Assuntos
Antipsicóticos/efeitos adversos , Catatonia/terapia , Eletroconvulsoterapia , Haloperidol/efeitos adversos , Esclerose Múltipla/complicações , Síndrome Maligna Neuroléptica/terapia , Adulto , Antipsicóticos/uso terapêutico , Catatonia/etiologia , Feminino , Alucinações/tratamento farmacológico , Haloperidol/uso terapêutico , Humanos , Síndrome Maligna Neuroléptica/etiologia , Resultado do TratamentoAssuntos
Anestesia/efeitos adversos , Arritmias Cardíacas/terapia , Febre/terapia , Complicações Intraoperatórias/terapia , Taquicardia/terapia , Inconsciência/terapia , Adulto , Síndrome Anticolinérgica/diagnóstico , Síndrome Anticolinérgica/terapia , Diagnóstico Diferencial , Feminino , Febre/etiologia , Humanos , Síndrome Maligna Neuroléptica/diagnóstico , Síndrome Maligna Neuroléptica/prevenção & controle , Síndrome Maligna Neuroléptica/terapia , Taquicardia/etiologia , Inconsciência/etiologiaRESUMO
An 80-year-old woman with Parkinson's disease was scheduled for open heart surgery to repair thoracic aortic aneurysm. Parkinson's symptoms were normally treated using oral levodopa (200 mg), selegiline-hydrochloride (5 mg), bromocriptine-mesilate (2 mg), and amantadine-hydrochloride (200 mg) daily. On the day before surgery, levodopa 50mg was infused intravenously. Another 25 mg of levodopa was infused immediately after surgery. Twenty hours later, the patient developed tremors, heyperventilation, but no obvious muscle rigidity. Two days after surgery, the patient exhibited high fever, hydropoiesis, elevated creatine kinase, and a rise in blood leukocytes. She was diagnosed with neuroleptic malignant syndrome. She was intubated, and received dantrolene sodium. Symptoms of neuroleptic malignant syndrome disappeared on the fourth postoperative day. The stress of open heart surgery, specifically extracorporeal circulation and concomitant dilution of levodopa, triggered neuroleptic malignant syndrome in this patient. Parkinson's patients require higher doses of levodopa prior to surgery to compensate and prevent neuroleptic malignant syndrome after surgery.
Assuntos
Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/cirurgia , Procedimentos Cirúrgicos Cardíacos , Levodopa/administração & dosagem , Síndrome Maligna Neuroléptica/etiologia , Doença de Parkinson/complicações , Assistência Perioperatória , Complicações Pós-Operatórias/etiologia , Idoso de 80 Anos ou mais , Anestesia , Dantroleno/administração & dosagem , Circulação Extracorpórea/efeitos adversos , Feminino , Humanos , Infusões Intravenosas , Levodopa/sangue , Síndrome Maligna Neuroléptica/prevenção & controle , Síndrome Maligna Neuroléptica/terapia , Doença de Parkinson/tratamento farmacológico , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/terapiaRESUMO
AIM: The authors present the cases of three bipolar patients who developed Neuroleptic Malignant Syndrome (NMS) after antipsychotic treatment, both typical and atypical, focusing on relationship between NMS and catatonia. METHODS: In all three cases, administration of antipsychotics has been stopped at once, when fever and autonomic disturbances occurred. A supportive therapy (including rehydration, electrolyte restoration and blood pressure aids, together with antipyretics, antibiotics and anticoagulants) was prescribed in order to stabilize general conditions. Every patient started then Electroconvulsive Therapy (ECT) in combination with benzodiazepines. RESULTS: High risk of complications and lethal outcome, associated with NMS, were successfully reduced by the tempestive adoption of a supportive care, while combination between ECT and BDZ was effective in resolution of clinical picture. DISCUSSIONS; These cases may provide further evidences about hypothesis of catatonia and NMS as disorders on the same spectrum. In one patient, NMS occurred overlapping with a previous catatonic state, while two others exhibited catatonic features after resolution of NMS. However, catatonic symptoms arose or worsened with administration of antipsychotics, supporting hypothesis of neuroleptic-induced catatonia as a step of progressive development of NMS. Our experience also confirms efficacy and safety of ECT in combination with BDZ as treatment of NMS and residual catatonia.
Assuntos
Antipsicóticos/efeitos adversos , Catatonia/induzido quimicamente , Síndrome Maligna Neuroléptica/etiologia , Adulto , Antibacterianos/uso terapêutico , Antipsicóticos/administração & dosagem , Benzodiazepinas/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Catatonia/diagnóstico , Catatonia/terapia , Eletroconvulsoterapia , Feminino , Hidratação , Humanos , Pessoa de Meia-Idade , Síndrome Maligna Neuroléptica/diagnóstico , Síndrome Maligna Neuroléptica/terapia , Resultado do TratamentoRESUMO
We report a case of severe neuroleptic malignant syndrome developing in a 28-year-old female patient following deliberate self-poisoning with atypical antipsychotic drugs and serotonin reuptake inhibitors. Because of an increasing loss of consciousness she was rapidly transferred to an Intensive Care Unit. Following this, she became progressively febrile associated with rhabdomyolysis and life-threatening organ dysfunctions. Due to fast diagnosis and immediate therapy the patient was treated successfully. This article describes etiology, pathophysiology and symptoms of neuroleptic malignant syndrome. In addition therapeutic options are discussed.
Assuntos
Cuidados Críticos , Síndrome Maligna Neuroléptica/terapia , Adulto , Antidepressivos/efeitos adversos , Antidepressivos/uso terapêutico , Antipsicóticos/efeitos adversos , Antipsicóticos/uso terapêutico , Benzodiazepinas/efeitos adversos , Benzodiazepinas/uso terapêutico , Transtorno Bipolar/complicações , Transtorno Bipolar/tratamento farmacológico , Coma/induzido quimicamente , Creatina Quinase/sangue , Dantroleno/uso terapêutico , Feminino , Humanos , Relaxantes Musculares Centrais/uso terapêutico , Mioglobina/sangue , Síndrome Maligna Neuroléptica/diagnóstico , Síndrome Maligna Neuroléptica/tratamento farmacológico , Olanzapina , Sertralina/efeitos adversos , Sertralina/uso terapêutico , Resultado do TratamentoRESUMO
When fever occurs in a patient treated with a neuroleptic, the diagnosis of a neuroleptic malignant syndrome is difficult to differentiate to that of an infectious event. Among inflammation biomarkers of inflammation, serum procalcitonin levels increase both quickly and specifically during a bacterial infection. We report the first case of a neuroleptic malignant syndrome associated with a significant increase of serum procalcitonin levels, without concomitant septic syndrome. The neuroleptic malignant syndrome might be a non-infectious clinical situation associated with an increased serum procalcitonin concentration.
Assuntos
Calcitonina/sangue , Síndrome Maligna Neuroléptica/sangue , Precursores de Proteínas/sangue , Transtornos Psicóticos/etiologia , Idoso de 80 Anos ou mais , Analgésicos não Narcóticos/administração & dosagem , Analgésicos não Narcóticos/uso terapêutico , Antipsicóticos/uso terapêutico , Temperatura Corporal , Proteína C-Reativa/metabolismo , Peptídeo Relacionado com Gene de Calcitonina , Diagnóstico Diferencial , Feminino , Hidratação , Alucinações/etiologia , Haloperidol/uso terapêutico , Humanos , Inflamação/sangue , Inflamação/etiologia , Síndrome Maligna Neuroléptica/diagnóstico , Síndrome Maligna Neuroléptica/terapia , Resultado do TratamentoAssuntos
Benzodiazepinas/efeitos adversos , Vírus da Influenza A Subtipo H1N1 , Síndrome Maligna Neuroléptica/etiologia , Pneumonia Viral , Esquizofrenia , Antimaníacos/administração & dosagem , Antimaníacos/efeitos adversos , Antipsicóticos/administração & dosagem , Antipsicóticos/efeitos adversos , Benzodiazepinas/administração & dosagem , Creatina Quinase/sangue , Haloperidol/administração & dosagem , Haloperidol/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome Maligna Neuroléptica/sangue , Síndrome Maligna Neuroléptica/terapia , Olanzapina , Pneumonia Viral/complicações , Pneumonia Viral/etiologia , Esquizofrenia/complicações , Esquizofrenia/tratamento farmacológico , Resultado do Tratamento , Ácido Valproico/administração & dosagem , Ácido Valproico/efeitos adversos , Suspensão de TratamentoRESUMO
Two patients with the neuroleptic malignant syndrome (NMS), a man aged 31 years and a woman aged 83 years, were referred for electroconvulsive therapy after 70 and 7 days, respectively. Both patients benefited from the treatment, but the patient who had had the syndrome longer had persistent contractures. NMS is potentially lethal. Diagnosis and treatment should be done as soon as possible to prevent mortality and complications. Admission to a general hospital and early consultation of NMS-experienced colleagues is strongly advised. Electroconvulsive therapy is indicated ifa trial course of lorazepam yields insufficient improvement.
Assuntos
Eletroconvulsoterapia , Síndrome Maligna Neuroléptica/terapia , Adulto , Idoso de 80 Anos ou mais , Feminino , Humanos , Hipnóticos e Sedativos/uso terapêutico , Lorazepam/uso terapêutico , Masculino , Síndrome Maligna Neuroléptica/tratamento farmacológico , Fatores de Tempo , Resultado do TratamentoRESUMO
The above article presents a case report of a 28-year-old patient, primarily treated with a diagnosis of catatonic schizophrenia, in who in the course of hospitalization developed neuroleptic malignant syndrome (NMS). The patient presented unawareness, hyperthermia, respiratory insufficiency, muscle rigidity, CK increased activity. The patient required tracheotomy and oxygen therapy and then was subjected to a series of electroconvulsive therapy (ECT). Since the fifth ECT treatment we noted a gradual recovery to a completely normal mental status. We did not make an attempt to introduce neuroleptic maintenance treatment.
Assuntos
Antipsicóticos/efeitos adversos , Eletroconvulsoterapia/métodos , Síndrome Maligna Neuroléptica/etiologia , Síndrome Maligna Neuroléptica/terapia , Esquizofrenia Catatônica/complicações , Adulto , Antipsicóticos/administração & dosagem , Feminino , Humanos , Esquizofrenia Catatônica/tratamento farmacológico , Resultado do TratamentoRESUMO
We report a consensus statement of the collaborative research group on the prevention and treatment of malignant syndrome (MS) in Parkinson's disease. The syndrome is quite similar to neuroleptic MS. Although sudden withdrawal of levodopa was the most frequent cause, many other precipitating events were found such as intercurrent infections, dehydration, hot weather, discontinuation of other anti-parkinsonian drugs, and "wearing off" phenomenon. Awareness of this syndrome is most important for its early detection and the prompt commencement of treatment. MS should be suspected whenever the body temperature rises above 38 degrees C without an apparent cause. Treatment consists of ample intravenous fluid, cooling the body, anti-parkinsonian drugs (particularly levodopa and bromocriptine), dantrolene sodium, and antibiotics if infection is present. Rhabdomyolysis, disseminated intravascular coagulation, and acute renal failure constitute serious complications.
Assuntos
Antiparkinsonianos/efeitos adversos , Síndrome Maligna Neuroléptica/prevenção & controle , Síndrome Maligna Neuroléptica/terapia , Doença de Parkinson/tratamento farmacológico , Humanos , Síndrome Maligna Neuroléptica/etiologia , Síndrome de Abstinência a SubstânciasRESUMO
This article summarizes the prevention and treatment of malignant syndrome (MS) in Parkinson's disease. MS is often induced by sudden withdrawal of levodopa. However, many other events can be responsible for the induction of MS, including concomitant infections, dehydration, hot weather, discontinuation of other antiparkinsonian drugs, and 'wearing off' phenomenon. MS should be suspected when the body temperature rises above 38 degrees C without an apparent cause. The early detection and its prompt commencement of treatment are essential for improving the prognosis of the disease. The treatment consists of ample intravenous fluid, cooling the body, antiparkinsonian drugs (particularly, levodopa and bromocriptine), dantrolene sodium, and antibiotics if infection is present.
Assuntos
Antiparkinsonianos/administração & dosagem , Síndrome Maligna Neuroléptica/etiologia , Síndrome Maligna Neuroléptica/prevenção & controle , Doença de Parkinson/complicações , Humanos , Síndrome Maligna Neuroléptica/terapia , Síndrome de Abstinência a SubstânciasRESUMO
Electroconvulsive therapy (ECT) is a recognized and effective treatment in adults for several psychiatric and neurological conditions in which the use of pharmacotherapy is ineffective, untimely or contraindicated. It has been used with success in mood and psychotic disorders, catatonia, neuroleptic malignant syndrome, Parkinson's disease and intractable seizures. Its benefits have been recognized and its risks identified through an extensive body of research. The benefits of ECT are not limited to the adult population; research has been conducted on its use in child and adolescent populations for decades. In 2004, the American Academy of Child and Adolescent Psychiatry published practice parameters for the use of ECT in adolescent populations. However, ECT continues to be underused in cases where it is clearly indicated. In this article, we review the use of ECT in the adolescent population; its indications, administration, contraindications and risks, with emphasis on articles published after the American Academy of Child and Adolescent Psychiatry practice parameters were formulated. We also review reasons behind the underutilization of ECT in adolescents for whom this treatment modality is indicated.
Assuntos
Catatonia/terapia , Eletroconvulsoterapia , Síndrome Maligna Neuroléptica/terapia , Doença de Parkinson/terapia , Transtornos Psicóticos/terapia , Adolescente , Adulto , Criança , Contraindicações , Eletroconvulsoterapia/efeitos adversos , Feminino , Humanos , Masculino , Guias de Prática Clínica como Assunto , Transtornos Psicóticos/psicologia , Resultado do TratamentoAssuntos
Antidiscinéticos/uso terapêutico , Toxinas Botulínicas/uso terapêutico , Contratura/prevenção & controle , Distonia/terapia , Síndrome Maligna Neuroléptica/terapia , Terapia Combinada , Distonia/induzido quimicamente , Distonia/tratamento farmacológico , Feminino , Haloperidol/efeitos adversos , Humanos , Pessoa de Meia-Idade , Síndrome Maligna Neuroléptica/tratamento farmacológico , Síndrome Maligna Neuroléptica/etiologia , Doença de Parkinson Secundária/tratamento farmacológico , Doença de Parkinson Secundária/terapia , Modalidades de Fisioterapia , Transtornos Psicóticos/tratamento farmacológicoRESUMO
UNLABELLED: Neuroleptic malignant syndrome (NMS) is a relatively uncommon side effect that may develop after a recent increase in the therapeutic dose of an antipsychotic medication or the addition of a new agent in therapeutic doses. CASE REPORT: We report a case of NMS developing in a 36-year-old female patient 2 days following deliberate self-poisoning with 30 x 10-mg olanzapine tablets, 7 x 100-mg chlorpromazine tablets and an unknown amount of escitalopram. These were the patient's own medications. She had not been taking these for several weeks. The patient initially presented with sedation from her overdose which resolved over the next 24 hours. Following this, over the subsequent 24 hours, she became progressively confused, ataxic, hypertonic, ferbrile and tachycardic, with marked lead pipe rigidity of the limbs. Head CT, lumbar puncture and septic screen were all negative. She was treated with intravenous midazolam infusion, nasogastrically administered bromocriptine, external cooling and was mechanically ventilated. She gradually improved over a period of 10 days, with residual confusion lasting another week, and was discharged well with no deterioration from her premorbid neurologic state. CONCLUSION: To our knowledge, although there are numerous cases reported with therapeutic use, NMS has not been reported to develop following acute olanzapine overdose. Clinicians should be aware that this may be an uncommon side effect of antipsychotic medication.
Assuntos
Antipsicóticos/intoxicação , Benzodiazepinas/intoxicação , Clorpromazina/intoxicação , Síndrome Maligna Neuroléptica/etiologia , Adulto , Bromocriptina/administração & dosagem , Citalopram/intoxicação , Terapia Combinada , Agonistas de Dopamina/administração & dosagem , Overdose de Drogas , Feminino , Humanos , Hipnóticos e Sedativos/administração & dosagem , Hipotermia Induzida , Infusões Intravenosas , Midazolam/administração & dosagem , Síndrome Maligna Neuroléptica/terapia , Olanzapina , Respiração Artificial , Resultado do TratamentoRESUMO
OBJECTIVE: Neuroleptic malignant syndrome (NMS) is a potentially lethal adverse effect of neuroleptic medication, with no satisfactory treatment currently available. Electroconvulsive therapy (ECT) has been anecdotally reported to be effective in its treatment. We review 45 published case reports of ECT for NMS and describe nine new cases, to examine its effectiveness, the likelihood of adverse reactions, and the theoretical implications of such treatment. METHOD: The authors used Medline to identify reports in the English literature where ECT was used in cases of suspected NMS. In addition, the charts of patients referred to the second author for treatment of NMS were reviewed and cases in which ECT used were identified. RESULTS: The case reports suggest that ECT is effective in many individuals with NMS, even when drug therapy has failed. The response is usually apparent after a few treatments, generally up to six. The response is not predictable on the basis of age, gender, psychiatric diagnosis or any particular feature of NMS including catatonia. Electroconvulsive therapy is a relatively safe treatment in NMS, although the risk of cardiovascular complications should be considered. Malignant hyperthermia due to the anaesthesia associated with ECT has not been reported in patients with NMS, and succinylcholine has been used safely with the exception of one report of fever and raised creatine kinase levels and another report of hyperkalemia. CONCLUSIONS: Electroconvulsive therapy is the preferred treatment in severe NMS, cases where the underlying psychiatric diagnosis is psychotic depression or catatonia, and in cases where lethal catatonia cannot be ruled out. The effectiveness of ECT for the treatment of NMS has theoretical implications for the relationship between NMS and catatonia, and the possible pathophysiological mechanisms that underlie these disorders.
Assuntos
Eletroconvulsoterapia/métodos , Síndrome Maligna Neuroléptica/terapia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
The neuroleptic malignant syndrome (NMS) is an idiosyncratic reaction to neuroleptic drugs, made up of hyperthermia, muscular rigidity, disturbance of level of consciousness and autonomic dysfunction. It is potentially lethal and should be kept in mind whilst using anti-psychotic drugs; as most patients treated by them require further anti-psychotic treatment, the clinician faces the problem of treating those patients after a NMS episode, yet reports in the literature have generally neglected the problem of late management. A patient suffering from a psychosis and NMS is presented, and a rationale for management offered.
Assuntos
Assistência ao Convalescente , Doenças dos Gânglios da Base/terapia , Síndrome Maligna Neuroléptica/terapia , Adulto , Eletroconvulsoterapia , Humanos , Masculino , Metotrimeprazina/uso terapêutico , Síndrome Maligna Neuroléptica/complicações , Transtornos Psicóticos/complicações , Transtornos Psicóticos/terapia , Tioridazina/uso terapêuticoRESUMO
We report five cases of neuroleptic malignant syndrome (NMS) with psychotic symptoms treated with electroconvulsive therapy (ECT). Clinical response was observed after the first or the second session of ECT in every case, and the symptoms of NMS resolved by the third or fourth session. The mean time from the initial ECT to complete resolution was 6.0 days. No side effects from ECT were observed. Although the first treatment for NMS is pharmacotherapy using drugs such as dantrolene and bromocriptine, our results suggest that ECT is a useful therapeutic method for patients with NMS and psychotic symptoms.