotics is not an absolute contraindication, though most data support waiting at least 5 days and up to 2 weeks before reintroduction of the suspected offending agent.…”