Neuroleptic malignant syndrome antipsychotic-induced

Benazzi F. Clozapine-induced neuroleptic malignant syndrome not recurring with olanzapine, a structurally and pharmacologically similar antipsychotic. Hum Psychopharmacol Clin Exp 1999 14 511-12. 

Other autonomic effects of antipsychotic drugs are probably mediated by the hypothalamus, such as an impairment of the body s abihty to regulate temperature. Clozapine can induce moderate elevations of body temperature that can be confusing clinically central effects on temperatme regulation and cardiovascular and respiratory function probably contribute to the featmes of neuroleptic malignant syndrome (see Table 18-1). 

Cases cf Neurotoxicity Toxicity at therapeutic or subtherapeutic levels was reported in three cases. In two of these cases, the role of lithium is questionable. In one case of a rapidly fatal presentation of neuroleptic malignant syndrome (NMS) in a 72-year-old woman whose lithium level was 1.5 mM, the authors report a lithium-induced fatal NMS because she was not prescribed an antipsychotic [84 ]. However, her presentation is also consistent with fatal catatonia, sepsis, or unknown consumption of an antipsychotic, none of which were ruled out, and all of which are more likely than lithium-induced NMS. A second case in which a delirium with dyspraxia, but not ataxia in a 57-year-old man with a lithium level of 0.44 mM, that resolved after discontinuation of botii lithium and tricyclic antidepressant medication, was felt to be an interaction between the lithium and the antidepressant [85 ]. Lithium may have played a role, but he had been on lithium for years, and had developed anticholinergic problems with quetiapine previously, suggesting that the anticholinei c effects of the tricyclic antidepressant were more important in the delirium than the lithium. The third case of a 65-year-old man with multisystem atrophy becoming considerably worse with lithium at a level of 1.1 mM, is much more likely to represent lithium-related neurotoxicity at therapeutic levels [86 ]. 

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