1/110. clozapine-associated neuroleptic malignant syndrome: two new cases and a review of the literature.BACKGROUND: clozapine has recently been found to be associated with neuroleptic malignant syndrome (NMS). Our objective is to determine if clozapine causes NMS, if the presentation of clozapine-induced NMS differs from that of traditional agents, and which set of diagnostic criteria will most readily allow diagnosis of NMS associated with clozapine. methods: Two new cases of clozapine-associated NMS are presented, along with previously reported cases from the literature, identified by using a medline search (1966-August 1998). From all cases, concomitant medications and washout periods were examined (if available) to assess clozapine as the likely cause of NMS. Characteristics of clozapine and traditional antipsychotic-induced NMS were compared. Different diagnostic criteria for NMS were applied to the cases to determine which were more likely to diagnose the syndrome. RESULTS: clozapine was deemed a highly probable cause of NMS in 14 cases, a medium probability cause in five cases, and a low probability cause in eight cases. The most commonly reported clinical features were tachycardia, mental status changes, and diaphoresis. fever, rigidity, and elevated creatine kinase were less prominent than in NMS associated with classical neuroleptics. CONCLUSIONS: clozapine appears to cause NMS, although the presentation may be different than that of traditional antipsychotics. Levenson's original and Addonizio's modified criteria were more likely to diagnose NMS than were other criteria. clozapine-associated NMS may present with fewer clinical features. Limitations are the lack of detailed information provided by many of the case reports and the use of "modified" diagnostic criteria for retrospective diagnosis.- - - - - - - - - - ranking = 1keywords = psychotic (Clic here for more details about this article) |
2/110. electroconvulsive therapy for the treatment of neuroleptic malignant syndrome with psychotic symptoms: a report of five cases.We report five cases of neuroleptic malignant syndrome (NMS) with psychotic symptoms treated with electroconvulsive therapy (ECT). Clinical response was observed after the first or the second session of ECT in every case, and the symptoms of NMS resolved by the third or fourth session. The mean time from the initial ECT to complete resolution was 6.0 days. No side effects from ECT were observed. Although the first treatment for NMS is pharmacotherapy using drugs such as dantrolene and bromocriptine, our results suggest that ECT is a useful therapeutic method for patients with NMS and psychotic symptoms.- - - - - - - - - - ranking = 3keywords = psychotic (Clic here for more details about this article) |
3/110. Acute hypernatremia and neuroleptic malignant syndrome in parkinson disease.neuroleptic malignant syndrome is a clinical syndrome characterized by fever, muscle rigidity, and mutism. Some patients with neuroleptic syndrome may have elevated creatine phosphokinase values and abnormal liver aminotransferase values. precipitating factors are important clues for prompt diagnosis. Typical precipitating factors include antipsychotic agents and major tranquilizers. In parkinson disease, drug withdrawal, menstruation, and hyponatremia are precipitating factors. We report a case of neuroleptic malignant syndrome in a patient with parkinson disease and hypernatremia. In addition, we hypothesized that sudden change of sodium concentrations in the central nervous system could trigger neuroleptic malignant syndrome in patients with parkinson disease. According to our experience, neuroleptic malignant syndrome is a clinical diagnosis and prompt diagnosis avoids unnecessary, expensive work-ups.- - - - - - - - - - ranking = 0.5keywords = psychotic (Clic here for more details about this article) |
4/110. neuroleptic malignant syndrome during low dosed neuroleptic medication in first-episode psychosis: a case report.neuroleptic malignant syndrome (NMS) is a rare but potentially fatal side-effect of antipsychotic drug therapy, especially of dopamine receptor antagonists. As a dose relationship has been postulated, low dose neuroleptization would be expected to help to avoid this side-effect. In contrast, we report on a 21-year-old female following low dose fluphenazine treatment with 2.5 mg/day. The patient recovered from NMS after 3 days of dantrolene administration. Eventually, remission from psychotic symptoms was achieved with clozapine. At 8-month follow-up, psychopathology remained stable and there were no more signs of NMS.- - - - - - - - - - ranking = 1keywords = psychotic (Clic here for more details about this article) |
5/110. Repeated propofol anesthesia for a patient with a history of neuroleptic malignant syndrome.neuroleptic malignant syndrome (NMS) is the most serious side effect produced by the administration of antipsychotic drugs. NMS shares many clinical similarities with malignant hyperthermia (MH), but the etiology of NMS and the relation between NMS and MH remain unknown. Anesthetic regimens for patients with NMS are not well established. We gave repeated anesthesia to a patient with a history of NMS undergoing electroconvulsive therapy for the treatment of depression. propofol and vecuronium were used in twelve consecutive ECT sessions without complications. In this case report, we describe the safe and satisfactory repeated use of propofol in a patient with a history of NMS, and outline NMS and its questionable relation to MH.- - - - - - - - - - ranking = 0.5keywords = psychotic (Clic here for more details about this article) |
6/110. Electroconvulsive treatment of neuroleptic malignant syndrome: a review and report of cases.OBJECTIVE: neuroleptic malignant syndrome (NMS) is a potentially lethal adverse effect of neuroleptic medication, with no satisfactory treatment currently available. electroconvulsive therapy (ECT) has been anecdotally reported to be effective in its treatment. We review 45 published case reports of ECT for NMS and describe nine new cases, to examine its effectiveness, the likelihood of adverse reactions, and the theoretical implications of such treatment. METHOD: The authors used medline to identify reports in the English literature where ECT was used in cases of suspected NMS. In addition, the charts of patients referred to the second author for treatment of NMS were reviewed and cases in which ECT used were identified. RESULTS: The case reports suggest that ECT is effective in many individuals with NMS, even when drug therapy has failed. The response is usually apparent after a few treatments, generally up to six. The response is not predictable on the basis of age, gender, psychiatric diagnosis or any particular feature of NMS including catatonia. electroconvulsive therapy is a relatively safe treatment in NMS, although the risk of cardiovascular complications should be considered. malignant hyperthermia due to the anaesthesia associated with ECT has not been reported in patients with NMS, and succinylcholine has been used safely with the exception of one report of fever and raised creatine kinase levels and another report of hyperkalemia. CONCLUSIONS: electroconvulsive therapy is the preferred treatment in severe NMS, cases where the underlying psychiatric diagnosis is psychotic depression or catatonia, and in cases where lethal catatonia cannot be ruled out. The effectiveness of ECT for the treatment of NMS has theoretical implications for the relationship between NMS and catatonia, and the possible pathophysiological mechanisms that underlie these disorders.- - - - - - - - - - ranking = 0.5keywords = psychotic (Clic here for more details about this article) |
7/110. neuroleptic malignant syndrome and severe thrombocytopenia: case report and literature review.We report an unusual case of thrombocytopenia associated with neuroleptic malignant syndrome (NMS). A 31-year-old Black male with a history of hypertension, partial seizures, and schizophrenia developed acute rigidity closely followed by severe hyperpyrexia (temperature 102 degree F), tachypnea, and tachycardia. His home medications at the time of presentation included propanolol 10 mg tid, haloperidol 10 mg bid, sodium valproate 500 mg bid, benztropine 1 mg bid, and haloperidol decanoate 100 mg i.m. every 3 weeks, from another psychiatric facility. Despite vigorous therapy for the hyperthermia, he rapidly developed significant hypoxia requiring mechanical ventilation. A diagnosis of neuroleptic malignant syndrome was made and the patient continued to receive aggressive supportive care. On hospital day 2 his platelet count dropped to 47,000/microl and bottomed out at 36,000/microl by day 3 with other blood cell counts remaining within normal limits. Over the next few days he showed rapid clinical improvement with normalization of his blood chemistries and he was discharged home after 5 days of hospitalization in good condition.- - - - - - - - - - ranking = 1.0141945841202keywords = schizophrenia (Clic here for more details about this article) |
8/110. Muscle changes in the neuroleptic malignant syndrome.AIMS: To characterise the skeletal muscle changes in the neuroleptic malignant syndrome (NMS). methods: Detailed light and ultrastructural examination was carried out on skeletal muscle from three cases of NMS, two associated with recreational drugs (3,4-methlenedioxymethylamphetamine (MDMA, Ecstasy) and lysergic acid diethylamide (LSD)) and one with antipsychotic drugs (fluoxetine (Prozac) and remoxipride hydrochloride monohydrate (Roxiam)). RESULTS: The muscles were grossly swollen and oedematous in all cases, in one with such severe local involvement that the diagnosis of sarcoma was considered. On microscopy, there was conspicuous oedema. In some fascicles less than 10% of fibres were affected whereas in others more than 50% were pale and enlarged. There was a spectrum of changes: tiny to large vacuoles replaced most of the sarcoplasm and were associated with necrosis. A striking feature in some fibres was the presence of contraction bands separating segments of oedematous myofibrils. Severe endomysial oedema was also detectable. There was a scanty mononuclear infiltrate but no evidence of regeneration. CONCLUSIONS: The muscle changes associated with NMS are characteristic and may be helpful in differential diagnosis.- - - - - - - - - - ranking = 0.5keywords = psychotic (Clic here for more details about this article) |
9/110. neuroleptic malignant syndrome during olanzapine and levomepromazine treatment.OBJECTIVE: To date only five reports of neuroleptic malignant syndrome (NMS) related to olanzapine exist. The first case report was published in November 1998. METHOD: We report the case of a 78-year-old woman suffering from chronic schizophrenia who developed a NMS while being treated with olanzapine and levomepromazine. Before this her medication had been unchanged for more than 2 years. RESULTS: When treated with olanzapine and levomepromazine, the patient had a fulminant NMS which was complicated with pneumonia. When the neuroleptic drug treatment was discontinued, the patient recovered. However, when this combination was restarted later due to severe agitation and hallucinations, the symptoms of NMS reappeared. CONCLUSION: This case report shows that the neuroleptic malignant syndrome can occur during olanzapine treatment as well as during treatment with conventional neuroleptics. This syndrome may develop even after a long and stable neuroleptic treatment.- - - - - - - - - - ranking = 1.0141945841202keywords = schizophrenia (Clic here for more details about this article) |
10/110. neuroleptic malignant syndrome: a diagnosis easily missed.A woman admitted with psychotic depression developed a number of physical problems. urinary incontinence, headache, neck stiffness and breathing difficulties were all treated separately but were later found to be part of the neuroleptic malignant syndrome. Treatment of the disorder led to complete recovery. We review the criteria for diagnosis of this serious disorder and some differential diagnoses.- - - - - - - - - - ranking = 0.5keywords = psychotic (Clic here for more details about this article) |
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