Neuroleptic malignant syndrome, and

Keck PE Jr, Caroff SN, McElroy SL (1995) Neuroleptic malignant syndrome and malignant hyperthermia end of a controversy J Neuropsychiatry Clin Neurosci 7(2) 135-144... 

Chapter 3 mentioned the similarity between neuroleptic malignant syndrome and an acute episode of the viral disorder, lethargic encephalitis... 

Prozac and the other SSRIs, as well as any antidepressant that blocks the removal of serotonin from the synapse, can produce a well-documented, severe condition called the serotonin syndrome (Sternbach, 1991). This disorder includes the usual signs of overstimulation, such as euphoria and hypomania, agitation, confusion, and gastrointestinal upset, including diarrhea. However, the serotonin syndrome additionally involves overstimulation of the brain stem and spinal cord, producing fever and chills, severe incoordination, muscle spasms, and hyperactive reflexes. It bears some similarity to neuroleptic malignant syndrome, and like NMS it can also be lethal (chapter 4). 

Sechi, G., Agnetti, V., Masuri, R., Deiana, G., Pugliatti, M., Paulus, K., et al. (2000). Risperidone, neuroleptic malignant syndrome and probable dementia with Lewy bodies. Progress in Neuro-psychopharmacology and Biological Psychiatry, 24, 1043-1051. 

Severe adverse reactions to SSRIs that were reported to Health Canada s database in 1986-1996 have been reviewed (73). There were 295 severe adverse reactions with 87 deaths. Of the fatal cases, 65 were due to intentional overdose. The other 22 deaths were due chiefly to other forms of suicide or were accidental or indeterminate (12 cases). Of the rest there were three cases of neuroleptic malignant syndrome and individual cases of cardiac or respiratory disease in which the role of SSRIs was less clear. 

Lin PY, Wu CK, Sun TF. Concomitant neuroleptic malignant syndrome and lithium intoxication in a patient with bipolar I disorder case report. Chang Gung Med J 2000 23(10) 624-9. 

Reddig S, Minnema AM, Tandon R. Neuroleptic malignant syndrome and clozapine. Ann Clin Psychiatry 1993 5(l) 25-7. 

Black KJ, Racette B, Perlmutter JS. Preventing contractions in neuroleptic malignant syndrome and dystonia. Am J Psychiatry 1998 155(9) 1298-9. 

Neuroleptic malignant syndrome and subsequent acute interstitial nephritis has been reported in a 44-year-old woman (102). This patient met the main criteria for neuroleptic malignant syndrome, although she did not develop rigidity or a rise in creatine kinase activity. On the other hand, abnormal creatine kinase activity and signs of myotoxicity were respectively found in 14% and 2.1% of patients who took clozapine for an average of 18 months (n = 94) (103). 

Duggal HS. Clozapine-induced neuroleptic malignant syndrome and subdural hematoma. J Neuropsychiatry Clin Neurosci 2004 16 118-9. 

Sierra-Biddle D, Herran A, Diez-Aja S, Gonzalez-Mata JM, Vidal E, Diez-Manrique F, Vazquez-Barquero JL. Neuroleptic malignant syndrome and olanzapine. J Clin Psychopharmacol 2000 20(6) 704-5. 

This is not the first report of similarities between the neuroleptic malignant syndrome and baclofen withdrawal (18,20,24). In addition, hyperthermia seems to be common in baclofen withdrawal (20). 

Ehara H, Maegaki Y, Takeshita K. Neuroleptic malignant syndrome and methylphenidate. Pediatr Neurol 1998 19(4) 299-301. 

Ward A, Chaffman MO, Sorkin EM. Dantrolene. A review of its pharmacodynamic and pharmacokinetic properties and therapeutic use in malignant hyperthermia, the neuroleptic malignant syndrome and an update of its use in muscle spasticity. Drugs 1986 32(2) 130-68. 

Rigidity may also be seen with a number of toxins and may be caused by CNS effects or spinal cord stimulation. Neuroleptic malignant syndrome and serotonin syndrome (see p 22) are characterized by rigidity, hyperthermia, metabolic acidosis, and an tered mental status. Rigidity seen with malignant hyperthermia (see p 22) is caused by a defect at the muscle cell level and may not reverse with neuromuscular blockade. 

Amantadine (Symmetrel) is an antiviral agent that is also effective in the treatment of Parkinson s disease and for prophylaxis against the parkinsonian side effects of neuroleptic agents. Although there is limited information about its effects in acute overdose, it has been associated with seizures, arrhythmias, neuroleptic malignant syndrome, and death. 

C. Chronic use has been associated with bone marrow depression, hepatitis, renal disease, cardiomyopathy, hyponatremia, and exfoliative dermatitis. Carbamazepine has also been implicated in rigidity-hyperthermia syndromes (eg, neuroleptic malignant syndrome and serotonin syndrome) in combination with other drugs. 

Fluoxetine and probably paroxetine may cause clinically significant increases in aripiprazole levels. The concurrent use of aripiprazole with SSRIs or venlafaxine has led to adverse effects such as the neuroleptic malignant syndrome and extrapyramidal symptoms. 

Ananth J, Johnson KM, Levander EM, Harry JL. Diabetic ketoacidosis, neuroleptic malignant syndrome, and myocardial infarction in a patient taking risperidone and lithium carbonate. 

Fava S,Galizia AC. Neuroleptic malignant syndrome and lithium carbonate. rosci ( 995) 20,305-6. 

The most common CNS effects associated with cyclobenzaprine overdose are drowsiness and tachycardia. Less frequent manifestations include tremor, agitation, coma, ataxia, hypertension, slurred speech, confusion, dizziness, nausea, vomiting, and hallucinations. Rare but potentially critical manifestations of overdose are cardiac arrest, chest pain, cardiac dysrhythmias, severe hypotension, seizures, and neuroleptic malignant syndrome and stroke. Changes in the electrocardiogram, particularly in QRS axis or width, are clinically signilicant indicators of cyclobenzaprine toxicity. 

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