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Neuroleptic Malignant Syndrome

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1. Drug information update. Atypical antipsychotics and neuroleptic malignant syndrome: nuances and pragmatics of the association Full Text available with Trip Pro

Drug information update. Atypical antipsychotics and neuroleptic malignant syndrome: nuances and pragmatics of the association Neuroleptic malignant syndrome (NMS) is a rare but potentially fatal adverse event associated with the use of antipsychotics. Although atypical antipsychotics were initially considered to carry no risk of NMS, reports have accumulated over time implicating them in NMS causation. Almost all atypical antipsychotics have been reported to be associated with NMS (...) . The clinical profile of NMS caused by certain atypical antipsychotics such as clozapine has been reported to be considerably different from the NMS produced by typical antipsychotics, with diaphoresis encountered more commonly, and rigidity and tremor encountered less frequently. This article briefly discusses the evidence relating to the occurrence, presentation and management of NMS induced by atypical antipsychotics.

2017 BJPsych bulletin

3. Neuroleptic malignant syndrome

. Neuroleptic-induced extrapyramidal symptoms with fever: heterogeneity of the 'neuroleptic malignant syndrome'. Arch Gen Psychiatry. 1986 Sep;43(9):839-48. http://www.ncbi.nlm.nih.gov/pubmed/2875701?tool=bestpractice.com History and exam presence of risk factors altered mental status muscle rigidity autonomic dysfunction hyperthermia psychiatric hx hx of iron deficiency hx of Wilson's disease exposure to antipsychotic medications abrupt withdrawal of dopaminergic drugs structural brain abnormality older (...) Neuroleptic malignant syndrome Neuroleptic malignant syndrome - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Neuroleptic malignant syndrome Last reviewed: February 2019 Last updated: November 2017 Summary A serious, potentially life-threatening complication of treatment with antipsychotic drugs or abrupt withdrawal of dopamine agonists. Characterised by a tetrad of altered mental status, muscle rigidity, autonomic

2017 BMJ Best Practice

4. A Case of Neuroleptic Malignant Syndrome in a Profoundly Intellectually Disabled Patient with Successful Reintroduction of Antipsychotic Therapy with Quetiapine Full Text available with Trip Pro

A Case of Neuroleptic Malignant Syndrome in a Profoundly Intellectually Disabled Patient with Successful Reintroduction of Antipsychotic Therapy with Quetiapine Neuroleptic Malignant Syndrome (NMS) is a rare condition clinically characterized by muscle rigidity, hyperthermia, autonomic instability, and acute mental status change. NMS is most often associated with use of high-potency first-generation antipsychotic medications; though, other neuroleptics have been implicated as well. NMS can (...) then discuss our decision to reintroduce an atypical antipsychotic agent, quetiapine. This case illustrates the importance of early recognition of the signs and symptoms of NMS and the need to initiate treatment promptly in order to prevent complications, including death. This case also highlights the decision to resume antipsychotic pharmacotherapy after adequate resolution of NMS, demonstrating that it can be done so safely if started at low doses coupled with intensive monitoring of the patient.

2018 Case reports in psychiatry

5. Neuroleptic malignant syndrome following reintroduction of an antipsychotic after overdose Full Text available with Trip Pro

Neuroleptic malignant syndrome following reintroduction of an antipsychotic after overdose 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.© BMJ Publishing Group Limited 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights

2018 BMJ case reports

6. Neuroleptic malignant syndrome following catatonia: Vigilance is the price of antipsychotic prescription Full Text available with Trip Pro

Neuroleptic malignant syndrome following catatonia: Vigilance is the price of antipsychotic prescription To describe a case of neuroleptic malignant syndrome following antipsychotic treatment of catatonia, highlighting the potentially serious complications of this rare adverse drug reaction.We present a case report of a patient who developed this syndrome with various sequelae.The patient developed neuroleptic after being treated with lorazepam and olanzapine for catatonia. He subsequently (...) developed the complications of rhabdomyolysis, acute kidney injury, pulmonary embolism, urinary retention and ileus. He received high-dose lorazepam, anticoagulation and intravenous fluids. Antipsychotic medication in the form of haloperidol was reinstated with no adverse effect, and he went on to make a full recovery.This case illustrates the potential life-threatening complications of neuroleptic malignant syndrome and the need for a low index of clinical suspicion. It also highlights the lack

2017 SAGE Open Medical Case Reports

7. Persistent psychotic disorders: avoid combining neuroleptics

combining neuroleptics Combining oral neuroleptics cumulates adverse effects but offers no proven benefits. In adult patients with psychotic disorders associated with a psychiatric condition such as schizophrenia, there is no evidence that one oral neuroleptic is particularly more effective than another. In monotherapy, the choice between neuroleptics is mainly guided by the drugs' adverse effect profile weighed against both the observed beneficial effects on clinical outcomes and any adverse effect (...) compared to monotherapy. Combinations of neuroleptics expose the patient to an accumulation of serious adverse effects, including antimuscarinic, cardiac, extrapyramidal, sedative and metabolic effects, as well as neuroleptic malignant syndromes, rhabdomyolysis and drug interactions. In the absence of well-established efficacy, it is wise to avoid combining neuroleptics. When a combination of neuroleptics seems justified, it is best to prescribe the lowest possible doses, taking into account

2020 Prescrire

8. Royal College of Psychiatrists' and Royal College of Physicians' statement on neuroleptic malignant syndrome

Coroner, Inner London South, to comment on a case where a young woman died in psychiatric care. There was some inconsistency in the evidence given to the coroner’s court which this statement aims to rectify. The Colleges make the following joint recommendations for the diagnosis and management of neuroleptic malignant syndrome (NMS): 1 NMS is a rare and serious complication of antipsychotic therapy about which there is much uncertainty over definitions, cause, course and outcome. Nonetheless, all (...) Royal College of Psychiatrists' and Royal College of Physicians' statement on neuroleptic malignant syndrome Royal College of Psychiatrists' and Royal College of Physicians' statement on neuroleptic malignant syndrome Position Statement PS03/2014 December 2014 Royal College of Psychiatrists London Approved by the Policy and Public Affairs Committee: November 20142 http://www.rcpsych.ac.uk Position Statement PS03/2014 The Royal Colleges of Psychiatrists and Physicians were asked by the Senior

2014 Royal College of Psychiatrists

9. Clozapine Rechallenge Following Neuroleptic Malignant Syndrome: A Systematic Review. (Abstract)

Clozapine Rechallenge Following Neuroleptic Malignant Syndrome: A Systematic Review. Neuroleptic malignant syndrome (NMS) has been described with most antipsychotics, most commonly first generation. Clozapine has also been associated with NMS.We conducted a systematic review to identify all studies investigating or describing (a) clozapine rechallenge following suspected NMS associated with clozapine, (b) clozapine use after suspected NMS associated with another antipsychotic, and (c (...) ) rechallenge with nonclozapine antipsychotics after suspected clozapine-associated NMS.We identified 51 reports detailing 67 cases. Thirty-eight described clozapine administration after NMS on a nonclozapine antipsychotic; 12 described a clozapine rechallenge after an NMS on clozapine monotherapy; and 17 described the use of nonclozapine antipsychotics after an NMS on clozapine. The outcome of clozapine rechallenge was favorable (no recurrence of NMS) in 92% (n = 11) of cases after an NMS on clozapine

2019 Journal of Clinical Psychopharmacology

10. A case of malignant hyperthermia that was difficult to be differentiated from oral antipsychotic polypharmacy-associated neuroleptic malignant syndrome Full Text available with Trip Pro

A case of malignant hyperthermia that was difficult to be differentiated from oral antipsychotic polypharmacy-associated neuroleptic malignant syndrome Malignant hyperthermia (MH) occurred during anesthesia with volatile inhalation anesthetics in a patient under treatment with multiple oral antipsychotic drugs and with a history of multi-acting receptor-targeted antipsychotic drug (MARTA)-induced elevation of serum creatine kinase (CK). Since the patient was considered to be at high risk (...) for neuroleptic malignant syndrome (NMS) based on this history, differential diagnosis between MH and NMS was difficult at the time of onset. Later, the patient was found to be predisposed to MH based on abnormal high rate of the Ca2+-induced Ca2+ release (CICR). We concluded that MH was induced by the volatile inhalation anesthetics.

2016 Ja Clinical Reports

11. A Mixed Presentation of Serotonin Syndrome vs Neuroleptic Malignant Syndrome in a 12-Year-Old Boy. (Abstract)

A Mixed Presentation of Serotonin Syndrome vs Neuroleptic Malignant Syndrome in a 12-Year-Old Boy. Neuroleptic malignant syndrome (NMS) and serotonin syndrome (SS) are serious medical conditions associated with commonly prescribed psychiatric medications. Although the mechanisms differ, they can be clinically difficult to distinguish. We report a case of a pediatric patient with complicated psychiatric history that developed features of both syndromes in the setting of polypharmacy.A 12-year (...) transitioned to the inpatient psychiatric unit on hospital day 7.Diagnosis of NMS or SS can be difficult when there is overlap between syndromes, particularly in the setting of multiple potential offending agents or underlying developmental delay. In addition, pediatric patients may present atypically as compared with adult patients with the same condition.The use of antipsychotic medications for young children with behavioral problems has risen dramatically in the last decade, increasing their risk

2018 Pediatric Emergency Care

12. Acute Abdomen with Ileus: A Heralding Presentation of Neuroleptic Malignant Syndrome Full Text available with Trip Pro

Acute Abdomen with Ileus: A Heralding Presentation of Neuroleptic Malignant Syndrome The pathophysiology of neuroleptic malignant syndrome (NMS) with use of psychotropic drugs is still unclear. Although a rare event with an incidence of 0.02-3.2%, when not promptly recognized and managed, it carries a high mortality (10-20%) and morbidity rate. Presentation can be either typical, with muscle rigidity and hyperpyrexia, or atypical, the latter posing diagnostic and early management challenges

2018 Case reports in gastroenterology

13. Atypical Neuroleptic Malignant Syndrome Precipitated by Clozapine and Quetiapine Overdose: A Diagnostic Challenge Full Text available with Trip Pro

Atypical Neuroleptic Malignant Syndrome Precipitated by Clozapine and Quetiapine Overdose: A Diagnostic Challenge Neuroleptic malignant syndrome (NMS) is a rare, idiosyncratic, but life-threatening adverse reaction associated with the use of antipsychotic drugs. It is characterized by a tetrad of fever, rigidity, autonomic instability, and altered mental status. Failure to diagnose NMS early and institute appropriate treatment can result in serious medical complications and death. While (...) was found to be markedly elevated. Clinicians should have a high index of suspicion for NMS. Routine checking and trending of serum CK in patients on antipsychotic drugs who present with features of NMS is recommended to facilitate diagnosis. Future research is needed to define and validate threshold scores for existing diagnostic criteria for NMS.

2018 Innovations in clinical neuroscience

14. Forced Diuresis and Expedient Blood Pressure Control in the Management of Quetiapine Induced Neuroleptic Malignant Syndrome: A Case Report Full Text available with Trip Pro

Forced Diuresis and Expedient Blood Pressure Control in the Management of Quetiapine Induced Neuroleptic Malignant Syndrome: A Case Report This case report intends to highlight the importance of safeguarding renal function from rhabdomyolysis in neuroleptic malignant syndrome (NMS) by concomitant administration of parenteral fluids at a high rate together with high doses of parenteral loop diuretics (we utilised 6 mg bumetanide daily) and tailed over a few days, in order to preserve glomerular (...) high dose bumetanide were instituted to safeguard the kidneys against damage due to nephron deposition, both from haemoglobinuria as well as possibly myoglobin from rhabdomyolysis. A working diagnosis of the neuroleptic malignant syndrome with secondary malignant hypertension was made, and the quetiapine withdrawn. Blood pressure was after that subsequently controlled on amlodipine, and the haemoglobinuria quickly settled within 24 hours, with large amounts of dilute urine being passed on account

2018 Open access Macedonian journal of medical sciences

15. Early detection of an atypical presentation of neuroleptic malignant syndrome: A case report Full Text available with Trip Pro

Manual of Mental Disorders, 5th edition, diagnostic features, a sequential treatment strategy was initiated and the patient appropriately responded to antipsychotic cessation in addition to combination therapy with dantrolene and bromocriptine. Neuroleptic malignant syndrome diagnostic criteria, treatment, and prognosis are discussed. (...) Early detection of an atypical presentation of neuroleptic malignant syndrome: A case report Neuroleptic malignant syndrome (NMS), which is considered a neurologic emergency, is believed to be caused by exposure to dopamine antagonist or withdrawal from a dopamine agonist. This article reports a case of suspected atypical NMS in a patient following rapid conversion of ziprasidone to risperidone without titration. While the initial presentation did not fully meet the Diagnostic and Statistical

2018 The Mental Health Clinician

16. Diagnostic, Treatment, and System Challenges in the Management of Recurrent Neuroleptic Malignant Syndrome on a General Medical Service Full Text available with Trip Pro

Diagnostic, Treatment, and System Challenges in the Management of Recurrent Neuroleptic Malignant Syndrome on a General Medical Service Neuroleptic malignant syndrome (NMS), an iatrogenic form of malignant catatonia, carries high morbidity and mortality rates especially in the context of delayed recognition and standard intervention protocol of lorazepam trial. However, there is limited guidance available through literature for further management if benzodiazepine treatment is ineffective (...) and electroconvulsive therapy (ECT) is not readily accessible. This case report describes a multimodal approach to address the diagnostic, treatment, and logistical system challenges in an acute medical hospital through the case of a 69-year-old man with schizophrenia who represented from a psychiatric ward with neuroleptic malignant syndrome. We educated our inpatient colleagues for timely recognition of hyperexcited subtype of catatonia to avoid iatrogenic progression to neuroleptic malignant syndrome and our

2018 Case reports in psychiatry

17. Neuroleptic malignant syndrome: a case responding to electroconvulsive therapy plus bupropion Full Text available with Trip Pro

Neuroleptic malignant syndrome: a case responding to electroconvulsive therapy plus bupropion Neuroleptic malignant syndrome (NMS) is a severe motor syndrome occurring as a consequence of neuroleptic treatment. We present a case of a 67-year-old Caucasian woman with a history of a major depressive disorder with psychotic features. During her third hospital admission, symptoms of autonomic instability, hyperpyrexia, severe extrapyramidal side effects, and delirium appeared, suggesting NMS due (...) to concomitant treatment with risperidone and quetiapine, among other drugs. Despite several consecutive pharmacological treatments (lorazepam, bromocriptine and amantadine) and prompt initiation of electroconvulsive therapy (ECT), clinical improvement was observed only after combining bupropion with ECT. The symptoms that had motivated the admission gradually remitted and the patient was discharged home. Bupropion increases dopaminergic activity in both the nucleus accumbens and the prefrontal cortex

2018 Clinics and practice

18. Brain imaging changes in malignant hyperthermia, neuroleptic malignant syndrome, and heat stroke: a systematic review

Brain imaging changes in malignant hyperthermia, neuroleptic malignant syndrome, and heat stroke: a systematic review Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability for the content of this registration record, any associated (...) . No metastases/ only primary tumor 4. No control group 5. Combination therapy or contamination 6. Not about analgesics used in the clinic Full text-screening: As above, with the addition of: 7. No relevant outcome measure reported ">Prioritise the exclusion criteria Example: Two reviewers will independently extract data from each article. We first try to extract numerical data from tables, text or figures. If these are not reported, we will extract data from graphs using digital ruler software. In case data

2019 PROSPERO

19. Neuroleptic Malignant Syndrome/Malignant Catatonia in Child Psychiatry: Literature Review and a Case Series. (Abstract)

Neuroleptic Malignant Syndrome/Malignant Catatonia in Child Psychiatry: Literature Review and a Case Series. To describe the presentation of neuroleptic malignant syndrome (NMS) and malignant catatonia (MC) in children and adolescents.NMS and MC are life-threatening, neuropsychiatric syndromes, associated with considerable morbidity and mortality. NMS is diagnosed when there is a recent history of treatment with an antipsychotic (AP) medication, while MC is diagnosed when the symptoms resemble (...) NMS but without a history of exposure to an AP agent. Some authorities believe that apart from the history of exposure to an AP medication, the two conditions are identical. The symptoms of NMS/MC include severe agitation, behavior disregulation, motor and speech changes, self-injury and aggression, autonomic instability, and a range of psychiatric symptoms (affective, anxiety, or psychotic symptoms). Patients may be misdiagnosed with another disorder leading to extensive tests and a delay

2017 Journal of Child and Adolescent Psychopharmacology

20. Src is the primary target of aripiprazole, an atypical antipsychotic drug, in its anti-tumor action Full Text available with Trip Pro

Src is the primary target of aripiprazole, an atypical antipsychotic drug, in its anti-tumor action Aripiprazole (ARP) is an atypical anti-psychotic drug widely used to treat schizophrenia and bipolar disorder. The pharmacological effects of ARP on cancer cells are still poorly understood. In this study, anti-cancer effects of ARP on various malignant tumor cells and its molecular mechanism were further carefully examined by using cell proliferation assay, xenograft mouse model, immunoblotting (...) . In agreement with the in vitro results, ARP compound also significantly suppressed the growth of tumor masses formed by injecting CT26 colon cancer cells into mice. ARP treatment also effectively decreased the migratory ability of U251 glioma cells by downregulating metalloproteinase-9. Levels of phosphorylated Src, phosphorylated phosphatidylinositide 3-kinase (PI3K), and phosphorylated signal transducer and activator of transcription 3 (STAT3) were significantly decreased following ARP treatment. ARP

2017 Oncotarget

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