Abstract

Neuroleptic malignant syndrome (NMS) is a rare, idiosyncratic and potentially fatal side effect of antipsychotics. The syndrome is characterised by hyperthermia (fever), muscle rigidity, autonomic disturbances and alterations of mental state. Psychotropic medications, such as typical and atypical antipsychotics, certain dopamine receptor-blocking drugs used in the treatment of nausea and gastroparesis (e.g. promethazine, metoclopramide and prochlorperazine) and antidepressants, such as amoxapine, have all been implicated in the aetiology of NMS. Herein, we report three cases of NMS and discuss their possible aetiology with reference to the existing literature.

Keywords: Fever, antipsychotics, mental state alterations

References

  1. Hsin-tung PIE, Simpson GM. Medication-induced movement disorders. In: Sadock BJ, Sadock VA, editors. Kaplan and Sadock’s comprehensive text book of psychiatry. 7th ed. Philadelphia: Lippincott Williams and Wilkins; 2000. p. 2266-7.
  2. Levenson JL. Neuroleptic malignant syndrome. Am J Psychiatry 1985;142:1137-45.
  3. Caroff SN. The neuroleptic malignant syndrome. J Clin Psychiatry 1980;41:79-83.
  4. Caroff SN, Mann SC. Neuroleptic malignant syndrome. Med Clin North Am 1993;77:185-202.
  5. Srivastava A, Borkar HA, Chandak S. Olanzapine-induced neuroleptic malignant syndrome in a patient with paranoid schizophrenia. Psychiatry Clin Neurosci 2009;63:119-21.
  6. Erol A, Putgül G, Sert E, Mete L. Klozapin kullanımına bağlı nöroleptik malign sendrom ve ardışık katatoni: olgu sunumu [Clozapine-associated neuroleptic malignant syndrome followed by catatonia: a case report]. Turk Psikiyatri Derg 2013;24:140-4.
  7. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-IV. 4th Edition. American Psychiatric Association; 1994. p. 866.
  8. Kosten TR, Kleber HD. Sudden death in cocaine abusers: relation to neuroleptic malignant syndrome. Lancet 1987;1:1198-9.
  9. Behan WM, Bakheit AM, Behan PO, More IA. The muscle findings in the neuroleptic malignant syndrome associated with lysergic acid diethylamide. J Neurol Neurosurg Psychiatry 1991;54:741-3.
  10. Tse L, Barr AM, Scarapicchia V, Vila-Rodriguez F. Neuroleptic Malignant Syndrome: A Review from a Clinically Oriented Perspective. Curr Neuropharmacol 2015;13:395-406.
  11. Kasantikul D, Kanchanatawan B. Neuroleptic malignant syndrome: a review and report of six cases. J Med Assoc Thai 2006;89:2155-60.
  12. Baba O, Yamagata K, Tomidokoro Y, Tamaoka A, Itoh H, Yanagawa T, et al. Neuroleptic malignant syndrome in a patient with tongue cancer: a report of a rare case. Case Rep Dent 2013;2013:542130.
  13. Wysokiński A. Intensive electroconvulsive therapy in drug resistant neuroleptic malignant syndrome - case report. Psychiatr Danub 2012;24:219-22.
  14. Moscovich M, Nóvak FT, Fernandes AF, Bruch T, Tomelin T, Nóvak EM, et al. Neuroleptic malignant syndrome. Arq Neuropsiquiatr 2011;69:751-5.
  15. Kadiroğlu AK, Ebik B, Kaya Ö, Yıldırım S, Bez Y. Nöroleptik malign sendrom tanılı üç olgu: Ayırıcı tanı ve predispozan nedenler. Yoğun Bakım Derg 2011;3:67-70.
  16. Munhoz RP, Moscovich M, Araujo PD, Teive HA. Movement disorders emergencies: a review. Arq Neuropsiquiatr 2012;70:453-61.
  17. González-Blanco L, García-Prada H, Santamarina S, Jiménez-Treviño L, Bobes J. Recurrence of neuroleptic malignant syndrome. Actas Esp Psiquiatr 2013;41:314-8.
  18. Edokpolo O, Fyyaz M. Lithium toxicity and neurologic effects: probable neuroleptic malignant syndrome resulting from lithium toxicity. Case Rep Psychiatry 2012;2012:271858.
  19. Janati AB, Alghasab N, Osman A. Neuroleptic malignant syndrome caused by a combination of carbamazepine and amitriptyline. Case Rep Neurol Med 2012;2012:183252.
  20. Tu MC, Hsiao CC. Amisulpride and neuroleptic malignant syndrome. Chang Gung Med J 2011;34:536-40.
  21. Pereira YD, Srivastava A, Cuncoliencar BS, Naik N. Resolution of symptoms in neuroleptic malignant syndrome. Indian J Psychiatry 2010;52:264-6.
  22. Amore M, Zazzeri N. Neuroleptic malignant syndrome after neuroleptic discontinuation. Prog Neuropsychopharmacol Biol Psychiatry 1995;19:1323-34.

Copyright and license

Copyright © 2021 The Author(s). This is an open access article distributed under the Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to cite?

1.
Akın Şen İ, Kılınç M, Şen C, Sungurtekin H. Neuroleptic Malignant Syndrome Requires Intensive Care Monitoring: A Review with Three Cases. Turk J Intensive Care. 2021;19(2):94-97. https://doi.org/10.4274/tybd.galenos.2021.18480