Precautionary measures reduce risk of definite neuroleptic malignant syndrome in newly typical neuroleptic-treated schizophrenia inpatients

Shiloh, Roni; Valevski, Avi; Bodinger, Liron; Misgav, Sagit; Aizenberg, Dov; Dorfman-Etrog, Pnina; Weizman, Abraham; Munitz, Hanan

doi:10.1097/00004850-200305000-00004

Cited by 3 publications

(4 citation statements)

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“…Once antipsychotics are stopped, NMS is self-limited barring complications, with the duration to resolution of NMS up to two weeks in the majority of cases (Shalev & Munitz, 1986;Addonizio et al, 1987;Caroff et al, 1988). The notion that prompt withdrawal of the offending agent at early stage can prevent progression to definite NMS has been corroborated by the study reported by Shiloh et al (2003).…”

Section: Clinical Course and Outcomementioning

confidence: 71%

“…The high incidence of NMS reported in earlier studies from the United States is, however, evidently overestimated due to a variety of factors, e.g., retrospective study design, loose diagnostic criteria, adherence to an amorphous "spectrum concept", and clinical practices in vogue (Adityanjee et al, 1999a). Based on the more recent reports (Spivak et al, 2000;Montoya et al, 2003;Shiloh et al, 2003) as well as my own clinical experience as a psychiatrist at the front for almost three decades, the incidence of definite NMS does not appear to exceed 2-3 cases out of one thousand consecutive patients treated with antipsychotics, as long as precautionary measures and monitoring are cautiously and sufficiently employed for the early recognition and prevention of NMS.…”

Section: Epidemiologymentioning

confidence: 99%

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Miscellanea on Encephalopathies

Tanasescu¹

2012

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and the European Federation of Neurological Societies with two scientific Fellowship research grants for projects studying advanced imaging techniques and stem cell therapy in multiple sclerosis (University of Nottingham, UK). He conducted the firsts studies in Romania on neurological manifestations associated with antiphospholipid antibodies, being awarded with a PhD degree in 2007. He is author of more than 100 published scientific contributions and was contributor to 6 medical books. As a member of EFNS scientific Panels of Neuroimmunology and Neurotoxicology he co-authored two Guideline Papers of the EFNS. Dr Tanasescu's area of expertise covers clinical neuroimmunology, multiple sclerosis, neurology of systemic diseases and stroke. ContentsPreface XIII Chapter Minimal Hepatic Encephalopathy (MHE) 1

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Section: Clinical Course and Outcomementioning

confidence: 71%

Section: Epidemiologymentioning

confidence: 99%

Miscellanea on Encephalopathies

Tanasescu¹

2012

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“…proper hydration and nutrition in neuroleptictreated patients, low-potency neuroleptics), obtaining and analyzing detailed history of previous episodes, and monitoring of early signs of NMS. The physician should wait approximately two weeks after recovery from NMS before introducing neuroleptics again in the patients [4,31]. Furthermore, a written informed consent should be obtained from patients and family members regarding the risks and benefits of restarting antipsychotic treatment.…”

Section: Treatment the Success In Nms Treatment Depends On Prompt DImentioning

confidence: 99%

Life-threatening conditions in psychiatry – neuroleptic malignant syndrome (NMS)

Kucmin¹,

Kucmin²,

Płowaś-Goral³

et al. 2015

J Pre Clin Clin Res.

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The introduction of neuroleptics in the 1950's was a turning point in psychiatric treatment. The new drugs brought hope to millions of patients and their doctors. However, there were also some side-effects, one of which is Neuroleptic malignant syndrome (NMS), a rare complication of antipsychotic treatment and untreated it may lead to mortality as high as 20%. The incidence of NMS, estimated to be 0.01-0.02%, has decreased significantly probably due to higher awareness of the diseases and shift to atypical antipsychotics. The aim of this study was to present the signs and symptoms of this rare condition and describe management possibilities since this condition is observed not only in psychiatric departments but also in emergency rooms. NMS is thought to be related to change caused by neuroleptics within the central nervous system due to dopamine D2 receptor antagonism, especially nigrostriatal pathways and the hypothalamus. There are three symptoms which are considered as major and indicate a high probability of NMS: muscle rigidity, hyperthermia (core body temperature above 38.5 °C), and elevated creatine phosphokinase concentration (above 1000 U/l). NMS is a diagnosis of exclusion and clinicians must be vigilant in detecting early signs of NMS. The basic management in NMS is antipsychotic discontinuation and proper supportive care of the patient (vital signs monitoring, hydration, correction of electrolyte and acid-base disturbances). In more severe cases, the introduction of bromocriptine or dantrolene, as well as benzodiazepines, may indicated. Further usage of neuroleptic in patients with a history of NMS should be with care, and low doses of low-potency neuroleptics or atypical neuroleptics seem to be the best treatment choice.

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“…9,10 We note that some investigators are examining ways to identify NMS early and even prevent NMS. 9,11 We also hope to examine some of the other risk factors listed above, such as low baseline serum iron level. The study of NMS is difficult due to the paucity of prospective studies.…”

Section: Sirmentioning

confidence: 99%

A Cautionary Note When Using Zonisamide in Youths

Majeres¹,

Suppes²

2004

J. Clin. Psychiatry

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Sir: Zonisamide is a third-generation sulfonamide anticonvulsant indicated for treatment of partial seizures. As with other anticonvulsants, it has shown efficacy in treating bipolar disorder in adults 1 and, unlike other agents, does not appear to cause weight gain. Zonisamide is contraindicated in patients with known sulfa allergies due to the risk of developing a medically serious rash. Case report. Ms. A, a 16-year-old white female with bipolar disorder, complained to her psychiatrist about weight gain during valproic acid and quetiapine treatment. Although she was psychiatrically stable, valproic acid was replaced with zonisamide in May 2003. The patient did not have a personal history of sulfonamide allergy and took no other medications. Her father had no drug allergies, and her mother reported being allergic to paroxetine and sulfa drugs. After 2 weeks of zonisamide treatment, several "fever blisters" appeared on Ms. A's upper chest and zonisamide was stopped. However, a bright, erythematous rash soon covered her chest, back, and buttocks and extended onto her upper extremities bilaterally. The rash reddened and became painful, and on the third day bullae rapidly formed, causing large sheets of epidermis to be lost. Ms. A was admitted to an intensive care unit for fluid resuscitation, IV access, and management. Her temperature ranged from 39.0°C to 40.0°C (102°F to 104°F), and her white blood cell count reached a high of 15.3 × 10 3 /µL, while her blood cultures remained negative. A biopsy taken within 36 hours of bullae formation showed extensive basal cell necrosis. In addition to extensive mucosal membrane involvement, she lost epidermis over an estimated 51% to 60% of her total body surface area. A diagnosis of toxic epidermal necrolysis was made. By the end of the second week of hospitalization, she was able to take food and medicine orally. Treatment with quetiapine and valproic acid was restarted, and she was discharged home.

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Precautionary measures reduce risk of definite neuroleptic malignant syndrome in newly typical neuroleptic-treated schizophrenia inpatients

Cited by 3 publications

References 10 publications

Miscellanea on Encephalopathies

Miscellanea on Encephalopathies

Life-threatening conditions in psychiatry – neuroleptic malignant syndrome (NMS)

A Cautionary Note When Using Zonisamide in Youths

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