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Neuroleptic Malignant Syndrome, a Sequalae of Multiple Administration of Antipsychotics: A Case Report

Received: 21 September 2019     Accepted: 9 October 2019     Published: 5 November 2019
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Abstract

Neuroleptic malignant syndrome (NMS) is a lethal adverse drug reaction (ADR) that is often attributed to the administration of dopamine blockers, antiemetic agents as well as anti-parkinsonism medication withdrawal. We describe a challenging case of NMS, with malignant catatonia as a differential diagnosis, who was difficult to respond to treatment. The patient developed severe complications following her exposure to rapid titration using high doses of olanzapine, which was abruptly converted to chlorpromazine due to lack of efficacy, in addition to administering multiple as needed (PRN) medications for agitation. Hyperthermia, muscle rigidity, dysautonomia, mental status changes, catatonia, and some laboratory derangement were reported in this case. It is possible that factors such as naïve patients, high doses of neuroleptics, a switch from one agent to another, rapid escalation, and the increased use of parenteral therapy for managing of agitation acted collectively or individually as risk factors for developing NMS. Health care professionals should be cautious about the cumulative dose of antipsychotics used per day, including PRN medications. The delay in recognizing the early symptoms of NMS could put patients at higher risk of mortality. Lastly, it is pivotal to exclude other infectious or autoimmune etiologies before treating as NMS case.

Published in American Journal of Psychiatry and Neuroscience (Volume 7, Issue 4)
DOI 10.11648/j.ajpn.20190704.12
Page(s) 83-87
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2019. Published by Science Publishing Group

Keywords

Malignant, Adverse Drug Reaction (ADR), Dopamine Blockers, Hyperthermia, Catatonia, Neuroleptics

References
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[8] D. P. Seitz and S. S. Gill, “Neuroleptic Malignant Syndrome Complicating Antipsychotic Treatment of Delirium or Agitation in Medical and Surgical Patients: Case Reports and A Review of the Literature,” Psychosomatics, vol. 50, no. 1, pp. 8–15, Jan. 2009.
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[15] M. S. Arnaout, F. P. Antun, and K. Ashkar, “Neuroleptic malignant syndrome with olanzapine associated with severe hypernatremia,” Hum. Psychopharmacol. Clin. Exp., vol. 16, no. 3, pp. 279–281, Apr. 2001.
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    Nervana Abdelfattah Hafez Elbakary, Mohamed Adil Shah Khoodoruth. (2019). Neuroleptic Malignant Syndrome, a Sequalae of Multiple Administration of Antipsychotics: A Case Report. American Journal of Psychiatry and Neuroscience, 7(4), 83-87. https://doi.org/10.11648/j.ajpn.20190704.12

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    ACS Style

    Nervana Abdelfattah Hafez Elbakary; Mohamed Adil Shah Khoodoruth. Neuroleptic Malignant Syndrome, a Sequalae of Multiple Administration of Antipsychotics: A Case Report. Am. J. Psychiatry Neurosci. 2019, 7(4), 83-87. doi: 10.11648/j.ajpn.20190704.12

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    AMA Style

    Nervana Abdelfattah Hafez Elbakary, Mohamed Adil Shah Khoodoruth. Neuroleptic Malignant Syndrome, a Sequalae of Multiple Administration of Antipsychotics: A Case Report. Am J Psychiatry Neurosci. 2019;7(4):83-87. doi: 10.11648/j.ajpn.20190704.12

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  • @article{10.11648/j.ajpn.20190704.12,
      author = {Nervana Abdelfattah Hafez Elbakary and Mohamed Adil Shah Khoodoruth},
      title = {Neuroleptic Malignant Syndrome, a Sequalae of Multiple Administration of Antipsychotics: A Case Report},
      journal = {American Journal of Psychiatry and Neuroscience},
      volume = {7},
      number = {4},
      pages = {83-87},
      doi = {10.11648/j.ajpn.20190704.12},
      url = {https://doi.org/10.11648/j.ajpn.20190704.12},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajpn.20190704.12},
      abstract = {Neuroleptic malignant syndrome (NMS) is a lethal adverse drug reaction (ADR) that is often attributed to the administration of dopamine blockers, antiemetic agents as well as anti-parkinsonism medication withdrawal. We describe a challenging case of NMS, with malignant catatonia as a differential diagnosis, who was difficult to respond to treatment. The patient developed severe complications following her exposure to rapid titration using high doses of olanzapine, which was abruptly converted to chlorpromazine due to lack of efficacy, in addition to administering multiple as needed (PRN) medications for agitation. Hyperthermia, muscle rigidity, dysautonomia, mental status changes, catatonia, and some laboratory derangement were reported in this case. It is possible that factors such as naïve patients, high doses of neuroleptics, a switch from one agent to another, rapid escalation, and the increased use of parenteral therapy for managing of agitation acted collectively or individually as risk factors for developing NMS. Health care professionals should be cautious about the cumulative dose of antipsychotics used per day, including PRN medications. The delay in recognizing the early symptoms of NMS could put patients at higher risk of mortality. Lastly, it is pivotal to exclude other infectious or autoimmune etiologies before treating as NMS case.},
     year = {2019}
    }
    

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    AU  - Nervana Abdelfattah Hafez Elbakary
    AU  - Mohamed Adil Shah Khoodoruth
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    AB  - Neuroleptic malignant syndrome (NMS) is a lethal adverse drug reaction (ADR) that is often attributed to the administration of dopamine blockers, antiemetic agents as well as anti-parkinsonism medication withdrawal. We describe a challenging case of NMS, with malignant catatonia as a differential diagnosis, who was difficult to respond to treatment. The patient developed severe complications following her exposure to rapid titration using high doses of olanzapine, which was abruptly converted to chlorpromazine due to lack of efficacy, in addition to administering multiple as needed (PRN) medications for agitation. Hyperthermia, muscle rigidity, dysautonomia, mental status changes, catatonia, and some laboratory derangement were reported in this case. It is possible that factors such as naïve patients, high doses of neuroleptics, a switch from one agent to another, rapid escalation, and the increased use of parenteral therapy for managing of agitation acted collectively or individually as risk factors for developing NMS. Health care professionals should be cautious about the cumulative dose of antipsychotics used per day, including PRN medications. The delay in recognizing the early symptoms of NMS could put patients at higher risk of mortality. Lastly, it is pivotal to exclude other infectious or autoimmune etiologies before treating as NMS case.
    VL  - 7
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Author Information
  • Mental Health Hospital, Hamad Medical Corporation, Doha, Qatar

  • Mental Health Hospital, Hamad Medical Corporation, Doha, Qatar

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