1
|
Mędrala W, Rodek P, Alli-Balogun B, Barabasz-Gembczyk A, Wójcik P, Kucia K. Malignant complications of masturbation - a case study. Psychiatr Pol 2023; 57:1057-1062. [PMID: 36542768 DOI: 10.12740/pp/onlinefirst/138338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
We present a case of a 32-years-old female patient diagnosed with paranoid schizophrenia for many years who has developed neuroleptic malignant syndrome (NMS) as a result of long-acting antipsychotic's injection. Since the initial ineffectiveness of benzodiazepines, the course of electroconvulsive therapy (ECT) has been carried out. In spite of the initial promising response to ECT 3 weeks after the admission her somatic and mental state deteriorated greatly, that was hardly explicable solely by the potential loss of effectiveness of ECT or laboratory tests. Diagnostics extended with imaging tests and gynecological examination revealed the connective tissue-covered cap of a popular multivitamin supplement in patient's vagina. During the following deepened interview, she admitted that in fact 6 months ago a piece had gotten stuck while masturbating. However due to the sense of shame and subjective lack of disturbing symptoms she had left it unsaid. One month after the evacuation of the foreign body she has been discharged from the hospital remaining the full remission. The presented case shows that inflammation in the body can complicate catatonia and NMS, causing a non-specific course and difficulties in diagnosis and treatment. In some patients, the inflammatory process may be caused by a foreign body located in various natural orifices in the body. It appears significant in the group of psychiatric patients. Once again it highlights the tremendous role of meticulously conducted interview including the patient's autoerotic life.
Collapse
Affiliation(s)
- Wojciech Mędrala
- Śląski Uniwersytet Medyczny w Katowicach, Górnośląskie Centrum Medyczne im. prof. Leszka Gieca, Oddział Psychiatrii i Psychoterapii
| | - Patryk Rodek
- Śląski Uniwersytet Medyczny w Katowicach, Górnośląskie Centrum Medyczne im. prof. Leszka Gieca, Oddział Psychiatrii i Psychoterapii
| | - Barbara Alli-Balogun
- Śląski Uniwersytet Medyczny w Katowicach, Wydział Lekarski, Klinika Psychiatrii i Psychoterapii
| | | | - Paulina Wójcik
- Śląski Uniwersytet Medyczny w Katowicach, Górnośląskie Centrum Medyczne im. prof. Leszka Gieca, Oddział Psychiatrii i Psychoterapii
| | - Krzysztof Kucia
- Śląski Uniwersytet Medyczny w Katowicach, Wydział Lekarski, Klinika Psychiatrii i Psychoterapii
| |
Collapse
|
2
|
Messieha ZS. Office-based General Anesthesia for a Patient With a History of Neuroleptic Malignant Syndrome. Anesth Prog 2023; 70:20-24. [PMID: 36995955 PMCID: PMC10069533 DOI: 10.2344/anpr-69-04-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/03/2022] [Indexed: 03/31/2023] Open
Abstract
First described in 1956 subsequent to a reaction reported to the newly introduced antipsychotic drug chlorpromazine, neuroleptic malignant syndrome (NMS) is a rare, potentially life-threatening reaction to antipsychotic drugs characterized by high fever, muscle rigidity, altered mental status, and autonomic instability. All neuroleptics, including newer antipsychotics, have been linked to this condition. Due to similar symptoms, it is debatable if individuals with NMS can be susceptible to malignant hyperthermia (MH). This case report presents the anesthetic care of a 30-year-old male undergoing general anesthesia in the office-based dental environment. The rationale behind the selected total intravenous anesthesia technique without NMS or MH triggering agents is outlined as well as other agents that may still be questionable regarding their trigger effect for NMS.
Collapse
Affiliation(s)
- Zakaria S Messieha
- Dentist Anesthesiologist, Private Practice, Clinical Professor (Retired), Oakbrook Terrace, Illinois
| |
Collapse
|
3
|
Marloth PV, Ladefoged MR, Boesen MS. [Neuroleptic malignant syndrome caused by olanzapine, risperidone and haloperidol]. Ugeskr Laeger 2022; 184:V08220506. [PMID: 36345898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Neuroleptic malignant syndrome is a rare neuropsychiatric complication caused by antipsychotic drugs. Symptoms include decreased consciousness, fever, muscle rigidity and autonomic dysfunction. Creatine kinase concentration is often elevated. This is a case report of a 27-year-old man who developed neuroleptic malignant syndrome after administration of olanzapine, risperidone and haloperidol. He was treated with benzodiazepine, dantrolene, amantadine and electroconvulsive therapy with good recovery.
Collapse
|
4
|
Mizuno T, Takahashi R, Kamiyama T, Suzuki A, Suzuki M. Neuroleptic Malignant Syndrome with Adrenal Insufficiency After BNT162b2 COVID-19 Vaccination in a Man Taking Valproate: A Case Report. Am J Case Rep 2022; 23:e936217. [PMID: 35514081 PMCID: PMC9087139 DOI: 10.12659/ajcr.936217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/03/2022] [Accepted: 03/11/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Considering the ongoing coronavirus disease 2019 (COVID-19) pandemic, sufficient information about common and serious adverse events is needed to rapidly distribute COVID-19 vaccines worldwide. We report a case of neuroleptic malignant syndrome (NMS) with adrenal insufficiency after initial vaccination with Pfizer/BioNTech BNT162b2. CASE REPORT A 48-year-old man presented to the Emergency Department with fever and an altered mental status 7 days after receiving the first dose of the BNT162b2 COVID-19 vaccine. The patient had a history of end-stage renal disease and epilepsy treated with valproate. He was diagnosed with NMS based on the clinical findings of hyperthermia, muscular rigidity, and an elevated creatine kinase level. Additionally, a reduction in the response of cortisol to adrenocorticotropic hormone (ACTH) stimulation was observed in the rapid ACTH stimulation test. The patient was treated with dantrolene, bromocriptine, and hydrocortisone, and he responded well to treatment. Dantrolene and bromocriptine were tapered off over 4 weeks. Hydrocortisone was also tapered, and the patient was discharged on oral hydrocortisone (30 mg). CONCLUSIONS The present case suggests a possible link between the BNT162b2 COVID-19 vaccine and NMS with adrenal insufficiency based on the temporal relationship between vaccine administration and disease onset, although the patient was taking valproate, a potential cause of NMS. Having a high level of suspicion is important because the diagnosis of NMS with adrenal insufficiency is often challenging due to non-specific clinical manifestations. However, this case does not negate the utility of vaccination because these complications are extremely rare and can be treated with early diagnosis and proper management.
Collapse
|
5
|
Aki ÖE, Gürcan A, Gürel ŞC, Yazici MK. A Severe Neuroleptic Malignant Syndrome Treated with Daily Electroconvulsive Therapy: A Case Report. Turk Psikiyatri Derg 2022; 33:139-142. [PMID: 35730514 DOI: 10.5080/u26535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Neuroleptic malignant syndrome (NMS) is a rare but life-threatening condition caused by dopamine modulating medications, particularly antipsychotics. First-line treatments of neuroleptic malignant syndrome are supportive care, discontinuation of the offending agent and pharmacotherapy. In drug-resistant and severe situations, electroconvulsive therapy (ECT) is recommended as well. In this paper we present a 23-year old male with bipolar disorder who was treated with multiple injections of zuclopenthixol long acting and depot forms for a recent manic episode and developed NMS. The patient was transferred to an intensive care unit, medical management was initiated including benzodiazepines, bromocriptine and dantrolene. Due to the inadequate response after several days, ECT (bitemporal electrode placement, briefpulse, on a daily basis) was initiated. After 17 sessions, NMS relieved and there was no need for maintenance ECT. The patient is under follow-up care for 3 years with no cognitive and physical sequela. Keywords: Electroconvulsive therapy, neuroleptic malignant syndrome, bipolar disorder.
Collapse
|
6
|
Arora P, Nagpal S, Tewari A, Jose NA, Mahla VP, Tripathi A, Gupta P, Siwatch A, Ogha A. Post-Electroconvulsive Therapy Hyperthermia: A Case Report. J ECT 2021; 37:e37-e38. [PMID: 34294650 DOI: 10.1097/yct.0000000000000784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
7
|
Maia A, Cotovio G, Barahona-Corrêa B, Oliveira-Maia AJ. Diagnosis and Treatment of Neuroleptic Malignant Syndrome in the Intensive Care Unit: A Case Report. ACTA MEDICA PORT 2021; 34:464-467. [PMID: 32997617 DOI: 10.20344/amp.13019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 12/16/2019] [Accepted: 04/03/2020] [Indexed: 01/03/2023]
Abstract
Neuroleptic malignant syndrome is a neurological emergency caused by dysregulation of dopaminergic neurotransmission. While it is typically characterized by muscle rigidity, fever and altered mental status, it may have a heterogeneous and non-specific presentation, leading to delays in diagnosis and treatment. Treatment involves cessation of dopamine-receptor antagonists and supportive measures, but in more severe cases, bromocriptine, dantrolene, benzodiazepines and/or electroconvulsive therapy should be considered. We present the case of a 66-year-old man with severe neuroleptic malignant syndrome, diagnosed due to need for continuous invasive ventilation in an Intensive Care Unit, after successful treatment for respiratory sepsis. The patient recovered after electroconvulsive therapy and administration of bromocriptine. This unusually severe case illustrates the need for a high level of suspicion for neuroleptic malignant syndrome in critically ill patients with malignant catatonic syndromes, allowing for an early diagnosis and potentially lifesavingtreatment.
Collapse
Affiliation(s)
- Ana Maia
- Departament of Psychiatry and Mental Health. Hospital Egas Moniz. Centro Hospitalar de Lisboa Ocidental. Lisboa. NOVA Medical School | Faculdade de Ciências Médicas. Universidade NOVA de Lisboa. Lisboa. Champalimaud Research and Clinical Centre. Champalimaud Centre for the Unknown. Lisboa. b. NOVA Medical School | Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal c. Champalimaud Research and Clinical Centre, Champalimaud Centre for the Unkown, Lisboa, Portugal
| | - Gonçalo Cotovio
- Departament of Psychiatry and Mental Health. Hospital Egas Moniz. Centro Hospitalar de Lisboa Ocidental. Lisboa. NOVA Medical School | Faculdade de Ciências Médicas. Universidade NOVA de Lisboa. Lisboa. Champalimaud Research and Clinical Centre. Champalimaud Centre for the Unknown. Lisboa. b. NOVA Medical School | Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal c. Champalimaud Research and Clinical Centre, Champalimaud Centre for the Unkown, Lisboa, Portugal
| | - Bernardo Barahona-Corrêa
- Departament of Psychiatry and Mental Health. Hospital Egas Moniz. Centro Hospitalar de Lisboa Ocidental. Lisboa. NOVA Medical School | Faculdade de Ciências Médicas. Universidade NOVA de Lisboa. Lisboa. Champalimaud Research and Clinical Centre. Champalimaud Centre for the Unknown. Lisboa. b. NOVA Medical School | Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal c. Champalimaud Research and Clinical Centre, Champalimaud Centre for the Unkown, Lisboa, Portugal
| | - Albino J Oliveira-Maia
- Departament of Psychiatry and Mental Health. Hospital Egas Moniz. Centro Hospitalar de Lisboa Ocidental. Lisboa. NOVA Medical School, Faculdade de Ciências Médicas. Universidade NOVA de Lisboa. Lisboa. Champalimaud Research and Clinical Centre. Champalimaud Centre for the Unknown. Lisboa. b. NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal c. Champalimaud Research and Clinical Centre, Champalimaud Centre for the Unkown, Lisboa, Portugal
| |
Collapse
|
8
|
Abstract
ABSTRACT Catatonia is a motor and mood disorder of behavior increasingly recognized in systemic medically ill. Neuroleptic malignant syndrome, delirious mania, self injurious behaviors in autism, and limbic encephalitis are conditions in which ECT-responsive catatonia is increasingly recognized and effectively treated.
Collapse
Affiliation(s)
- Max Fink
- From the Departments of Psychiatry and Neurology, Stony Brook University School of Medicine, Stony Brook, NY
| |
Collapse
|
9
|
Rajan R, Sage M. Successful Emergency Treatment of Refractory Neuroleptic Malignant Syndrome With Electroconvulsive Therapy and a Novel Use of Dexmedetomidine: A Case Report From California in the Era of COVID-19. J ECT 2021; 37:71-73. [PMID: 33600120 PMCID: PMC7889040 DOI: 10.1097/yct.0000000000000725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/17/2020] [Indexed: 12/02/2022]
Abstract
ABSTRACT We describe the case of a patient, hospitalized in a California community medical ICU for over a month, with severe neuroleptic malignant syndrome (NMS), unresponsive to medical management, but responsive to electroconvulsive therapy (ECT). We discuss the medical, logistical, and legal challenges in providing ECT in this setting. We also describe a previously unpublished use of dexmedetomidine, which aided in the safe and rapid reduction of benzodiazepines and permitted a successful ECT course. The rapid delivery and efficacy of ECT were essential because of the burgeoning coronavirus pandemic. The patient's treatment required exemplary efforts by providers across multiple disciplines, ongoing medicolegal consultation with the county mental health medical director, as well as consultation with expert members of the International Society for ECT and Neurostimulation. We conclude with a discussion of the unique challenges of providing emergency ECT to patients in California, including during a serious pandemic, when courts are closed. This case illustrates the importance of cultivating and maintaining high-quality ECT expertise in community hospitals and keeping ECT services available even during pandemics. Also, this case demonstrates that ECT is not "merely an elective procedure" but a vital, life-saving treatment, even during the era of COVID-19. To our knowledge, this is the first such published case of emergency ECT performed in California.
Collapse
Affiliation(s)
- Rajani Rajan
- From the Department of Psychiatry, Kaiser Permanente, Santa Clara
| | - Mary Sage
- Department of Psychiatry, Kaiser Permanente, Walnut Creek, CA
| |
Collapse
|
10
|
van Achter ON, Sivagurunathan S. [Neuroleptic malignant syndrome treated with electroconvulsive therapy]. Ugeskr Laeger 2020; 182:V09200630. [PMID: 33269687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Neuroleptic malignant syndrome (NMS) is a rare but severe complication to antipsychotic treatment. Both first-generation and second-generation antipsychotics can induce NMS. This is a case report of NMS induced by second-generation antipsychotic treatment with aripiprazole causing symptoms of rigidity, altered mental status, diaphoresis and creatine kinase elevation. A 27-year-old man was admitted to an ICU and underwent ECT treatment on day ten, 11 and 12 after presentation of the symptoms. There was significant symptom improvement after ECT treatment and full recovery after two weeks.
Collapse
|
11
|
Brogna P, Colasuonno R, Di Michele F, Paterniti AM, Talamo A, Ribolsi M, Jannini TB, Siracusano A, Niolu C. Diagnostic and therapeutic challenges in neuroleptic malignant syndrome: a severe medical case. Riv Psichiatr 2020; 55:236-239. [PMID: 32724236 DOI: 10.1708/3417.34000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Neuroleptic malignant syndrome (NMS) is a rare, idiosyncratic medical emergency usually associated with the use of dopamine antagonists, commonly typical antipsychotic drugs. However, it has been observed that it can occur with atypical antipsychotics as well. NMS is characterized by altered consciousness, fever, rigidity, autonomic instability and high creatine phosphokinase (CPK) blood levels. Here, we report a case of a 44-year-old female patient with history of a treatment-resistant bipolar disorder. She was admitted to our psychiatric ward for severe psychomotor agitation and treated with a therapy based on typical and atypical antipsychotics. During the course of the hospitalization she developed NMS. In this case, the diagnosis was delayed due to the slow and insidious symptom presentation, therefore requiring a differential diagnosis. Autoimmune NMDA receptor encephalitis, catatonic syndrome and malignant catatonia have been excluded. The patient met all the DSM-5 criteria for NMS: exposure to dopamine-blocking agent, severe muscle rigidity, fever, diaphoresis, dysphagia, altered level of consciousness, mutism, tremors, tachycardia, high or labile blood pressure, leukocytosis, high creatine phosphokinase. Since robust evidence-based protocols are lacking, here we discuss the relevance of this case in order to highlight the hurdles of a prompt diagnosis, clinical management of associated complications and treatment possibilities for such emergency.
Collapse
Affiliation(s)
- Pasquale Brogna
- Psychiatry and Clinical Psychology Unit, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Rosangela Colasuonno
- Psychiatry and Clinical Psychology Unit, Fondazione Policlinico Tor Vergata, Rome, Italy - Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Flavia Di Michele
- Psychiatry and Clinical Psychology Unit, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Angela Maria Paterniti
- Psychiatry and Clinical Psychology Unit, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Alessandra Talamo
- Psychiatry and Clinical Psychology Unit, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Michele Ribolsi
- Psychiatry and Clinical Psychology Unit, Fondazione Policlinico Tor Vergata, Rome, Italy - Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Tommaso B Jannini
- Psychiatry and Clinical Psychology Unit, Fondazione Policlinico Tor Vergata, Rome, Italy - Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Alberto Siracusano
- Psychiatry and Clinical Psychology Unit, Fondazione Policlinico Tor Vergata, Rome, Italy - Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Cinzia Niolu
- Psychiatry and Clinical Psychology Unit, Fondazione Policlinico Tor Vergata, Rome, Italy - Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| |
Collapse
|
12
|
|
13
|
Abstract
OBJECTIVES Neuroleptic malignant syndrome (NMS) is an uncommon condition associated with significant morbidity and mortality. Data on treatment interventions are limited. In this case series, we sought to describe all NMS cases requiring ECT from a large academic institution over a nearly 2-decade period. METHODS We retrospectively identified all patients with NMS who were treated with ECT over a 17-year period. Patients were included in the study based on chart review using the International Consensus Diagnostic Criteria for NMS. Data were collected related to clinical findings, treatment course, and response to ECT. RESULTS We identified 15 patients meeting the inclusion criteria. Most patients had neurocognitive or schizophrenia spectrum disorders and developed NMS after exposure to multiple antipsychotic drugs. All patients received bitemporal ECT after failed pharmacotherapy for NMS. Electroconvulsive therapy was well tolerated and resulted in a remission rate of 73.3% (n = 11). Patients showed early initial response to ECT (mean of 4.2 treatments), but an average of 17.7 treatments was necessary to minimize recurrence of catatonic signs. One patient died after interruption of the index course of ECT because of severe infection, and another was discharged to hospice care after limited response. These cases highlight the lethality of NMS and its complications despite aggressive treatment measures. CONCLUSIONS Bitemporal ECT was well tolerated and effective in treating NMS refractory to pharmacotherapy. We suggest that ECT be considered early in cases of NMS that are refractory to pharmacological interventions, especially if the underlying condition is also responsive to ECT.
Collapse
Affiliation(s)
- Nicholas Morcos
- From the Michigan Medicine Department of Psychiatry, The University of Michigan, Ann Arbor, MI
| | | | | |
Collapse
|
14
|
González-Romero MF, Avina-Galindo AM, Elbe D, Friedlander R, Vila-Rodriguez F. Lifesaving Electroconvulsive Therapy for a Child With Autism Spectrum Disorder, Severe Self-Injurious Behavior, and Neuroleptic Malignant Syndrome. J ECT 2019; 35:e55-e56. [PMID: 31764456 DOI: 10.1097/yct.0000000000000598] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We present a case of a preteen with autism spectrum disorder and severe self-injurious behavior who developed neuroleptic malignant syndrome on antipsychotics and required urgent electroconvulsive therapy and continued maintenance electroconvulsive therapy for ongoing clinical stability.
Collapse
Affiliation(s)
| | | | - Dean Elbe
- Department of Psychiatry, University of British Columbia
- Child and Adolescent Mental Health Programs, BC Children's Hospital
- Department of Pharmacy, Children's and Women's Health Centre of British Columbia
| | - Robin Friedlander
- Department of Pharmacy, Children's and Women's Health Centre of British Columbia
| | - Fidel Vila-Rodriguez
- Department of Pharmacy, Children's and Women's Health Centre of British Columbia
- Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
15
|
Hakeem H, Nasir M, Khan MF, Syed NM, Rajput HM, Ahmed A, Javed MA, Bhatti DE. Recognizing Movement Disorder Emergencies - A Practical Review For Non-Neurologist. J Ayub Med Coll Abbottabad 2019; 31:448-453. [PMID: 31535526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Neurology still remains one of the most underserved specialties of medicine in Pakistan with roughly one neurologist per million people. Movement disorders (MD) are neurological problems that interfere with patient's motor abilities and diagnosis is typically clinical. In this review, we describe a practical approach to common MD emergencies that may be encountered by a non-neurologist physician, emphasizing on formulating a working diagnosis and their immediate management. Movement disorder emergencies can be classified based on MD phenomenology and we will provide a brief overview of dystonia including acute dystonic reaction, PAID syndrome and dystonic storm; chorea, myoclonus including serotonin syndrome and startle disease; and rigidity including neuroleptic malignant syndrome and malignant hyperthermia.
Collapse
Affiliation(s)
- Haris Hakeem
- Section of Neurology, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Memoona Nasir
- Department of Medicine and Allied Services, Pakistan Kidney and Liver Institute and Research Center, Lahore, Pakistan
| | - Muhammad Farhan Khan
- Division of Neurology, Shifa International Hospital, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Nabeel Muzaffar Syed
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States
| | - Haris Majid Rajput
- Department of Neurology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Arsalan Ahmed
- Division of Neurology, Shifa International Hospital, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | | | - Danish Ejaz Bhatti
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States
| |
Collapse
|
16
|
Abstract
Background Neuroleptic malignant syndrome is a rare but life-threatening idiosyncratic complication following the use of antipsychotic agents, anaesthesia and surgery. It is characterized by hyperthermia, muscle rigidity, autonomic disturbances and mental state alterations. Case A 31 year old female weighing 60kg received a depot preparation of Fluphenazine on account of depression with psychotic features observed two days prior to elective Cholecystectomy under general anaesthesia. Surgery and anaesthesia were essentially uneventful. Forty eight hours post-operatively, the patient developed features suggestive of neuroleptic malignant syndrome complicated by aspiration pneumonitis. This necessitated her admission into the intensive care unit. She had prolonged stay in the intensive care unit, where she was mechanically ventilated, developed deep venous thrombosis of the left upper limb and required tracheostomy on account of prolonged endotracheal intubation. Patient recovered fully following bromocriptine and dantrolene therapy. She was discharged home after 60 days on admission and has remained in good health. Conclusion Though rare, neuroleptic malignant syndrome can occur in young adult females following use of antipsychotics, anaesthesia and surgery. Its clinical course can be prolonged and distressing with the use of depot preparations. Early diagnosis and prompt supportive measures are essential to reduce morbidity and mortality.
Collapse
Affiliation(s)
- Peter I Agbonrofo
- Department of Surgery, University of Benin Teaching Hospital, PMB 1111, Benin City, Nigeria. ; . Tel:+234 802-829-6343
| | - John E Osakue
- Department of Anaesthesiology, University of Benin Teaching Hospital, PMB 1111, Benin City, Nigeria. . Tel:+234 806-036-2070, +234 809-111-4193
| |
Collapse
|
17
|
Abstract
Neuroleptic malignant syndrome (NMS) is a potentially lethal adverse drug reaction. We report a case of NMS potentially induced by dehydration in a female patient suffering from schizoaffective disorder. We discuss possible aetiologies and triggering factors alongside the existing literature.
Collapse
Affiliation(s)
- Théo Korchia
- Department of Psychiatry, Assistance Publique Hopitaux de Marseille, Marseille, France
| | - Graham Blackman
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Michel Cermolacce
- Department of Psychiatry, Assistance Publique Hopitaux de Marseille, Marseille, France
| | - Raphaëlle Richieri
- Department of Psychiatry, Assistance Publique Hopitaux de Marseille, Marseille, France
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Institut Fresnel - UMR 7249, Faculté des Sciences de Saint Jérôme, Marseille, France
| |
Collapse
|
18
|
Affiliation(s)
- S M Sagar
- Department of Medicine, Greenwich District Hospital, London
| |
Collapse
|
19
|
Schilter D, Eschle D. [Not Available]. Praxis (Bern 1994) 2018; 107:393-395. [PMID: 29587588 DOI: 10.1024/1661-8157/a002942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Zusammenfassung. Eine 69-jährige Patientin wurde wegen einer wahnhaften Störung mit Neuroleptika behandelt. Sie wurde notfallmässig wegen einer Verschlechterung der Vigilanz in Kombination mit einer erhöhten Körpertemperatur, generalisiertem Rigor und erhöhter Kreatinkinase aus der psychiatrischen Klinik überwiesen. Nach Ausschluss einer Meningitis und anderer Infektionen wurde ein malignes Neuroleptika-Syndrom (MNS) diagnostiziert und mit Amantadin i.v. behandelt. Nach überstandenem MNS persistierte ein invalidisierender Rigor an den Beinen.
Collapse
|
20
|
Halim U, Ajwani S, Lovell M. Neuroleptic Malignant Syndrome Following Bilateral Cemented Total Hip Replacements. Bull Hosp Jt Dis (2013) 2017; 75:286-288. [PMID: 29151017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Neuroleptic malignant syndrome (NMS) is a rare, serious complication caused by neuroleptic medications. It is characterized by rigidity, hyperthermia, tachycardia, leukocytosis, and an elevated creatine kinase (CK). We present a case of a 50-year-old male who underwent bilateral total hip replacements and subsequently developed NMS. This condition is typically triggered by the sudden introduction, omission, or change in dose of a neuroleptic; in contrast with previous case reports of post-surgical NMS, however, no such trigger was identifiable for our patient. Moreover, this is the first reported case of NMS after single-stage bilateral hip arthroplasty. Consequently, by presenting this case report we hope to make clinicians aware of the possibility of NMS occurring after hip arthroplasty in any patient taking longterm neuroleptics.
Collapse
|
21
|
Abstract
RATIONALE Neuroleptic malignant syndrome (NMS) is a life threatening neurologic emergency associated with neuroleptic or antipsychotic agent use. NMS is rarely related to thyroid disease. PATIENT CONCERNS We report a case of NMS in a 66-year-old male with past medical history of paranoid schizophrenia on chlorpromazine, diabetes, hypertension and asthma, who presented with a humeral fracture after a fall. Patient developed hyperpyrexia, altered consciousness, autonomic instability, elevated serum creatine kinase (CK) without rigidity. DIAGNOSES CT head and workup for infection were negative. Electroencephalogram (EEG) showed generalized slow wave activity. Ultrasound revealed a large goiter with nodules. INTERVENTIONS Chlorpromazine was stopped due to concern of NMS. Patient was treated with cooling, fluid and electrolyte maintenance. OUTCOMES Patient slowly improved and CK level normalized. Thyroid-stimulating hormone (TSH) level trended down from 10.2 mIU/L to 0.02 mIU/L. Patient was discharged with aripiprazole. LESSONS Hypothyroidism predisposes patients to NMS by altering central dopaminergic systems. The typical symptoms may be masked by hypothyroidism. Thyroid dysfunction should be excluded in all patients with NMS. Discontinuing antipsychotic agents decreases TSH levels which maybe due to the negative feedback of dopaminergic activity. This is the first case report describing dramatic changes in TSH after discontinuing chlorpromazine in NMS.
Collapse
Affiliation(s)
- Fan Zhang
- Department of Internal Medicine, Brookdale University Hospital and Medical Center, Brooklyn
| | - Parisa Kanzali
- Ross University School of Medicine, Portsmouth, Dominica
| | - Vadim Rubin
- Department of Internal Medicine, Brookdale University Hospital and Medical Center, Brooklyn
| | - Chris Paras
- Department of Internal Medicine, Brookdale University Hospital and Medical Center, Brooklyn
| | - Joel Goldman
- Division of Endocrinology, Brookdale University Hospital and Medical Center, Brooklyn, New York
| |
Collapse
|
22
|
Abstract
BACKGROUND Physicians can come across patients who are exposed to certain prescription drugs or toxins that can result in adverse effects and complications which have high rates of morbidity and mortality. OBJECTIVE To summarise the key clinical features and management of the common movement disorder toxidromes relevant to physicians (with an interest in neurology). METHODS We searched PUBMED from 1946 to 2016 for papers relating to movement toxidromes and their treatment. The findings from those studies were then summarised and are presented here. RESULTS The key features of 6 of the common movement disorder toxidromes and their treatment are tabulated and highlighted. The management of toxidromes with the highest mortality like neuroleptic malignant syndrome and serotonin syndrome are discussed in detail. CONCLUSION There are several toxidromes that have the potential to become a serious life-threatening emergency if there is a delay in recognition of key clinical features and instituting the appropriate treatment at the earliest is crucial.
Collapse
Affiliation(s)
- N Malek
- Department of Neurology, Ipswich Hospital NHS Trust, Ipswich, UK
| | - M R Baker
- Department of Neurology, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK
- Department of Clinical Neurophysiology, Royal Victoria Infirmary, Newcastle -upon-Tyne, UK
- Institute of Neuroscience, The Medical School, Newcastle University, Newcastle-upon-Tyne, UK
| |
Collapse
|
23
|
Marcolin KA, Rodrigues CO, Muller TMF, Salles FSD, Calegaro V, Cunha ABMD. Bitemporal ultra-brief pulse electroconvulsive therapy for the treatment of neuroleptic malignant syndrome in a first psychotic episode: a case report. Trends Psychiatry Psychother 2017; 39:62-63. [PMID: 28403325 DOI: 10.1590/2237-6089-2015-0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 07/13/2016] [Indexed: 06/07/2023]
Affiliation(s)
- Kathy Aleixo Marcolin
- Departamento de Neuropsiquiatria, Universidade Federal de Santa Maria (UFSM), Santa Maria, RS, Brazil
| | - Cazuza Oliveira Rodrigues
- Departamento de Neuropsiquiatria, Universidade Federal de Santa Maria (UFSM), Santa Maria, RS, Brazil
| | | | - Felipe Salles de Salles
- Departamento de Neuropsiquiatria, Universidade Federal de Santa Maria (UFSM), Santa Maria, RS, Brazil
| | - Vitor Calegaro
- Departamento de Neuropsiquiatria, UFSM, Santa Maria, RS, Brazil
| | | |
Collapse
|
24
|
Chun TH, Mace SE, Katz ER. Evaluation and Management of Children With Acute Mental Health or Behavioral Problems. Part II: Recognition of Clinically Challenging Mental Health Related Conditions Presenting With Medical or Uncertain Symptoms. Pediatrics 2016; 138:peds.2016-1573. [PMID: 27550976 DOI: 10.1542/peds.2016-1573] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
25
|
Chiou YJ, Lee Y, Lin CC, Huang TL. A Case Report of Catatonia and Neuroleptic Malignant Syndrome With Multiple Treatment Modalities: Short Communication and Literature Review. Medicine (Baltimore) 2015; 94:e1752. [PMID: 26512569 PMCID: PMC4985383 DOI: 10.1097/md.0000000000001752] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We describe a case with complicated clinical presentations who was difficult to treat. We described the possible etiologies and differential diagnosis of neuroleptic malignant syndrome (NMS), catatonia, and infection, in details. This patient was also referred to neuro-intensive care unit for extensive workup and treatments by neurologist guidelines. In addition, we also used lorazepam-diazepam protocol and antipsychotics, but both failed to completely relieve her symptoms. She eventually responded to electroconvulsive therapy (ECT).A 60-year-old female patient with schizophrenia was diagnosed to suspected pneumonia, urinary tract infection, and retarded catatonia at first. The brain computed tomography revealed no significant finding. She developed NMS caused by the administration of low-dose quetiapine (200 mg) after carbamazepine was discontinued. The Francis-Yacoub NMS rating scale (F-Y scale) total score was 90. We utilized lorazepam-diazepam protocol and prescribed bromocriptine and amantadine, but NMS was not improved. Meanwhile, we arranged the brain magnetic resonance imaging to survey the physical problem, which revealed agenesis of septum pellucidum and dilated lateral ventricles. She was then transferred to the neuro-intensive care unit on the 15th hospital day for complete study. The results of cerebrospinal fluid study and electroencephalography were unremarkable. She was transferred back to psychiatric ward on the 21st hospital day with residual catatonic and parkinsonian symptoms of NMS, and the F-Y scale total score was 63. Finally, her residual catatonic condition that followed NMS got improved after 11 sessions of ECT. On the 47th hospital day, the F-Y scale total score was 9.This report underscores that the ECT is an effective treatment for a patient of NMS when other treatments have failed.
Collapse
Affiliation(s)
- Yu-Jie Chiou
- From the Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | | | | | | |
Collapse
|
26
|
Yu M, Tadin D, Conrad EJ, Lopez FA. Clinical Case of the Month: A 48-Year-Old Man With Fever and Abdominal Pain of One Day Duration. J La State Med Soc 2015; 167:237-240. [PMID: 27159603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A 48-year-old man residing in a mental health department inpatient program with a history of schizoaffective disorder presented to the emergency department with a chief complaint of fever and intense abdominal pain for one day. The patient stated he initially fell in the shower and afterwards experienced back pain. He was transferred to an acute care unit within the facility for further evaluation. The facility physician noted that the patient had a mild temperature elevation and abdominal rigidity on exam. At that time, he was given two doses of benztropine intramuscularly, and transferred to our hospital for further evaluation. The patient exhibited fever, diffuse abdominal pain and a nonproductive cough, but denied chills, dysuria, urinary frequency, hematuria, weakness, diarrhea, melena or hematochezia. He did have a one-week history of constipation for which he was given sodium phosphate enemas, magnesium citrate and docusate sodium, eventually resulting in a bowel movement. He also complained of new onset dysphagia. There were no recent changes to his medications, which included clonazepam, divalproex sodium extended release, olanzapine and risperidone. He denied use of tobacco, alcohol or illicit drugs.
Collapse
|
27
|
Hashim H, Alrukn SAM, Al Madani AARS. Drug resistant neuroleptic malignant syndrome and the role of electroconvulsive therapy. J PAK MED ASSOC 2014; 64:471-473. [PMID: 24864649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Neuroleptic malignant syndrome is considered as a rare but potentially fatal complication of neuroleptic medications e.g.,antipsychotics, sedatives and anti emetics. It is characterized by hyperthermia, muscle rigidity, an elevated creatine kinase level and autonomic instability. The syndrome often develops after the start of antipsychotic or a sudden increase in dosage of the neuroleptic medication or in states of dehydration. Treatment is mainly supportive and includes withdrawal of the neuroleptic medication and, possibly, administration of drugs such as dantrolene and bromocriptine. In rare cases where drugs treatment remains ineffective a trial of electroconvulsive therapy is being given. The case presented is a drug resistant case of Neuroleptic Malignant Syndrome where finally electroconvulsive therapy was effective.
Collapse
|
28
|
Abstract
Neuroleptic malignant syndrome (NMS) can be caused by various drugs. We report a case of a 60-year-old woman who presented with high-grade fever, muscular rigidity, tachycardia, tachypnoea and altered sensorium along with seizures. She had been taking olanzapine for the past 2 years for psychosis. For the last month valproate was added to her treatment. Her blood investigations revealed hyponatraemia and raised serum ammonia and creatinine phosphokinase (CPK) levels. In view of hyperthermia, muscular rigidity, autonomic disturbances, altered mental status and raised CPK, a diagnosis of NMS was made. Valproate could have probably precipitated NMS; although the patient was taking antipsychotics for a long time, it was only with the addition of valproate that she developed these symptoms. Raised serum ammonia levels also indicated the presence of valproate toxicity. Seizures were probably due to electrolyte disturbances. Offending drugs were withdrawn. The patient improved with treatment by dopamine agonist and other supportive treatments.
Collapse
Affiliation(s)
- Rajesh Verma
- King George Medical University, Lucknow, Uttar Pradesh, India
| | | | | |
Collapse
|
29
|
Asztalos Z, Egervári L, Andrássy G, Faludi G, Frecska E. [Catatonia and neuroleptic malignant syndrome in view of a psychopathological and pathophysiological overlap: a brief review]. Neuropsychopharmacol Hung 2014; 16:19-28. [PMID: 24687015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Catatonia was first described in the 19th century as a syndrome with motor, affective and behavioral symptoms. During the 20th century it was rather regarded as a rare motoric manifestation of schizophrenia and that classification has almost resulted in the disappearance of catatonia among patients outside of the schizophrenia spectrum. With the introduction of neuroleptics, the incidence of catatonic schizophrenia also declined which was attributed to effective treatment. Simultaneously, neuroleptic malignant syndrome was described, which shows many similarities with catatonia. Recently, several researchers suggested a common origin of the two disorders. In this paper we review case reports of the last five years, in which both neuroleptic malignant syndrome and catatonia had emerged as a diagnosis. Additionally, based on the relevant literature, we propose a common hypothetical pathomechanism with therapeutic implications for the two syndromes. Besides underlining the difficulties of differential diagnosis, the reviewed cases demonstrate a transition between the two illnesses. The similarities and the possible shifts may suggest a neuropathological and pathophysiological overlap in the background of the two syndromes. Electroconvulsive therapy and benzodiazepines seem to be an effective treatment in both syndromes. These two treatment approaches can be highly valuable in clinical practice, especially if one considers the difficulties of differential diagnosis.
Collapse
Affiliation(s)
- Zoltán Asztalos
- Debreceni Egyetem Orvos- és Egészségtudományi Centrum, Pszichiátriai Tanszék, Debrecen, Hungary.
| | | | | | | | | |
Collapse
|
30
|
Buggenhout S, Vandenberghe J, Sienaert P. [Electroconvulsion therapy for neuroleptic malignant syndrome]. Tijdschr Psychiatr 2014; 56:612-615. [PMID: 25222100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A 64-year-old man, diagnosed with recurrent depression, developed a neuroleptic malignant syndrome (nms) during treatment with olanzapine and mirtazapine. Psychotropic drugs were discontinued. Supportive therapy in an intensive care setting was initiated and electroconvulsive therapy (ect) was administered, after which the patient recovered. This case report discusses the place of ect in the treatment of nms.
Collapse
|
31
|
Shinoda M, Sakamoto M, Shindo Y, Ando Y, Tateda T. [Case of neuroleptic malignant syndrome following open heart surgery for thoracic aortic aneurysm with parkinson's disease]. Masui 2013; 62:1453-1456. [PMID: 24498782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
An 80-year-old woman with Parkinson's disease was scheduled for open heart surgery to repair thoracic aortic aneurysm. Parkinson's symptoms were normally treated using oral levodopa (200 mg), selegiline-hydrochloride (5 mg), bromocriptine-mesilate (2 mg), and amantadine-hydrochloride (200 mg) daily. On the day before surgery, levodopa 50mg was infused intravenously. Another 25 mg of levodopa was infused immediately after surgery. Twenty hours later, the patient developed tremors, heyperventilation, but no obvious muscle rigidity. Two days after surgery, the patient exhibited high fever, hydropoiesis, elevated creatine kinase, and a rise in blood leukocytes. She was diagnosed with neuroleptic malignant syndrome. She was intubated, and received dantrolene sodium. Symptoms of neuroleptic malignant syndrome disappeared on the fourth postoperative day. The stress of open heart surgery, specifically extracorporeal circulation and concomitant dilution of levodopa, triggered neuroleptic malignant syndrome in this patient. Parkinson's patients require higher doses of levodopa prior to surgery to compensate and prevent neuroleptic malignant syndrome after surgery.
Collapse
Affiliation(s)
- Maiko Shinoda
- Department of Anesthesiology, ST Marianna University School of Medicine, Kawasaki 216-8511
| | - Mik Sakamoto
- Department of Anesthesiology, ST Marianna University School of Medicine, Kawasaki 216-8511
| | - Yuki Shindo
- Department of Anesthesiology, ST Marianna University School of Medicine, Kawasaki 216-8511
| | - Yumi Ando
- Department of Anesthesiology, ST Marianna University School of Medicine, Kawasaki 216-8511
| | - Takeshi Tateda
- Department of Anesthesiology, ST Marianna University School of Medicine, Kawasaki 216-8511
| |
Collapse
|
32
|
González-Blanco L, García-Prada H, Santamarina S, Jiménez-Treviño L, Bobes J. Recurrence of neuroleptic malignant syndrome. Actas Esp Psiquiatr 2013; 41:314-318. [PMID: 24096397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 09/01/2013] [Indexed: 06/02/2023]
Abstract
Neuroleptic malignant syndrome (NMS) is a rare idiosyncratic reaction associated with the use of neuroleptics that has an incidence of 0.02 to 3% among patients taking these drugs. This is a very serious complication with a mortality rate that reaches 10-20%. It is therefore very important to have high clinical suspicion and use appropriate criteria to objectify this clinical picture early, stopping the medication causing the picture and to avoid the subsequent complications as much as possible that would be responsible for both its mortality and sequels. We present that case of an 81-year old woman who was admitted to the Psychiatric Hospitalization Unit (PHU) for a depressive episode with psychotic symptoms who developed a neuroleptic malignant syndrome (NMS) when Haloperidol was introduced. After its suspension and subsequent clinical recovery, antipsychotic treatment with Risperidone was reintroduced and she suffered a recurrence of NMS. Finally, significant improvement was achieved with several sessions of electroshock therapy (EST).
Collapse
Affiliation(s)
- Leticia González-Blanco
- Médico Interno Residente de Psiquiatría Servicio de Psiquiatría del Hospital Universitario Central de Asturias (HUCA)
| | | | | | | | | |
Collapse
|
33
|
Kishida I, Furuno T, Kawanishi C. [Neuroleptic malignant syndrome (NMS)]. Nihon Rinsho 2012; 70 Suppl 6:612-615. [PMID: 23156583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Ikuko Kishida
- Department of Psychiatry, Yokohama City University, School of Medicine
| | | | | |
Collapse
|
34
|
Wysokiński A. Intensive electroconvulsive therapy in drug resistant neuroleptic malignant syndrome - case report. Psychiatr Danub 2012; 24:219-222. [PMID: 22706423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Adam Wysokiński
- Department of Old Age Psychiatry and Psychotic Disorders, Medical University of Lodz, Czechoslowacka 8/10, 92-216 Lodz, Poland.
| |
Collapse
|
35
|
Abstract
BACKGROUND Second-generation antipsychotic medications, or "atypical antipsychotics," are now first-line therapy in the treatment of schizophrenia and other psychotic disorders, and are additionally being used in a wide array of other psychiatric and non-psychiatric conditions in both adults and children. Overdose is frequently reported to poison control centers. OBJECTIVES We review the toxicology and general management of poisonings involving the atypical antipsychotic medications. DISCUSSION The most serious toxicity involves the cardiovascular system and the central nervous system. All typical and atypical antipsychotics cause sedation, which is pronounced in overdose. The most common cardiovascular effects that occur after atypical antipsychotic overdose are tachycardia, mild hypotension, and prolongation of the QTc interval. Other clinical syndromes in overdose include neuroleptic malignant syndrome (NMS) and antimuscarinic delirium. Seizures may be observed. No antidotes exist for these poisonings, but they most often do well with supportive care. CONCLUSION Antipsychotic overdose produces a gamut of manifestations that affect multiple organ systems. Treatment is primarily supportive. Specific therapies for NMS, hypotension, and seizures are discussed.
Collapse
Affiliation(s)
- Alicia B Minns
- Department of Emergency Medicine, Division of Medical Toxicology, University of California, San Diego, San Diego, California 92103, USA
| | | |
Collapse
|
36
|
Maeda T, Enomoto T, Kamiyama Y, Inada E. [Anesthetic management for electroconvulsive therapy using rocuronium bromide and sugammadex sodium in a patient with suspected malignant syndrome]. Masui 2011; 60:1384-1386. [PMID: 22256579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A 62-year-old woman was treated for schizophrenia for 40 years. When the symptoms had deteriorated and new medications had to be added, CPK rose and she malignant syndrome was suspected. The electroconvulsive therapy (ECT) was proposed because of no improvement of the symptoms. We employed rocuronium bromide instead of suxamethonium considering malignant syndrome. The maintenance of anesthesia was necessary, because the duration of rocuronium bromide is longer than that of suxamethonium chloride. Anesthesia was induced and maintained using target controlled infusion (TCI) of propofol. After ECT was performed, sugammadex sodium 4 mg . kg-1 was administered at 2 post-tetanic counts (PTC) and the patient could come out the operating room safely and speedy. ECT using rocuronium bromide and sugammadex sodium can be performed safely and speedily, when suxamethonium chloride cannot be used.
Collapse
Affiliation(s)
- Tsuyoshi Maeda
- Department of Anesthesiology, Juntendo University Urayasu Hospital, Urayasu 279-0021
| | | | | | | |
Collapse
|
37
|
Chow TKF. With the advent of sugammadex, a succinylcholine-free anaesthetic in electroconvulsive therapy may be the future standard. Anaesth Intensive Care 2011; 39:1154-1155. [PMID: 22165380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
|
38
|
Saeki N, Kwon R, Migita T, Fukuda H, Hamada H, Kawamoto M. Electroconvulsive therapy using rocuronium and sugammadex in patient with neuroleptic malignant syndrome. Anaesth Intensive Care 2011; 39:762-763. [PMID: 21823397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
|
39
|
Leone MC, Chiussi G, Pigna F, Baroni MC, Delsignore R. Unexpected hospitalisation side effects in an elderly man. Intern Emerg Med 2011; 6:187-8. [PMID: 20458555 DOI: 10.1007/s11739-010-0398-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Accepted: 04/07/2010] [Indexed: 10/19/2022]
|
40
|
Kotera A, Kouzuma S, Miyazaki N, Hashimoto M, Taki K, Esaki K. [Perioperative management of neuroleptic malignant syndrome in a schizophrenic patient scheduled to undergo operation for bowel obstruction]. Masui 2011; 60:373-376. [PMID: 21485109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Neroleptic malignant syndrome (NMS) is a serious side effect of antipsychotic medications. The risk factors for NMS are the patient's physiologic conditions such as dehydration, malnutrition, stress, and additional administration of sedative drugs including haloperidol. We report a case of 62-year-old schizophrenic man with bowel obstruction due to rectal cancer. Colostomy under general anesthesia was scheduled, and he had not taken oral medication. After intravenous injection of haloperidol for sedation, muscle rigidity, high fever, and an elevated serum level of creatine phosphokinase were observed. He was diagnosed as NMS, and sodium dantrolene was administered. After the improvement of NMS, colostomy was done. Dehydration and malnutrition of the patient were severe at the time of operation, and the possibility of NMS developing due to stress was thought to be very high. We administered sodium dantrolene to prevent NMS after the operation, and the management for prevention of NMS is discussed.
Collapse
Affiliation(s)
- Atsushi Kotera
- Department of Anesthesiology, National Hospital Organization Kumamoto Medical Center, Kumamoto 860-0008
| | | | | | | | | | | |
Collapse
|
41
|
Lemos J, Mós M, Monteiro A, Henriques P. [Neuroleptic malignant syndrome: a rare long lasting case report]. ACTA MEDICA PORT 2010; 23:1155-1159. [PMID: 21627894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2009] [Accepted: 02/05/2010] [Indexed: 05/30/2023]
Abstract
Neuroleptic malignant syndrome (NMS) is a neurological emergency related to neuroleptics medication. Diagnosis is clinical. Authors present the case of a 32-year-old Caucasian man with a history of moderated oligophreny treated with stable doses of psychotropic and neuroleptic drugs. Because of aggressivity outbreaks, he was administered high doses of intramuscular haloperidol decanoate for a period of ten days. One month later he had evolved with mental deterioration, mutism, generalized rigidity, fever, tachycardia, hypotension and diaphoresis. Neuroleptic malignant syndrome was diagnosed. Supporting treatment was provided and intercurrences treated. Neuroleptic malignant syndrome is a fatal disease in 10 to 20% of patients; otherwise it resolves in about two weeks. In rare cases, like this one the authors report, it has a prolonged evolution of months.
Collapse
Affiliation(s)
- Joana Lemos
- Serviço de Medicina Interna 1, Hospital de São Teotónio, Viseu
| | | | | | | |
Collapse
|
42
|
Tuerlings JHAM, van Waarde JA, Verwey B. A retrospective study of 34 catatonic patients: analysis of clinical care and treatment. Gen Hosp Psychiatry 2010; 32:631-5. [PMID: 21112456 DOI: 10.1016/j.genhosppsych.2010.08.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Revised: 08/29/2010] [Accepted: 08/31/2010] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To analyze clinical characteristics, time lag between diagnosis and treatment, and outcome of patients treated for catatonia, with the intention to improve daily clinical care. METHOD A retrospective case study. RESULTS Between 1991 and 2009, a total of 34 patients were clinically diagnosed to have benign catatonia (n=13), malignant catatonia (n=11) and neuroleptic malignant syndrome (n=10). A total of 63 additional psychiatric diagnoses were present, and half of the patients had comorbid medical and neurological disorders. The mean time lags between first catatonic symptoms and first treatment and between first catatonic symptoms and second treatment were 15±36 and 58±92 days, respectively. Of the 34 patients, 26 (76%) improved, with complete remission in 20 (58%); mortality rate was 9% (n=3). CONCLUSIONS Retrospective evaluation of 34 catatonic patients revealed a great variety of psychiatric diagnoses and somatic comorbidity. Although treatment was effective in 76%, time lag between the first symptoms and effective treatment was remarkably long. Based on our retrospective critical evaluation, a clinical protocol has been developed to improve daily care for these complex and very ill patients.
Collapse
|
43
|
Abstract
Catatonia is a distinct neuropsychiatric syndrome that is becoming more recognized clinically and in ongoing research. It occurs with psychiatric, metabolic, or neurologic conditions. It may occur in many forms, including neuroleptic malignant syndrome. Treatment with benzodiazepines or electroconvulsive therapy leads to a dramatic and rapid response, although systematic, randomized trials are lacking. An important unresolved question is the role of antipsychotic agents in treatment and their potential adverse effects.
Collapse
Affiliation(s)
- Andrew Francis
- Department of Psychiatry, Health Sciences Center T-10, SUNY Stony Brook, Stony Brook, NY 11794-8101, USA.
| |
Collapse
|
44
|
Affiliation(s)
- Farhana Mann
- Margarete Centre, Camden and Islington NHS Foundation Trust, London NW1 2LS.
| | | |
Collapse
|
45
|
Sanai T, Matsui R, Hirano T, Torichigai S, Yotsueda H, Higashi H, Hirakata H, Iida M. Successful Treatment of Six Patients with Neuroleptic Malignant Syndrome Associated with Myoglobulinemic Acute Renal Failure. Ren Fail 2009; 28:51-5. [PMID: 16526319 DOI: 10.1080/08860220500461252] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Neuroleptic malignant syndrome is a rare but potentially lethal, rare reaction to neuroleptics which is characterized by altered levels of consciousness, extrapyramidal effects, autonomic instability, hyperthermia, and elevated serum creatine phosphokinase levels. The most serious complication of neuroleptic malignant syndrome is acute renal failure. We investigated six cases of neuroleptic malignant syndrome associated with myoglobulinemic acute renal failure due to rhabdomyolysis and effect of hemodialysis or hemodiafiltration. The patients were five males and one female with a mean age of 43.5 yr. All of the patients, who developed acute renal failure induced from rhabdomyolysis, had previously received butyrophenone (haloperidol), phenothiazine, benzamide, iminomide, benzisoxazole, antidepressants, and hypnotics (benzodiazepine and barbiturate) for the treatment of schizophrenia. The clinical manifestations of neuroleptic malignant syndrome were characterized by altered consciousness, muscle rigidity and weakness, fever, and excessive perspiration. The peak laboratory data were blood urea nitrogen 102 +/- 26 (mean +/- SD) mg/dL, serum creatinine 9.1 +/- 2.1 mg/dL, serum creatine phosphokinase 229,720 +/- 289,940 IU/L, and all of them developed oliguric acute renal failure. Dantrolene sodium administration was given to five cases and hemodialysis or hemodiafiltration was performed in all of them. The serum creatinine level after hemodialysis or hemodiafiltration was 1.4 +/- 1.0 mg/dL. All patients were successfully cured of acute renal failure by hemodialysis or hemodiafiltration. As a result, myoglobulinemic acute renal failure associated with neuroleptic malignant syndrome was successfully treated by hemodialysis or hemodiafiltration.
Collapse
Affiliation(s)
- Toru Sanai
- The Division of Nephrology, Department of Internal Medicine and Clinical Research Institute, National Kyushu Medical Center, Fukuoka, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Imashuku Y, Kitagawa H, Kojima A, Ishikawa Y, Kuzukawa A, Nosaka S. [Anesthetic management for electroconvulsive therapy using target-controlled infusion of propofol]. Masui 2008; 57:889-891. [PMID: 18649646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A 66-year-old man received medical treatment of depression for several years. He had a suspected malignant syndrome and in addition the symptom had deteriorated, and the electroconvulsive therapy (ECT) was administered. Though suxamethonium chloride is usually used as a muscular relaxant in the electroconvulsive therapy, we used vecuronium bromide (VCB) considering malignant syndrome. Maintenance of anesthesia was necessary because of the long effect of VCB. Anesthesia was induced and maintained by target controlled infusion (TCI) of propofol. Because propofol suppresses the convulsion, it is necessary to adjust the depth of anesthesia by propofol, and we used TCI of propofol. When the predicted blood propofol concentrations were 1.5 microg x ml(-1) and 2.0 microg x ml(-1), electric stimulation was given to the patient and enough seizure duration was obtained. TCI of propofol is useful for ECT to patients for whom suxamethonium chloride can not be used.
Collapse
Affiliation(s)
- Yasuhiko Imashuku
- Department of Anesthesiology, Shiga University of Medical Science, Otsu 520-2192
| | | | | | | | | | | |
Collapse
|
47
|
Patel AL, Shaikh WA, Khobragade AK, Soni HG, Joshi AS, Sahastrabuddhe GS. Electroconvulsive therapy in drug resistant neuroleptic malignant syndrome. J Assoc Physicians India 2008; 56:49-50. [PMID: 18472502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
We report a case of a 20 years female referred to us with a history of a brief psychotic episode for which she was given inj. Haloperidol. The patient presented in an unconscious state with high grade fever. The diagnosis was kept as neuroleptic malignant syndrome after ruling out other possibilities. The patient did not respond to Bromocriptine and Dantrolene. With the recent evidence of electroconvulsive therapy being useful in these patients, we went ahead with the same. We present this case to share our experience of the excellent response of neuroleptic malignant syndrome to electroconvulsive therapy.
Collapse
Affiliation(s)
- A L Patel
- Department of General Medicine, Grant Medical College and Sir J. J. Group of Hospitals, Mumbai, India
| | | | | | | | | | | |
Collapse
|
48
|
Kawanishi C, Furuno T, Kishida I. [Drug-induced neuroleptic malignant syndrome]. Nihon Rinsho 2007; 65 Suppl 8:331-335. [PMID: 18074558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Chiaki Kawanishi
- Department of Psychiatry, Yokohama City University School of Medicine
| | | | | |
Collapse
|
49
|
|
50
|
Abstract
Atypical antipsychotics and newer antidepressants are commonly prescribed medications responsible for tens of thousands of adverse drug exposures each year. The emergency medicine physician should have a basic understanding of the pharmacology and toxicity of these agents. This knowledge is crucial to providing proper care and timely management of patients presenting with adverse drug effects from exposure to atypical antipsychotics and newer antidepressants.
Collapse
Affiliation(s)
- Tracey H Reilly
- Division of Medical Toxicology, Department of Emergency Medicine, University of Virginia, Charlottesville, VA 22908-0774, USA.
| | | |
Collapse
|