Treatment of a mild form of neuroleptic malignant syndrome with oral diazepam

Kontaxakis, V.P.; Christodoulou, George N.; Markidis, M.; Havaki-Kontaxaki, B.J.

doi:10.1111/j.1600-0447.1988.tb06355.x

Cited by 28 publications

(15 citation statements)

References 7 publications

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“…The explanation of such a high and rising incidence rather lies in changing diag nostic practices than in an actual increase of incidence over the years [10]. More specifically, this phenomenon may be due to the fact that psychiatrists have become more familiar with the syndrome and have started recog nizing and reporting less serious (milder) cases [11], or may reflect the possible diagnostic overlapping between NMS and other conditions, such as NIC.…”

Section: Discussionmentioning

confidence: 99%

“…To our knowledge AMD as well as benzodiazepines (mainly lorazepam) have been found effective in both NMS and NIC cases [1][2][3][4][11][12][13][14], With respect to the mode of action of these two drugs it appears that AMD has an indirect effect by enhancement of CNS dopaminergic activity on dopamine receptors through the release of intraneuronal extragranular dopamine and through do pamine reuptake blocking and a direct agonist effect on dopamine receptors mainly in the nigrostriatal dopamin ergic system [ 15]. The mode of action of DZP might be due to an indirect dopaminergic effect mediated by GABA-ergic feedback loops within nigrostriatal and mesolimbic centers [16].…”

Section: Discussionmentioning

confidence: 99%

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Neuroleptic-Induced Catatonia or a Mild Form of Neuroleptic Malignant Syndrome?

Kontaxakis

Vaidakis²,

Christodoulou³

et al. 1990

Neuropsychobiology

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Neuroleptic-induced catatonia (NIC) and milder neuroleptic malignant syndrome (NMS) share parkinsonian features, catatonic symptoms, mild fever, and have been described in patients receiving antipsychotic agents. We report the case of a patient with a schizophreniform disorder and a mild mental retardation who developed a condition which can be diagnosed either as NIC or as a mild form of NMS and has been treated successfully with a combination of amantadine (600 mg/day) and diazepam (30 mg/day). The overlapping between NIC and mild NMS cases might lead to an overestimation of the incidence of current NMS and reinforces the view of the existence of a ‘neuroleptic toxicity spectrum’.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Neuroleptic-Induced Catatonia or a Mild Form of Neuroleptic Malignant Syndrome?

Kontaxakis

Vaidakis²,

Christodoulou³

et al. 1990

Neuropsychobiology

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“…neurochemical, electrophysiological findings (Carroll and Goforth 1995;Jahanshahi et al 1995;Mann et al 2000;Nisijima and Ishiguro 1995;Northoff et al 1996;Northoff et al 2000;Wang and Hsieh 2001), and treatment response patterns (Lew and Tollefson 1983;Kontaxakis et al 1988;Miyaoka et al 1997;Koch et al 2000). Therefore, many investigators advocate that the many clinical and pathophysiological similarities between the two conditions place both of them along the same spectrum of disorders (White 1992;Fink 1996).…”

Section: Discussionmentioning

confidence: 92%

“…World J Biol Psychiatry Downloaded from informahealthcare.com by University of Auckland on 12/04/14 been reported for NMS (Kontaxakis et al 1988;Miyaoka et al 1997).…”

Section: Discussionmentioning

confidence: 93%

Catatonia as a risk factor for the development of neuroleptic malignant syndrome: Report of a case following treatment with clozapine

Paparrigopoulos

Tzavellas

Ferentinos

et al. 2009

The World Journal of Biological Psychiatry

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Catatonia is characterized by the predominance of psychomotor abnormalities and shares many clinical, biological and treatment response features with the neuroleptic malignant syndrome (NMS), a rare adverse reaction to psychoactive medications. It has been advocated that the two conditions should be placed along the same spectrum of disorders. A case of a 49-year-old woman, who developed NMS while on low dose clozapine soon after recovering from catatonia, is presented. The potential relationship between catatonia and NMS is discussed in the light of the existing literature, and attention is drawn to the risk for clozapine-induced NMS in catatonic patients.

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“…To prevent further rhabdomyolysis, patients have been paralyzed for several days [26]. Nifedipine [32], amantadine [33], physostigmine [34], diazepam [35], and electroconvulsive therapy [36] have all been tried with varying results.…”

Section: Treatmentmentioning

confidence: 99%

Four Cases of Neuroleptic Malignant Syndrome

et al. 1992

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The neuroleptic malignant syndrome (NMS) is a relatively uncommon, sometimes fatal, idiosyncratic drug reaction usually associated with the administration of neuroleptic drugs. The syndrome is characterized by generalized rigidity, fever, altered consciousness or mutism, tremor, autonomic dysfunction, tachypnea, elevated serum creatinine phosphokinase, leukocytosis and myoglobinuria. We report four cases of NMS; one following levodopa/bromocriptine withdrawal, two related to neuroleptic administration and one following heroin use. There are no previous reports linking heroin to NMS. The syndrome is thought to result from acute dopaminergic blockage or dopamine depletion. Levodopa, bromocriptine or both are recommended as specific treatment for this condition. Most cases of NMS occur following the administration of neuroleptic drugs. Recently, the syndrome has been described in patients on nonneuroleptic drugs [7][8][9][10][11][12][13][14][15][16][17] and after the withdrawal of certain drugs, especially antiParkinson medication [18,19]. This paper describes four cases of NMS recently encountered; one following levodopa/bromocriptine withdrawal, one probably due to heroin "snorting" and two related to neuroleptic administration. While heroin is known to produce rhabdomyolysis, there are no previous reports of its producing NMS. Case 1A 14-year-old Saudi female was brought to the hospital unresponsive. Forty days prior to admission trifluoperazine and imipramine were prescribed for agitation, anxiety, confusion and paranoia. She did not respond and eight days prior to admission these drugs were replaced by haloperidol 3 mg b.i.d. She developed progressive sluggishness, falling down spells, opisthotonic events, urinary incontinence and finally became unresponsive.On examination, her blood pressure was 104/60 mm Hg, pulse rate 150/min, respirations 40-60/ min and temperature was 38.9°C. There were bruises and abrasions on her shins. She respondedminimally to pain. Pupils were mid-position and reacted sluggishly. The limbs moved symmetrically· There was generalized rigidity including neck muscles and a fine tremor of the hands. Tendon reflexes were symmetrical and the plantar responses normal. Pertinent laboratory data: white blood count (WBC) was 16,000/mm 3 . Urinalysis was strongly positive for blood using the dip stick, but microscopic examination showed 0-1 red blood cells (RBC) per high powered field (HPF) strongly suggesting myoglobinuria. Serum lactic dehydrogenase (LDH) was 4,599 U/L, serum glutamic oxaloacetic transaminase (SGOT) 1381 U/L, serum glutamic pyruvic transaminase (SGPT) 236 U/L, total bilirubin 25 μmοl/L and direct bilirubin 6 μιηοΙ/L. Lumbar puncture opening pressure was 230 mm of water. Cerebrospinal

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Treatment of a mild form of neuroleptic malignant syndrome with oral diazepam

Abstract: A mild form of neuroleptic malignant syndrome (NMS) in a schizophrenic patient who was receiving a depot neuroleptic is described and beneficial response to oral diazepam 50 mg daily is reported.

Cited by 28 publications

References 7 publications

Neuroleptic-Induced Catatonia or a Mild Form of Neuroleptic Malignant Syndrome?

Neuroleptic-Induced Catatonia or a Mild Form of Neuroleptic Malignant Syndrome?

Catatonia as a risk factor for the development of neuroleptic malignant syndrome: Report of a case following treatment with clozapine

Four Cases of Neuroleptic Malignant Syndrome

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