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Prescribing for a first episode of schizophrenia-like psychosis
Published in Kathy J Aitchison, Karena Meehan, Robin M Murray, First Episode Psychosis, 2021
Kathy J Aitchison, Karena Meehan, Robin M Murray
Neuroleptic malignant syndrome is a rare but potentially lethal condition. It is characterized by rigidity, hyperthermia, autonomic disturbance and fluctuations in conscious level. The autonomic disturbance may include fluctuations of blood pressure, irregularities of heart rate and rhythm, loss of sphincter control, hyperpyrexia and muscle stiffness profuse sweating and sialorrhea,195 and waxing and waning of conscious level or coma.
Therapeutic Uses and Side Effects
Published in Fazal-I-Akbar Danish, Ahmed Ehsan Rabbani, Pharmacology in 7 Days for Medical Students, 2018
Fazal-I-Akbar Danish, Ahmed Ehsan Rabbani
Neurological side effects: Extrapyramidal side effects (like Parkinsonism) – acute dystonias, akathisia, tardive dyskinesia, perioral tremors – also called Rabbit’s syndrome.Neuroleptic malignant syndrome.
Questions and Answers
Published in David Browne, Brenda Wright, Guy Molyneux, Mohamed Ahmed, Ijaz Hussain, Bangaru Raju, Michael Reilly, MRCPsych Paper I One-Best-Item MCQs, 2017
David Browne, Brenda Wright, Guy Molyneux, Mohamed Ahmed, Ijaz Hussain, Bangaru Raju, Michael Reilly
Answer: A. Addition of lithium or anticholinergic agents can increase the risk of neuroleptic malignant syndrome. Female patients are at more risk as compared to male patients. Similarly, high-potency drugs carry more risk as compared to low-potency drugs such as quetiapine. Agitation and rapid initiation of antipsychotics are both risk factors for development of neuroleptic malignant syndrome. [AB. p. 868]
Atypical Neuroleptic Malignant Syndrome: Case Reports and Diagnostic Challenges
Published in Journal of Psychoactive Drugs, 2022
Anna Maria Szota, Izabela Radajewska, Aleksander Stanisław Araszkiewicz
Neuroleptic malignant syndrome (NMS) is a rare, severe and possibly fatal condition mainly caused by typical antipsychotic drugs (TAPDs) (Moscovich et al. 2011; Sarkar and Gupta 2017; Ware, Feller, and Hall 2018), but several cases of this syndrome induced by atypical antipsychotic drugs (AAPDs) have been reported (Ananth et al. 2004; Murri et al. 2015; Trollor et al. 2012). According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-V) criteria hyperthermia (> 38°C), muscle rigidity, changes in mental status (delirium, altered consciousness), increased activity of the autonomic nervous system (tachycardia, diaphoresis, blood pressure elevation, urinary incontinence, pallor, tachypnea and creatinine phosphokinase (CPK) > 4-times the upper limit must be present in order to make a diagnosis of NMS (DSM-V 2013).
Spasticity management and resolution of paroxysmal sympathetic hyperactivity in the acute care setting: a case series
Published in Brain Injury, 2022
Arline Edmond, Ondrea McKay, Natasha Mehta, Laurie Dabaghian, Peter Yonclas
PSH was first described in 1899 by Rosenblath (5). It was then described by Wilder Penfield in 1929 who used the term “diencephalic autonomic seizures” (9). In addition to diencephalic autonomic seizures, PSH has also been synonymous with sympathetic storming, acute hypothalamic instability, brainstem attack, central autonomic dysfunction, or paroxysmal autonomic instability with dystonia (PAID) in the historical literature (10). In 2014, Baguley et al. published a consensus on the nomenclature and diagnostic criteria for the autonomic hyperactivity seen after acquired brain injury and suggested the unifying term paroxysmal sympathetic hyperactivity (PSH) 11. This consensus suggested that measures for the evaluation of PSH should include the characteristic features of heart rate, respiratory rate, systolic blood pressure, temperature, sweating, and posturing, which contributes to grading its severity. Baguley also highlighted the episodic nature of occurrences and the over-reactivity to nonpainful stimuli. They also described its persistence at times lasting greater than three consecutive days and than two weeks after injury (11). While for most, these symptoms will resolve over time with natural recovery, there is a small population, approximately 8–33%, in which PSH persists past the ICU and into the rehabilitation stage (3,5–8). These symptoms can mimic several other medical conditions. Importantly, alternative diagnosis such as neuroleptic malignant syndrome, malignant hyperthermia, autonomic dysreflexia, and diencephalic seizures must be ruled out, making PSH a diagnosis of exclusion (2,9).
Safety and tolerability of antipsychotic agents in neurodevelopmental disorders: a systematic review
Published in Expert Opinion on Drug Safety, 2020
Felice Iasevoli, Annarita Barone, Elisabetta Filomena Buonaguro, Licia Vellucci, Andrea de Bartolomeis
The putative higher vulnerability in Intellectual Disability patients was demonstrated by a range of unusual effects, including tardive dyskinesia with aripiprazole [112] or clozapine-mediated EPS [145]. Notably, Intellectual Disability is often diagnosed in the context of complex genetic syndromes, in which altered neurodevelopment is frequently associated with multiple organic dysfunctions. This diathesis may confer higher risk to neurological side effects of antipsychotics. Accordingly, severe cognitive decline was described by first generation antipsychotics in Down’s Syndrome patients [150]. Uncommon side effects by clozapine were recognized in a substantial portion of 20 22q11.2DS adult patients [143]. Notably, myocarditis and neutropenia by clozapine in these patients were largely more frequent than observed in psychotic patients. Multiple case reports described neuroleptic malignant syndromes in patients with genetic syndromes [153–156], including one case of an aged patient with ID and Down’s syndrome that developed neuroleptic malignant syndrome after 3 months of 2.5 mg/day olanzapine [186].