[Electroconvulsive Therapy (ECT) in Neuroleptic Malignant Syndrome (NMS) on an Intensive Care Unit (ICU)]. / Elektrokonvulsivtherapie (EKT) bei malignem neuroleptischen Syndrom (MNS) auf Intensivstation.

A 57-year-old female patient with unclear somnolence was admitted to an Intermediate Care Unit (IMC) by an emergency physician. Several psychotropic drugs were on the medication list (quetiapine 450 mg/d, paroxetine 40 mg/d and perphenazine 12 mg/d), due to depression with psychotic features. As the patient's state deteriorated on day 3, she was intubated and transferred to Intensive Care Unit (ICU), where a malignant hyperthermia (MH) was assumed. The ICU's call to the MH hotline did not give a hint to consider a neuroleptic malignant syndrome (NMS) neither to consider electroconvulsive therapy (ECT). It was not until day 9 that a psychiatric consultation was undertaken, under the suspected diagnosis of NMS. On the same day ECT was performed, followed by a rapid remission of all clinical features and laboratory findings. Early consideration and application of ECT treatment for NMS on an ICU is life-saving.

Pharmacist-Initiated Management of a Suspected Case of Risperidone-Induced Neuroleptic Malignant Syndrome in an Aged-Care Resident. The Role of Residential Medication Management Reviews in Medication Safety.

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. It demonstrates the valuable role collaborative medication reviews play in managing adverse drug reactions in aged-care.

Risk of neuroleptic malignant syndrome in patients with bipolar disorder: a retrospective, population-based case-control study.

INTRODUCTION: Current data regarding risk factors of neuroleptic malignant syndrome (NMS) are limited. This study aims to examine factors associated with increased risk of NMS in patients with bipolar disorder. METHODS: A retrospective, population-based, case-control study was performed using a medical claims database covering January 1998 to December 2002. Fifty cases with a diagnosis of NMS were identified and matched with 800 controls. Conditional logistic regression analysis was used to estimate crude and adjusted odds ratios (ORs) of risk of NMS. RESULTS: Antipsychotic use was associated with an increased risk of NMS after controlling for other pharmacologic and clinical factors (OR = 2.36, 95% CI = 1.08-5.19). Other factors associated with an increased risk of NMS included being male (OR = 2.07, 95% CI = 1.07-4.02), confusion (OR = 2.91, 95% CI = 1.17-7.28), dehydration (OR = 3.99, 95% CI = 1.50-10.57), delirium (OR = 4.93, 95% CI = 2.07-11.72), and extrapyramidal symptoms (OR = 3.50, 95% CI = 1.10-11.09). CONCLUSIONS: Given the widespread use of antipsychotics for the treatment of bipolar disorder, clinicians should be vigilant of the potential pharmacologic and clinical factors associated with increased risk of NMS in patients with bipolar disorder.

Recognition, assessment and management of neuroleptic malignant syndrome.

Neuroleptic malignant syndrome (NMS) is a potentially fatal idiosyncratic complication of neuroleptic treatment. It was first described in 1968 by Delay and Deniker, and is characterized by hyperthermia, extrapyramidal signs, autonomic dysfunction and altered mentation. They reported that 0.5% to 1.0% of the patients on neuroleptic therapy developed NMS. Several retrospective studies have reported the frequency of NMS between 0.02% to 2.44%. These variations in the incidence of NMS may be due to difference in patient population, awareness and experience of clinicians, prescribing habits, different diagnostic criteria, or methodological differences in survey methods.

ECT as a treatment alternative for patients with symptoms of neuroleptic malignant syndrome.

The use of ECT as a treatment alternative in a clinical situation in which it is difficult to determine whether the patient is suffering from neuroleptic malignant syndrome (NMS) or an evolving catatonic state is investigated. Fourteen cases from the literature are reviewed and 3 new cases are presented. In 6 cases, ECT was rapidly effective in treating symptoms of NMS, but cardiac arrhythmias were reported in 4 cases. There was no evidence of malignant hyperthermia (MH) in patients receiving succinylcholine, suggesting that an association between NMS and MH may not be clinically relevant in patients being treated with ECT.