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Neuroleptic syndrome

Michael Schneider, Johannes Regente, Timo Greiner, Stephanie Lensky, Stefan Bleich, Sermin Toto, Renate Grohmann, Susanne Stübner, Martin Heinze
Neuroleptic malignant syndrome (NMS) is a rare, but severe adverse drug reaction of drugs with anti-dopaminergic properties. The main symptoms are fever and rigor. In addition, other symptoms such as creatine kinase elevation, alteration of consciousness and various neurological symptoms may occur. A total of 52 NMS cases have been documented in the drug safety program 'Arzneimittelsicherheit in der Psychiatrie' from 1993 to 2015. We calculated incidences and analyzed imputed substances and additional risk factors to study the impact of changing therapy regimes...
November 30, 2018: European Archives of Psychiatry and Clinical Neuroscience
Matthew I Hardman, Juraj Sprung, Toby N Weingarten
Phenibut is a glutamic acid derivative with activity on the γ-aminobutyric acid (GABA) B and A, and β-phenethylamine receptors. It is prescribed in former Communist Bloc countries for anxiolysis and related psychiatric disorders. It can be easily obtained in Western countries, and is thought to have abuse potential. Abrupt discontinuation has been reported to precipitate an abstinence syndrome. A review of the literature identified 22 reported cases, many of which were notable for severe psychomotor agitation and requirements for aggressive pharmacologic treatment...
December 3, 2018: Bosnian Journal of Basic Medical Sciences
Tiphaine Bourseau, Virginie Saoût, Pauline Ali, Uriell Pouliquen-Loriferne, Philippe Allain, Mickaël Dinomais
OBJECTIVE: To give a cross-sectional overview of ongoing management of behavioral disorders following traumatic brain injury (TBI) in a region of France, to compare this with recent recommendations from the French Society of Physical Medicine and Rehabilitation (SOFMER), and to evaluate associations between treatments and participant characteristics. SETTING: Outpatients referred to medical or community-based facilities in a region of France. PARTICIPANTS: One hundred twenty-nine adults with moderate to severe TBI, in the postacute period (over 3 months postinjury)...
November 28, 2018: Journal of Head Trauma Rehabilitation
Rainer Wirth, Rainer Dziewas
PURPOSE OF REVIEW: The review summarizes current knowledge and recent findings about how to practically apply medication in patients with dysphagia and how swallowing function may be positively or negatively affected by drugs. RECENT FINDINGS: Oropharyngeal dysphagia is a major health problem in older persons and was recently classified as a geriatric syndrome. Although the knowledge about an effective diagnostic approach increased during the last years, comparatively little is known about how to effectively manage and treat dysphagia and hardly anything is implemented in clinical routine...
January 2019: Current Opinion in Clinical Nutrition and Metabolic Care
Laura M Tormoehlen, Daniel E Rusyniak
The clinical manifestation of drug-induced abnormalities in thermoregulation occurs across a variety of drug mechanisms. The aim of this chapter is to review two of the most common drug-induced hyperthermic states, serotonin syndrome and neuroleptic malignant syndrome. Clinical features, pathophysiology, and treatment strategies will be discussed, in addition to differentiating between these two syndromes and differentiating them from other hyperthermic or febrile syndromes. Our goal is to both review the current literature and to provide a practical guide to identification and treatment of these potentially life-threatening illnesses...
2018: Handbook of Clinical Neurology
Clémentine Lantin, Miriam Franco, François-Xavier Dekeuleneer, Didier Chamart, Juan Martin Tecco
BACKGROUND: Neuroleptic malignant syndrome (NMS), which is linked to the use of antipsychotic medication, is a potentially lethal neurological emergency. The interest of our study is that NMS induced by the use of clotiapine has never previously been described. SUBJECTS AND METHODS: We present the case of a 61-year old man whose sleep disorders were treated with clotiapine 40 mg/day. After 7 days of taking 40 mg clotiapine, the patient presented with a deterioration of his general health which had gradually taken hold, with altered consciousness accompanied by generalised muscle rigidity and hypersalivation...
November 2018: Psychiatria Danubina
Yohei Harada, Tuhin Virmani, Murat Gokden, Vikki Stefans
Severe recurrent proximal muscle weakness without neuroleptic malignant syndrome secondary to antidopaminergic medication has rarely been reported. We report a 29-year-old man with history of obsessive compulsive disorder and Tourette syndrome who presented with 2 months of worsening dyspnea 3 weeks after starting ziprasidone 40 mg daily that required mechanical ventilation. A year before, after an increased risperidone dose from 0.5 to 1 mg daily, he had developed proximal muscle weakness that spontaneously improved 2 months after discontinuation of risperidone...
December 2018: Journal of Clinical Neuromuscular Disease
Michael Morcos, Jonathan Corns, Jodie Belinda Hillen
A 70-year-old female aged-care resident was referred by her general practitioner for a residential medication management review after nurses reported difficulties with swallowing, episodes of hyperthermia, elevated blood pressure, and tachycardia. These symptoms were accompanied by increasing confusion and drowsiness. Risperidone had recently been prescribed to treat behavioral and psychological symptoms of dementia. This case study describes the pharmacist-initiated management of the symptoms through a national medication review program...
November 14, 2018: Journal of Pharmacy Practice
Marina N Boushra, Susan N Miller, Alex Koyfman, Brit Long
BACKGROUND: Evaluation and treatment of the acutely ill patient is typically complicated by multiple comorbidities and incomplete medical histories. This is exemplified by patients with sepsis, whose care is complicated by variable presentations, shifting definitions, and a variety of potential sources. Many practitioners fail to consider and recognize less-common sources of infection in a timely manner. Additionally, multiple noninfectious conditions can present with the fever and tachycardia typical of the septic patient...
November 2, 2018: Journal of Emergency Medicine
Tatsuhiko Anzai, Kunihiko Takahashi, Michiko Watanabe
AIM: This study evaluates reports on neuroleptic malignant syndrome (NMS) as an adverse event associated with the use of atypical antipsychotic agents (AAAs) in Japan. We examined NMS occurrence following monotherapy and combination therapy with AAAs in real clinical practice using the Japanese Adverse Drug Event Report database. METHODS: Adverse drug reaction reports associated with the use of one or more AAAs or haloperidol were analyzed. The odds ratios of NMS occurrence after monotherapy and combination therapy with AAAs without typical antipsychotic agents (TAAs) relative to those after haloperidol monotherapy were estimated using multiple logistic regression...
October 29, 2018: Psychiatry and Clinical Neurosciences
Youssef Khaoula, Jawhar Mokni, Aloui Feten, Beizig Ameni, Maksoudi Chedly
Acute pancreatitis is a serious disease having a guarded prognosis. Its etiology involves either bladder or alcohol. Traumatic origin is extremely rare and it is often associated with other intra-abdominal lesions. We here report the case of a 56-year old man with a history of psychiatric disorders for which he was under therapy with neuroleptics and of left nephrotomy. He presented, after a stair fall occurred 3 days before, with occlusive syndrome. Clinical examination showed normal respiratory hemodynamic and neurological status as well as epigastric tenderness...
2018: Pan African Medical Journal
Chukwunonso Chime, Ahmed Alemam, Kishore Kumar, Manjeet Dhallu
The pathophysiology of neuroleptic malignant syndrome (NMS) with use of psychotropic drugs is still unclear. Although a rare event with an incidence of 0.02-3.2%, when not promptly recognized and managed, it carries a high mortality (10-20%) and morbidity rate. Presentation can be either typical, with muscle rigidity and hyperpyrexia, or atypical, the latter posing diagnostic and early management challenges in clinical practice. Our patient presented with delayed fever and ileus, making early diagnosis difficult...
September 2018: Case Reports in Gastroenterology
Ai-Leng Foong, Kelly A Grindrod, Tejal Patel, Jamie Kellar
OBJECTIVE: To review the symptoms of serotonin toxicity (commonly referred to as serotonin syndrome ) and the causative drugs and their mechanisms of action, and to equip primary care providers with practical strategies to prevent and identify serotonin toxicity. QUALITY OF EVIDENCE: PubMed and Google Scholar were searched for relevant articles on serotonin toxicity, the causes, and the differential diagnosis using search terms related to serotonin toxicity ( serotonin syndrome, serotonin toxicity, serotonin overdose ), causes (individual names of drug classes, individual drug names), and diagnosis ( differential diagnosis, neuroleptic malignant syndrome, anticholinergic toxicity, discontinuation syndrome, malignant hyperthermia, serotonin symptoms )...
October 2018: Canadian Family Physician Médecin de Famille Canadien
David Choon Liang Teo, Hon Khuan Wong, Sheng Neng Tan
Neuroleptic malignant syndrome (NMS) is a rare, idiosyncratic, but life-threatening adverse reaction associated with the use of antipsychotic drugs. It is characterized by a tetrad of fever, rigidity, autonomic instability, and altered mental status. Failure to diagnose NMS early and institute appropriate treatment can result in serious medical complications and death. While diagnostic criteria for NMS exist, atypical presentations that lack one or more characteristic features pose a diagnostic dilemma to clinicians...
July 2018: Innovations in Clinical Neuroscience
Franchi Angélique, Gauchotte Guillaume, Gambier Nicolas, Raul Jean Sébastien, Martrille Laurent
In this daily practice, the forensic pathologist is rarely confronted with postmortem hyperthermia associated with the rapid onset of rigor mortis. We report 2 similar cases where the rectal temperature value taken during the on-scene investigations by the forensic pathologist was greater than 40°C (104°F) in both cases, and rigor mortis was complete within less than 6 hours postmortem. The first case was due to a deadly intoxication by ecstasy and the second one to the deadly association of methadone and a possible neuroleptic malignant syndrome...
December 2018: American Journal of Forensic Medicine and Pathology
Fabio Caputo, Roberta Agabio, Teo Vignoli, Valentino Patussi, Tiziana Fanucchi, Paolo Cimarosti, Cristina Meneguzzi, Giovanni Greco, Raffaella Rossin, Michele Parisi, Davide Mioni, Sarino Arico', Vincenzo Ostilio Palmieri, Valeria Zavan, Pierluigi Allosio, Patrizia Balbinot, Maria Francesca Amendola, Livia Macciò, Doda Renzetti, Emanuele Scafato, Gianni Testino
The chronic use of alcohol can lead to the onset of an alcohol use disorder (AUD). About 50% of subjects with an AUD may develop alcohol withdrawal syndrome (AWS) when they reduce or discontinue their alcohol consumption and, in 3-5% of them, convulsions and delirium tremens (DTs), representing life-threatening complications, may occur. Unfortunately, few physicians are adequately trained in identifying and treating AWS. The Italian Society on Alcohol has, therefore, implemented a task force of specialists to draw up recommendations for the treatment of AWS with the following main results: (1) while mild AWS may not require treatment, moderate and severe AWS need to be pharmacologically treated; (2) out-patient treatment is appropriate in patients with mild or moderate AWS, while patients with severe AWS need to be treated as in-patients; (3) benzodiazepines, BDZs are the "gold standard" for the treatment of AWS and DTs; (4) alpha-2-agonists, beta-blockers, and neuroleptics may be used in association when BDZs do not completely resolve specific persisting symptoms of AWS; (5) in the case of a refractory form of DTs, the use of anaesthetic drugs (propofol and phenobarbital) in an intensive care unit is appropriate; (6) alternatively to BDZs, sodium oxybate, clomethiazole, and tiapride approved in some European Countries for the treatment of AWS may be employed for the treatment of moderate AWS; (7) anti-convulsants are not sufficient to suppress AWS, and they may be used only in association with BDZs for the treatment of refractory forms of convulsions in the course of AWS...
September 5, 2018: Internal and Emergency Medicine
Stéphane Thobois, Stéphane Prange, Christian Scheiber, Emmanuel Broussolle
The diagnosis of a parkinsonian syndrome based on clinical criteria remains sometimes difficult, especially at disease onset. Brain or heart molecular imaging techniques (SPECT or PET) can provide a major help to improve and speed up diagnosis, influencing treatment strategies. Presynaptic dopaminergic imaging using either [18 F]-Dopa PET or 123 I -2β-Carbomethoxy-3β-(4-Iodophenyl)- N-(3-Fluoropropyl) Nortropane ([123 I]-Ioflupane)SPECT demonstrates or rules out the presence of a dopaminergic degenerative process...
August 30, 2018: Parkinsonism & related Disorders
D Hirjak, A Sartorius, K M Kubera, R C Wolf
In rare cases, pharmacotherapy in schizophrenic psychoses can be associated with life-threatening antipsychotic-induced movement disorders. The two most severe complications are antipsychotic-associated catatonic symptoms (ACS) and neuroleptic malignant syndrome (NMS). Although both constellations necessitate rapid medical care, the diagnosis is still a clinical challenge. Although there is no established treatment of ACS (here designated as a specific subtype of catatonic symptoms), an attempt should be made with benzodiazepines and memantine can also be helpful...
August 20, 2018: Der Nervenarzt
Kamal Patel, Brandon Lilly, Oluwadamilare Ajayi, Kelly Melvin
Neuroleptic Malignant Syndrome (NMS) is a rare condition clinically characterized by muscle rigidity, hyperthermia, autonomic instability, and acute mental status change. NMS is most often associated with use of high-potency first-generation antipsychotic medications; though, other neuroleptics have been implicated as well. NMS can be fatal with estimated mortality rates as high as 20%. Patients experiencing certain severe complications, including renal failure, have been associated with mortality as high as 50%, stressing the need for early recognition and treatment...
2018: Case Reports in Psychiatry
Devashish Desai, Kartik Gupta, Rohit Kumar, Ashutosh Biswas
A 53-year-old woman, known case of diabetes mellitus and rheumatoid arthritis, presented with a 4-day history of hyperthermia, rigidity, tremor and altered sensorium. She developed these symptoms after having been administered parenteral levosulpiride to control vomiting due to secondary adrenal insufficiency. We managed her as a case of life-threatening neuroleptic malignant syndrome (NMS) requiring mechanical ventilation, bromocriptine and other supportive care. She subsequently recovered and was discharged in a stable condition...
August 11, 2018: BMJ Case Reports
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