Neuroleptic malignant syndrome induced by atypical antipsychotics

Farver, Debra K

doi:10.1517/eods.2.1.21.21397

Cited by 16 publications

(29 citation statements)

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“…It has been suggested that atypical neuroleptics with 5‐HT 2A and dopamine (and indeed α 1 ‐adrenoceptor) antagonist actions such as risperidone (Shioda et al ., 2008) and clozapine (Blessing et al ., 2003; 2006) could prove of value in treating potentially fatal hyperthermia in humans. However, the fact that atypical neuroleptics can also induce the neuroleptic malignant syndrome (Farver, 2003) does mean that their use should be approached with caution.…”

Section: Discussionmentioning

confidence: 99%

The role of monoamines in the changes in body temperature induced by 3,4‐methylenedioxymethamphetamine (MDMA, ecstasy) and its derivatives

Docherty

2010

British J Pharmacology

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Hyperthermia is probably the most widely known acute adverse event that can follow ingestion of 3,4-methylenedioxymethamphetamine (MDMA, ecstasy) by recreational users. The effect of MDMA on body temperature is complex because the drug has actions on all three major monoamine neurotransmitters [5-hydroxytryptamine (5-HT), dopamine and noradrenaline], both by amine release and by direct receptor activation. Hyperthermia and hypothermia can be induced in laboratory animals by MDMA, depending on the ambient temperature, and involve both central thermoregulation and peripheral changes in blood flow and thermogenesis. Acute 5-HT release is not directly responsible for hyperthermia, but 5-HT receptors are involved in modulating the hyperthermic response. Impairing 5-HT function with a neurotoxic dose of MDMA or p-chlorophenylalanine alters the subsequent MDMA-induced hyperthermic response. MDMA also releases dopamine, and evidence suggests that this transmitter is involved in both the hyperthermic and hypothermic effects of MDMA in rats. The noradrenergic system is also involved in the hyperthermic response to MDMA. MDMA activates central a2A-adrenoceptors and peripheral a1-adrenoceptors to produce cutaneous vasoconstriction to restrict heat loss, and b3-adrenoceptors in brown adipose tissue to increase heat generation. The hyperthermia occurring in recreational users of MDMA can be fatal, but data reviewed here indicate that it is unlikely that any single pharmaceutical agent will be effective in reversing the hyperthermia, so careful body cooling remains the principal clinical approach. Crucially, educating recreational users about the potential dangers of hyperthermia and the control of ambient temperature should remain key approaches to prevent this potentially fatal problem.

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Section: Discussionmentioning

confidence: 99%

The role of monoamines in the changes in body temperature induced by 3,4‐methylenedioxymethamphetamine (MDMA, ecstasy) and its derivatives

Docherty

2010

British J Pharmacology

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“…[7][8][9][10]21 In addition, a review of 21 cases of risperidone-induced NMS in which temperature was recorded found that two patients did not display hyperthermia throughout the course of illness. 22 In a case of olanzapine-induced NMS, the patient's body temperature fluctuated over time, including a 10-day period in which the patient was afebrile. 23 Aripiprazole, at high doses, has also been reported to cause NMS without hyperthermia or with only low-grade temperature elevations, although several clinical and systemic factors, such as concurrent infection, confound many of the reported cases.…”

Section: Core Symptomsmentioning

confidence: 99%

Atypical Neuroleptic Malignant Syndrome: Diagnostic Controversies and Considerations

et al. 2008

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Neuroleptic malignant syndrome (NMS) is a serious and potentially fatal adverse effect of antipsychotic drugs. The diagnosis of NMS commonly requires core symptoms of hyperthermia and muscle rigidity. Although diagnostic criteria for NMS have been established and are widely accepted and used, it should be recognized that atypical presentations pose a diagnostic dilemma, as hyperthermia and/or muscle rigidity may be absent or develop slowly over several days, leading to impairment or a significant delay in diagnosis and treatment. Evidence from case reports and retrospective evaluations supports a concept of atypical NMS, particularly with regard to treatment with atypical antipsychotics. However, it remains unclear whether these atypical presentations represent early or impending NMS. Furthermore, it is unclear whether dysfunction in other neurotransmitter systems, in addition to dopamine, may be involved in the pathogenesis of NMS induced by atypical antipsychotics. In patients receiving any antipsychotic, clinicians should carefully evaluate any features of NMS and should not prematurely exclude a diagnosis of NMS in cases where severe rigidity or hyperthermia is not initially apparent.

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“…With widespread use of atypical antipsychotics in recent years, NMS induced by these drugs has attracted much attention of clinicians and researchers Farver, 2003;Ananth et al, 2004b;Trollor et al, 2009). At the same time, great interest has also been taken in the concept of "atypical NMS", which is often presumed to be more associated with atypical antipsychotics than with conventional drugs (Picard et al, 2008).…”

Section: Nms Associated With Atypical Antipsychoticsmentioning

confidence: 99%

Encephalopathy Associated with Psychotropic Drug Therapy

Odagaki¹

2012

Miscellanea on Encephalopathies - A Second Look

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Neuroleptic malignant syndrome induced by atypical antipsychotics

Cited by 16 publications

References 0 publications

The role of monoamines in the changes in body temperature induced by 3,4‐methylenedioxymethamphetamine (MDMA, ecstasy) and its derivatives

The role of monoamines in the changes in body temperature induced by 3,4‐methylenedioxymethamphetamine (MDMA, ecstasy) and its derivatives

Atypical Neuroleptic Malignant Syndrome: Diagnostic Controversies and Considerations

Encephalopathy Associated with Psychotropic Drug Therapy

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