Catatonia: harbinger of the neuroleptic malignant syndrome

Article Abstract:

Neuroleptic malignant syndrome (NMS) is a rare but potentially fatal condition associated with the administration of neuroleptic (antipsychotic) medications. NMS symptoms include rigidity and tremor, high fever, altered consciousness including coma, autonomic instability, and chemical imbalances. Five patients (three women and two men ranging in age from 20 to 47 years) diagnosed with NMS, and consecutively admitted to a psychiatric emergency unit, are briefly described. None of the patients had a previous history of psychiatric illness. Each manifested catatonic withdrawal and excitement during the week prior to neuroleptic treatment. Four became withdrawn, mute, or uncommunicative, which was followed by an acutely agitated state before admission to the psychiatric unit. One patient was diabetic and had high blood pressure. She became mute for two days then became excited, incoherent, and exhibited catatonic posturing. In each case, NMS symptoms began within 72 hours after one to three doses of neuroleptic treatment given to control the catatonic symptoms. Since catatonia preceded NMS in all cases, it is posited that the two disorders have a common neurochemical basis. Catatonia is most often thought of as a schizophrenic feature. However, none of these patients were schizophrenic. Their catatonia occurred as a result of either a mood disorder or an organic illness. Several studies have linked NMS and dopamine deficiency. This link helps explain why the deficient dopaminergic activity found in catatonic patients might be further aggravated by the dopamine blocking effects of neuroleptics. Since schizophrenia is a disease marked by increased dopamine levels, it would also explain the fact that schizophrenics who routinely take neuroleptics have a very low incidence of NMS. Results indicate that neuroleptic treatment of catatonic patients requires re-evaluation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Risk factors, Nervous system, Sympathetic, Sympathetic nervous system, Catatonia

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Is the predisposition to neuroleptic malignant syndrome genetically transmitted?

Article Abstract:

Neuroleptic malignant syndrome (NMS) is a rare but potentially fatal complication of treatment with neuroleptic (e.g. tranquilizing) medications. Symptoms include mutism or stupor, muscle rigidity or tremor, and possibly elevated blood pressure, irregular heart beat, perspiration, and painful urination. The rate of death from NMS is currently thought to be about 15 percent and is usually directly related to cardiovascular problems, kidney failure, or breathing complications. It is not yet known exactly what leads to NMS in patients taking neuroleptic medications. Genetic links have not been found, and familial NMS has not been reported. In the present paper, a 43-year-old Japanese woman and her daughters, aged 22 years and 20 years, all exhibited symptoms of NMS when treated with various dosages of neuroleptics. All suffered from schizophrenia, for which they received the neuroleptic treatment, but the specific drug that each received was different. All three patients were physically healthy. The mother and her eldest daughter had a history of muscular rigidity when treated for schizophrenia in the past. The dosage of neuroleptic that was required for NMS to appear varied from very small, subtherapeutic dosages to larger, therapeutic dosages. There were no other unusual findings. This report suggests that there is a genetic basis for NMS and that those with a history of muscular rigidity may be at increased risk. Neuroleptic treatment should be used with caution when there is family history of NMS. Even very small dosages may place a patient with a family history of NMS at risk. (Consumer Summary produced by Reliance Medical Information, Inc.)

Genetic aspects, Extrapyramidal disorders

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Carbamazepine and forme fruste neuroleptic malignant syndrome

Article Abstract:

Neuroleptics, or antipsychotics, are prescribed to moderate psychotic symptoms. When taken in excessive doses, however, they can cause neuroleptic malignant syndrome (NMS), which is characterized by fever, rigidity, instability and loss or alteration of consciousness. Clinical signs for diagnosing the condition are elevated levels of creatine kinase (CK), an enzyme in the brain, and a high white blood cell count. A case is presented of a 58-year-old woman who developed a forme fruste (incompletely manifested) case of NMS following an impulsive overdose of the antipsychotic trifluoperazine and the mood drug (also used to treat some forms of epilepsy) carbamazepine. While the accepted minimal criteria for diagnosing NMS include the presence of fever, rigidity, and elevated CK, in this case fever was absent. The authors point out that in the absence of fever, it is important to rule out other causes of elevated CK, such as a convulsion due to overdose of carbamazepine. It is possible that the combination of carbamazepine with neuroleptics contributes to NMS, and perhaps was involved in the incomplete manifestation of the condition seen in this case. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Physiological aspects, Drug interactions, Carbamazepine

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