Neuroleptic malignant syndrome symptoms

Once neuroleptic malignant syndrome (NMS) develops, signs and symptoms may escalate over 24—72 h and may have a prolonged clinical course... 

Neuroleptic malignant syndrome (NMS) A potentially fatal symptom complex sometimes referred to as NMS has been reported in association with promethazine alone or in combination with antipsychotic drugs. Clinical manifestations of NMS are hyperpyrexia, muscle rigidity, altered mental status, and evidence of autonomic instability (eg, irregular pulse or blood pressure, tachycardia, diaphoresis, cardiac dysrhythmias). 

Intrathecal - Early symptoms of baclofen withdrawal may include return of baseline spasticity, pruritus, hypotension, and paresthesias. Some clinical characteristics of the advanced intrathecal baclofen withdrawal syndrome may resemble autonomic dysreflexia, infection (sepsis), malignant hyperthermia, neuroleptic-malignant syndrome, or other conditions associated with a hypermetabolic state or widespread rhabdomyolysis. 

Tapering of dose Cases of a symptom complex resembling neuroleptic malignant syndrome characterized by elevated temperature, muscular rigidity, altered consciousness, and elevated creatine phosphokinase (CPK) have been reported in association with the rapid dose reduction or withdrawal of other dopaminergic drugs. 

Neuroleptic malignant syndrome is a rare condition which can occur even after the single administration of antipsychotics. It manifests itself with hyperpyrexia, muscle rigidity, autonomic symptoms, clouding of consciousness and it has a mortality rate of over 10%. The aetiology is unknown but dopamine blockade may play a role. 

Which drug may be useful in the management of the neuroleptic malignant syndrome, although it can worsen the symptoms of schizophrenia ... 

Extrapyramidal symptoms and neuroleptic malignant syndrome occur rarely. 

Other etiologies need to be ruled out because many of the symptoms of serotonin syndrome overlap with those of early sepsis or neuroleptic malignant syndrome, conditions associated with significant mortality. It is critical to evaluate for sepsis and to determine that a neuroleptic has not been started or increased prior to the onset of... 

The primary indication for ECT in adolescents is the short-term treatment of mood symptoms, depressive or manic (Walter et al., 1999). Mood symptoms in the course of major depression, psychotic depression, bipolar disorder, organic mood disorders, schizophrenia, and schizoaffective disorder respond well to ECT. Psychotic symptoms in mood disorders also respond well to ECT whereas the effectiveness of ECT in the treatment of psychotic symptoms in schizophrenia is doubtful. There are suggestions that other uncommon clinical conditions in adolescents such as catatonia and neuroleptic malignant syndrome also benefit from ECT. The effectiveness of ECT seems to lessen when there is a comorbid personality disorder or drug and/or alcohol problems. There are very few data about usefulness on prepubertal children. 

Addonizio G, Susman VL. ECT as a treatment alternative for patients with symptoms of neuroleptic malignant syndrome. J Clin Psychiatry 1987 48 102-105. 

Immediate discontinuation of the antipsychotic and the use of bromocriptine when needed to manage symptoms if a neuroleptic malignant syndrome develops... 

A rare, but potentially fatal idiosyncratic adverse effect is neuroleptic malignant syndrome. This can occur with any antipsychotic drug. The symptoms are rigidity, hyperthermia, autonomic lability, and reduced level of consciousness. Massively elevated levels of creatinine kinase are usually found. Prior to 1984, the mortality rate was around 25% but improved early recognition has considerably reduced this. Management is cessation of antipsychotics, appropriate conservative measures and dantrolene if necessary for muscle rigidity. 

Neuroleptic Malignant Syndrome. Patients taking relatively high doses of the more potent antipsychotics may experience a serious disorder known as neuroleptic malignant syndrome (NMS).48 Symptoms of NMS... 

The essential feature of Neuroleptic Malignant Syndrome is the development of severe muscle rigidity and elevated temperature in an individual using neuroleptic medication. This is accompanied by two (or more) of the following symptoms diaphoresis, dysphagia, tremor, incontinence, changes in level of consciousness ranging from confusion to coma, mutism, tachycardia, elevated or labile blood pressure, leukocytosis, and laboratory evidence of muscle injury (e.g., elevated creatine phosphokinase [CPK].1... 

Addonizio, G., Susman, V., Roth, S. (1986). Symptoms of neuroleptic malignant syndrome in 82 consecutive inpatients. American Journal of Psychiatry, 143, 1587-1590. 

There have been reports of neuroleptic malignant syndrome precipitated by promethazine 100 mg/day to treat neuroleptic drug-induced extrapyramidal symptoms and lorazepam 6 mg/day to treat agitation (349), after the addition of intramuscular haloperidol 23 mg to atypical neuroleptic drugs (350), and in other instances in children and adolescents (351). 

A 19-year-old man with bipolar disorder received intramuscular haloperidol 30 mg/day and chlorproma-zine 300 mg/day and developed neuroleptic malignant syndrome the neuroleptic drugs were withdrawn. One month later he had a recurrence. It transpired that he had discontinued his medication 2 weeks after discharge, but because his manic symptoms recurred his relatives had started to give him haloperidol 10 mg/day again, which led to the recurrence. 

Rhabdomyolysis has been described in a handicapped child without other symptoms of neuroleptic malignant syndrome (524). 

Levinson DF, Simpson GM. Neuroleptic-induced extra-pyramidal symptoms with fever. Heterogeneity of the neuroleptic malignant syndrome . Arch Gen Psychiatry 1986 43(9) 839-48. 

Nisijima K, Ishiguro T. Electroconvulsive therapy for the treatment of neuroleptic malignant syndrome with psychotic symptoms a report of five cases. J ECT 1999 15(2) 158-63. 

Another case of possible neuroleptic malignant syndrome associated with olanzapine has been reported in a patient who had taken clozapine for 3 years without incident (100). Symptoms suggestive of neuroleptic malignant syndrome appeared 19 days after the addition of olanzapine. 

A 78-year-old woman developed fulminant neuroleptic malignant syndrome complicated by pneumonia while taking olanzapine and levomepromazine. When the neuroleptic drugs were withdrawn she recovered however, when the combination was restarted later, because of severe agitation and hallucinations, the symptoms of neuroleptic malignant syndrome recurred (107). 

Although quetiapine seems to cause a lower incidence of extrapyramidal symptoms, a case of neuroleptic malignant syndrome has been described (9). 

Neuroleptic malignant syndrome has been reported in a 52-year-old woman with Parkinson s disease and psychotic symptoms who took ziprasidone (23). 

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