Novel Antipsychotics and the Neuroleptic Malignant Syndrome: A Review and Critique

Hasan, Samia; Buckley, Peter F.

doi:10.1176/ajp.155.8.1113

Cited by 175 publications

(72 citation statements)

References 28 publications

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“…117,121,124 Ten studies related to the incidence of blood dyscrasias such as agranulocytosis and leucopenia. [125][126][127][128][129][130][131][132][133][134] One was a study of NMS, 135 another of venous thromboembolic complications that occurred during clozapine treatment. 136 Five were studies of epilepsy or seizure rates 122,[137][138][139][140] …”

Section: Rare or Long-term Eventsmentioning

confidence: 99%

See 1 more Smart Citation

A systematic review of atypical antipsychotic drugs in schizophrenia

Bagnall

Jones

Ginnelly

et al. 2003

Health Technol Assess

151

114

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Non-UK purchasers will have to pay a small fee for post and packing. For European countries the cost is £2 per monograph and for the rest of the world £3 per monograph.You can order HTA monographs from our Despatch Agents:-fax (with credit card or official purchase order) -post (with credit card or official purchase order or cheque) -phone during office hours (credit card only).Additionally the HTA website allows you either to pay securely by credit card or to print out your order and then post or fax it. Contact Payment methods Paying by chequeIf you pay by cheque, the cheque must be in pounds sterling, made payable to Direct Mail Works Ltd and drawn on a bank with a UK address. Paying by credit cardThe following cards are accepted by phone, fax, post or via the website ordering pages: Delta, Eurocard, Mastercard, Solo, Switch and Visa. We advise against sending credit card details in a plain email. Paying by official purchase orderYou can post or fax these, but they must be from public bodies (i.e. NHS or universities) within the UK. We cannot at present accept purchase orders from commercial companies or from outside the UK. How do I get a copy of HTA on CD?Please use the form on the HTA website (www.hta.ac.uk/htacd.htm). Or contact Direct Mail Works (see contact details above) by email, post, fax or phone. HTA on CD is currently free of charge worldwide.The website also provides information about the HTA Programme and lists the membership of the various committees. HTAA systematic review of atypical antipsychotic drugs in schizophrenia NHS R&D HTA ProgrammeT he NHS R&D Health Technology Assessment (HTA) Programme was set up in 1993 to ensure that high-quality research information on the costs, effectiveness and broader impact of health technologies is produced in the most efficient way for those who use, manage and provide care in the NHS.The research reported in this monograph was commissioned by the HTA Programme on behalf of the National Institute for Clinical Excellence (NICE). Technology assessment reports are completed in a limited time to inform the appraisal and guidance development processes managed by NICE. The review brings together evidence on key aspects of the use of the technology concerned. However, appraisals and guidance produced by NICE are informed by a wide range of sources.The research reported in this monograph was funded as project number 00/20/01.The views expressed in this publication are those of the authors and not necessarily those of the HTA Programme, NICE or the Department of Health. The editors wish to emphasise that funding and publication of this research by the NHS should not be taken as implicit support for any recommendations made by the authors. Criteria for inclusion in the HTA monograph seriesReports are published in the HTA monograph series if (1) they have resulted from work commissioned for the HTA Programme, and (2) they are of a sufficiently high scientific quality as assessed by the referees and editors.Reviews in Health Technology Assessment are termed 'syst...

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Section: Rare or Long-term Eventsmentioning

confidence: 99%

“…Data extraction sheets for these studies can be found in appendix 4. One was on tardive dyskinesia, 266 one on NMS, 135 one included information on both tardive dyskinesia and NMS, 267 and three contained information on mortality.…”

Section: Rare or Long-term Eventsmentioning

confidence: 99%

A systematic review of atypical antipsychotic drugs in schizophrenia

Bagnall

Jones

Ginnelly

et al. 2003

Health Technol Assess

151

114

View full text Add to dashboard Cite

show abstract

“…Mortality and morbidity associated with NMS can be further reduced by increased awareness of its initial clinical symptoms and signs, allowing for prompt clinical menagement 33 . Newer agents, typically regarded as safe, are also not uncommonly related to NMS and the use of these AP should not preclude diagnostic suspicion 4,11,[14][15][16][17] .…”

Section: Discussionmentioning

confidence: 99%

“…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.

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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.

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“…These cases were associated with either a recent increase in the therapeutic dose of olanzapine or the addition of or a change from another antipsychotic agent [4,11]. Features of NMS in cases following therapeutic treatment with olanzapine and other atypical antipsychotics commonly follow a typical pattern with autonomic instability, hypertonia and lead-pipe rigidity, and mental status changes [12,13]. However, there have been no case reports of NMS documented in the literature following overdose of olanzapine or overdose of olanzapine and chlorpromazine.…”

Section: Discussionmentioning

confidence: 99%

Neuroleptic malignant syndrome developing after acute overdose with olanzapine and chlorpromazine

2009

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Neuroleptic malignant syndrome (NMS) is a relatively uncommon side effect that may develop after a recent increase in the therapeutic dose of an antipsychotic medication or the addition of a new agent in therapeutic doses.Case Report: We report a case of NMS developing in a 36-year-old female patient 2 days following deliberate self-poisoning with 30 ϫ10-mg olanzapine tablets, 7 ϫ100-mg chlorpromazine tablets and an unknown amount of escitalopram. These were the patient's own medications. She had not been taking these for several weeks. The patient initially presented with sedation from her overdose which resolved over the next 24 hours. Following this, over the subsequent 24 hours, she became progressively confused, ataxic, hypertonic, ferbrile and tachycardic, with marked lead pipe rigidity of the limbs. Head CT, lumbar puncture and septic screen were all negative. She was treated with intravenous midazolam infusion, nasogastrically administered bromocriptine, external cooling and was mechanically ventilated. She gradually improved over a period of 10 days, with residual confusion lasting another week, and was discharged well with no deterioration from her premorbid neurologic state.Conclusion: To our knowledge, although there are numerous cases reported with therapeutic use, NMS has not been reported to develop following acute olanzapine overdose. Clinicians should be aware that this may be an uncommon side effect of antipsychotic medication.

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Novel Antipsychotics and the Neuroleptic Malignant Syndrome: A Review and Critique

Cited by 175 publications

References 28 publications

A systematic review of atypical antipsychotic drugs in schizophrenia

A systematic review of atypical antipsychotic drugs in schizophrenia

Neuroleptic malignant syndrome

Neuroleptic malignant syndrome developing after acute overdose with olanzapine and chlorpromazine

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