[Neuroleptic malignant syndrome - unexpected complication in a COVID-19 patient].

Neuroleptic malignant syndrome is a life-threatening condition that can be fatal if unrecognized and inadequately treated. This disease is rarely seen in infectious diseases wards. As infectiologists, however, we are confronted with an increasingly broader spectrum of diagnoses and this disease should therefore be considered in any patient taking psychiatric medication who develops the typical symptoms of hyperthermia, rigidity and muscle tremors, autonomic lability and impaired consciousness. A case report is presented of a young man with schizophrenia admitted to the intensive care unit with COVID-19, who was treated with antipsychotics (formerly known as neuroleptics) for restlessness and who developed neuroleptic malignant syndrome. In cooperation with psychiatrists, a targeted therapy was initiated, after which the symptoms subsided and the patient's clinical condition resolved.

Plasma Levels of Long-Acting Injectable Antipsychotics in Outpatient Care: A Retrospective Analysis.

PURPOSE: Antipsychotic efficacy in schizophrenia depends on its availability in the body. Although therapeutic outcomes remain still far from satisfactory, therapeutic drug monitoring is not a common part of clinical practice during treatment with long-acting injectable antipsychotics (LAI AP). The real effectiveness of LAI AP is thus uncertain. PATIENTS AND METHODS: We made a retrospective evaluation of plasma levels of LAI AP. Collection of blood samples was performed just before the drug application and one week later. Forty patients with a stabilized clinical condition and steady-state plasma levels were included. RESULTS: In the observed cohort of patients, flupentixol decanoate (n = 23) was the most often used drug, followed by fluphenazine decanoate (n = 7), haloperidol decanoate (n = 5), paliperidone palmitate (n = 3), and risperidone microspheres (n = 2). Just 5 of 40 patients were treated with a monotherapy. In the period before the application, 60% of the patients did not reach the therapeutic reference range (TRR) and 20% of the patients had an undetectable plasma level. At the time of collection of the second blood samples performed after 7 days, 24% of the patients were under the TRR. CONCLUSION: We have found a surprisingly high incidence of plasma levels under the TRR in patients treated with LAI AP. Notwithstanding individual variability in pharmacokinetics, it seems that LAI AP may be underdosed in usual clinical practice.