REVIEW PAPER
Life-threatening conditions in psychiatry – neuroleptic malignant syndrome (NMS)
 
More details
Hide details
1
Department of Trauma Surgery and Emergency Medicine, Medical University of Lublin, Poland;
2
Psychiatric Hospital in Suchowola, Poland
3
Department of Psychology of Emotion and Cognition, Maria Curie-Skłodowska University, Lublin, Poland
4
Department of Trauma Surgery and Emergency Medicine, Medical University of Lublin, Poland
CORRESPONDING AUTHOR
Tomasz Kucmin   

Department of Trauma Surgery and Emergency Medicine, Medical University of Lublin, Staszica 16, 20-081 Lublin
 
J Pre Clin Clin Res. 2015;9(1):74–78
KEYWORDS
ABSTRACT
The introduction of neuroleptics in the 1950’s was a turning point in psychiatric treatment. The new drugs brought hope to millions of patients and their doctors. However, there were also some side-effects, one of which is Neuroleptic malignant syndrome (NMS), a rare complication of antipsychotic treatment and untreated it may lead to mortality as high as 20%. The incidence of NMS, estimated to be 0.01–0.02%, has decreased significantly probably due to higher awareness of the diseases and shift to atypical antipsychotics. The aim of this study was to present the signs and symptoms of this rare condition and describe management possibilities since this condition is observed not only in psychiatric departments but also in emergency rooms. NMS is thought to be related to change caused by neuroleptics within the central nervous system due to dopamine D2 receptor antagonism, especially nigrostriatal pathways and the hypothalamus. There are three symptoms which are considered as major and indicate a high probability of NMS: muscle rigidity, hyperthermia (core body temperature above 38.5 °C), and elevated creatine phosphokinase concentration (above 1000 U/l). NMS is a diagnosis of exclusion and clinicians must be vigilant in detecting early signs of NMS. The basic management in NMS is antipsychotic discontinuation and proper supportive care of the patient (vital signs monitoring, hydration, correction of electrolyte and acid-base disturbances). In more severe cases, the introduction of bromocriptine or dantrolene, as well as benzodiazepines, may indicated. Further usage of neuroleptic in patients with a history of NMS should be with care, and low doses of low-potency neuroleptics or atypical neuroleptics seem to be the best treatment choice.
 
REFERENCES (31)
1.
Adnet P, Lestavel P, Krivosic-Horber R. Neuroleptic malignant syndrome. Br J Anaesth. 2000; 85(1): 129–135.
 
2.
Petit JR. Psychiatria ratunkowa. Urban&Partner, Wrocław, 2007 (in Polish).
 
3.
Liberman JA, Stroup TS, Perkins DO. Schizofrenia. American Psychiatric Publishing INC, 2006.
 
4.
Strawn JR, Keck PE Jr, Caroff SN. Neuroleptic malignant syndrome. Am J Psychiatry. 2007; 164(6): 870–876.
 
5.
Rzewuska M. Leczenie zaburzeń psychicznych. Warszawa: Wydawnictwo Lekarskie PZWL; 2003 (in Polish).
 
6.
Rzewuska M. Leki przeciwpsychityczne. In: Bilikiewicz A, Pużyński S, Rybakowski J, Wciórka J (eds.). Psychiatria. Tom III, Urban&Partner, Wrocław, 2003 (in Polish).
 
7.
Gurrera RJ, Caroff SN, Cohen A, Carroll BT, DeRoos F, Francis A. An international consensus study of neuroleptic malignant syndrome diagnostic criteria using the Delphi method. J Clin Psychiatry. 2011; 72(9): 1222–1228.
 
8.
Gurrera RJ, Velamoor V, Cernovsky ZZ. A Validation Study of the International Consensus Diagnostic Criteria for Neuroleptic Malignant Syndrome. J Clin Psychopharmacol. 2013; (Epub ahead of print).
 
9.
Lazarus A, Mann SC, Caroff SN. The Neuroleptic Malignant Syndrome and Related Conditions. Washington, DC: American Psychiatric Press; 1989.
 
10.
Gurrera RJ. Sympathoadrenal hyperactivity and the etiology of neuroleptic malignant syndrome. Am J Psychiatry. 1999; 156(2): 169–180.
 
11.
Bazire S. Psychotropic drug directory 2014, Lloyd-Reinhold Communications LLP.
 
12.
Lopez E, Fraile S, Hidalgo FJ, García B. Possible malignant neuroleptic syndrome associated with aripiprazole and imipramine and treated with bromocriptine. Med Clin (Barc). 2013; 141(6): 273–274. doi: 10.1016/j. medcli.2013.01.018.
 
13.
Ogłodek E, Szota A, Araszkiewicz A. Olanzapine-induced neuroleptic malignant syndrome after 10 years of treatment. Aust N Z J Psychiatry. 2013; 47(10): 972. doi: 10.1177/0004867413487230.
 
14.
Raval C, Tiwari D, Panchal B, Vala A. Typical neuroleptic malignant syndrome presented in patient on maintenance quetiapine. Indian Journal Of Psychological Medicine 2014; 36(1): 88–90. doi:10.4103/0253– 7176.127263.
 
15.
Strawn JR, Keck PE Jr. Early bicarbonate loading and dantroline for ziprasidone/haloperidol-induced neuroleptic malignant syndrome. J Clin Psychiatry. 2006; 67(4): 677.
 
16.
Verma R, Junewar V, Rathaur BP. An atypical case of neuroleptic malignant syndrome precipitated by valproate. BMJ Case Rep. 2014; doi: 10.1136/bcr-2013-202578.
 
17.
Shalev A, Hermesh H, Munitz H. Mortality from neuroleptic malignant syndrome. J Clin Psychiatry. 1989; 50(1): 18–25.
 
18.
Sachdev P, Kruk J, Kneebone M, et al. Clozapine induced neuroleptic malignant syndrome: review and report of new cases. J Clin Psychopharmacol. 1995; 15: 365–371.
 
19.
Berardi D, Amore M, Keck PE Jr, Troia M, Dell‘Atti M. Clinical and pharmacologic risk factors for neuroleptic malignant syndrome: a case-control study. Biol Psychiatry. 1998; 15; 44(8): 748–754.
 
20.
Fleischhacker WW, Unterweger B, Kane JM, Hinterhuber H. The neuroleptic malignant syndrome and its differentiation from lethal catatonia. Acta Psychiatrica Scandinavica 1990; 81: 3–5. doi: 10.1111/ j.1600-0447.1990.tb06439.x.
 
21.
Soar J, Perkins GD, Abbas G, et al. European Resuscitation Council Guidelines for Resuscitation 2010. Section 8. Cardiac arrest in special circumstances: electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution. Resuscitation 2010; 81: 1400–1433.
 
22.
Davis JM, Caroff SN, Mann S.C. Treatment of neuroleptic malignant syndrome. Psychiatr Ann. 2000; 30: 325–331.
 
23.
Rosenberg MR, Green M. Neuroleptic malignant syndrome. Review of response to therapy. Arch Intern Med. 1989;149(9): 1927–1931.
 
24.
Reulbach U, Dütsch C, Biermann T, Sperling W, Thuerauf N, Kornhuber J, et al. Managing an effective treatment for neuroleptic malignant syndrome. Crit Care. 2007; 11(1): R4. doi:10.1186/cc5148.
 
25.
Hermesh H, Aizenberg D, Weizman A. A successful electroconvulsive treatment of neuroleptic malignant syndrome. Acta Psychiatr Scand. 1987; 75(3): 237–239. doi: 10.1111/j.1600-0447.1987.tb02782.x.
 
26.
Ozer F, Meral H, Aydin B, Hanoglu L, Aydemir T, Oral T. Electroconvulsive therapy in drug-induced psychiatric states and neuroleptic malignant syndrome. J ECT. 2005; 21(2): 125–127.
 
27.
Troller JN, Sachdev PS. Electroconvulsive treatment of neuroleptic malignant syndrome: a review and report of cases. Aust NZ J Psychiatry. 1999; 33: 650–659.
 
28.
Caroff SN, Mann SC. Neuroleptic malignant syndrome. Psychopharmacol Bull. 1988; 24(1): 25–29.
 
29.
Pope HG Jr, Aizley HG, Keck PE Jr, McElroy SL. Neuroleptic malignant syndrome: long-term follow-up of 20 cases. J Clin Psychiatry. 1991; 52: 208–212.
 
30.
Caroff SN, Mann SC, Lazarus A. Neuroleptic malignant syndrome. Arch Gen Psychiatry. 1987; 44(9): 838–840.
 
31.
Shiloh R, Valevski A, Bodinger L, Misgav S, Aizenberg D, Dorfman- Etrog P, et al. Precautionary measures reduce risk of definite neuroleptic malignant syndrome in newly typical neuroleptic-treated schizophrenia inpatients. Int Clin Psychopharmacol. 2003; 18(3): 147–149.
 
eISSN:1898-7516
ISSN:1898-2395