Neuroleptic malignant syndrome
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Web Resources for Neuroleptic malignant syndrome
ICD 10 code: G21.0
Relevant Clinical Literature
UK Guidance
Other Wikis
Medpedia on Neuroleptic malignant syndrome (Less technical, good quality control)
Wikipedia on Neuroleptic malignant syndrome (Less technical, ? quality control)
 | High Fever and Antipsychotic agent |
Contents |
Presentation
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- High fever, usually above 38 C
- Fluctuating consciousness leading to coma
- Muscle rigidity and sometimes pain
- Autonomic dysfunction manifest as
- Sweating
- Pallor
- Labile blood pressure
- Incontinence
Differential Diagnosis
It is unusual for NMS to occur beyond 1 month after a treatment change. It is also argued as to whether forms without rigidity and high temperature are the true syndrome but most regard this as the case[1].
- Serotonin Syndrome
- Delirium due to other causes
- Excited or stuporous catatonia can present with fever and rigidity and is a rationale for considering ECT.
Treatment
Treatment should ideally take place in I.C.U. and it is a good idea for those familiar with the condition to ensure that others understand the severity of the condition. Less severe cases with mild pyrexia can be treated in medical ward.
- Stopping the offending drug
- Mean recovery time after drug discontinuation is in the range of 7–10 days
- Rehydration
- Dantrolene
- Cooling[2]
- Dopamine agonists (most case reports with bromocriptine but cabergoline and amantadine (which may work by a different mechanism) have been used successfully in mild cases)
- It may be possible if long term treatment is needed in schizophrenia or resistant mania, for a different low potency atypical antipsychotic to be tried[3][4] but this needs to be done with care considering issues such as CYP2D6 metabolism[5], that all drugs with dopaminergic blockade have been implicated, abet some such as quetiapine, ziprasidone, or aripiprazole rarely [6]., the 30% relapse rate and the few actual case reports of success.
- Case reports and series exist of ECT being used with success[7]
References
- ↑ Picard LS, Lindsay S, Strawn JR, Kaneria RM, Patel NC, Keck PE. Atypical neuroleptic malignant syndrome: diagnostic controversies and considerations. Pharmacotherapy. 2008 Apr; 28(4):530-5.(Link to article – subscription may be required.)
- ↑ Diedler J, Mellado P, Veltkamp R. Endovascular cooling in a patient with neuroleptic malignant syndrome. Journal of the neurological sciences. 2008 Jan 15; 264(1-2):163-5.(Link to article – subscription may be required.)
- ↑ Trutia A, Bledowski J, Pandurangi A, Kahn DA. Neuroleptic rechallenge with aripiprazole in a patient with previously documented neuroleptic malignant syndrome. Journal of psychiatric practice. 2008 Nov; 14(6):398-402.(Link to article – subscription may be required.)
- ↑ Strawn JR, Keck PE, Caroff SN. Neuroleptic malignant syndrome. The American journal of psychiatry. 2007 Jun; 164(6):870-6.(Link to article – subscription may be required.)
- ↑ Kato D, Kawanishi C, Kishida I, Furuno T, Suzuki K, Onishi H, Hirayasu Y. Effects of CYP2D6 polymorphisms on neuroleptic malignant syndrome. European journal of clinical pharmacology. 2007 Nov; 63(11):991-6.(Link to article – subscription may be required.)
- ↑ Strawn JR, Keck PE, Caroff SN. Neuroleptic malignant syndrome. The American journal of psychiatry. 2007 Jun; 164(6):870-6.(Link to article – subscription may be required.)
- ↑ Patel AL, Shaikh WA, Khobragade AK, Soni HG, Joshi AS, Sahastrabuddhe GS. Electroconvulsive therapy in drug resistant neuroleptic malignant syndrome. The Journal of the Association of Physicians of India. 2008 Jan; 56:49-50.
