Neuroleptic malignant syndrome (NAIS) is arare, potentially life-threatening disorder that results from the use of neuroleptics, a class of drugs that is being used with increasing frequency in intensive care units (ICUs). Unfortunately, critically ill patients typically have coexisting conditions that make accurate diagnosis of NAIS difficult and complicate treatment decisions. Diagnostic criteria, risk factors, and treatment options for NMS are discussed; case examples are provided.
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References
1.
KeckPEMcElroySLPopeHG.Epidemiology of neuroleptic malignant syndrome. Psychiatr Ann1991;21: 148–151.
2.
ShalevAHermeshHMunitzH.Mortality from neuroleptic malignant syndrome. J Clin Psychiatry1989;50: 18–25.
3.
NierenbergDDischMManheimerEFacilitating prompt diagnosis and treatment of the neuroleptic malignant syndrome. Clin Pharmacol Ther1991;50: 580–586.
4.
DelayJDenikerP.Drug-induced extrapyramidal syndromes. In: VinkenPJBruynGW, eds. Handbook of clinical neurology: diseases of the basal ganglia, Vol. 6. Amsterdam: North Holland, 1968:248–266.
5.
AddonizioGSusmanVLRothSD.Symptoms of neuroleptic malignant syndrome in 82 consecutive inpatients. Am J Psychiatry1986;143: 1587–1590.
PopeHGKeckPEMcElroySL.Frequency and presentation of neuroleptic malignant syndrome in a large psychiatric hospital. Am J Psychiatry1986;143: 1227–1233.
8.
LevensonJL.Neuroleptic malignant syndrome. Am J Psychiatry1985;142: 1137–1145.
9.
GurreraRJChangSSRomeroJAA comparison of diagnostic criteria for neuroleptic malignant syndrome. J Clin Psychiatry1992;53: 56–61.
10.
AdityanjeeSinghSSinghGOngS.Spectrum concept of neuroleptic malignant syndrome. Br J Psychiatry1988;153: 107–111.
11.
ClarkCEShandDYuillGMGreenMHP.Clinical spectrum of neuroleptic malignant syndrome (letter). Lancet1988;2: 969–970.
12.
DowlingJJPatrickV.Delirium with dystonia: a variant of neuroleptic malignant syndrome? (letter). Am J Psychiatry1989;146: 276–277.
13.
WalkerWD.Spectrum concept of the neuroleptic malignant syndrome (letter). Br J Psychiatry1988;153:579.
14.
MannSCCaroffSNLazarusA.Pathogenesis of the neuroleptic malignant syndrome. Psychiatr Ann1991;2: 175–180.
MartinDTSwashM.Muscle pathology in the neuroleptic malignant syndrome. J Neurol1987;235: 120–121.
17.
MontgomeryJNIronsideJW.Neuroleptic malignant syndrome in the intensive therapy unit. Anaesthesia1990;45: 311–313.
18.
KumagaiHOnoyamaKWashioMA case of neuroleptic malignant syndrome with acute renal failure effectively treated with dantrolene. Curr Ther Res1987;42: 889–894.
19.
BacaLMartinelliL.Neuroleptic malignant syndrome: a unique association with a tricyclic antidepressant. Neurology1990;40: 1797–1798.
20.
BrennanDMacManusMHoweJMcLoughlinJ.“Neuroleptic malignant syndrome” without neuroleptics. Br J Psychiatry1988; 152:578–579.
21.
GrantRE.Neuroleptic malignant syndrome (letter). Br Med J1984;288:1690.
22.
KoehlerPJMirandolleJF.Neuroleptic malignant-like syndrome and lithium. Lancet1988;2: 1499–1500.
23.
BamrahJS.Neuroleptic-induced pyrexia: a benign variant?J Nerv Ment Dis1988;176: 741–743.
HermeshHAizenbergDLapidotMMunitzH.Risk of malignant hyperthermia among patients with neuroleptic malignant syndrome and their families. Am J Psychiatry1988;145: 1431–1434.
33.
SternbachH.The serotonin syndrome. Am J Psychiatry1991;148: 705–713.
34.
SternTASchwartzJHShusterJL.Catastrophic illness associated with the combination of clomipramine, phenelzine, and chlorpromazine. Ann Clin Psychiatry1992;4: 81–85.
35.
DengMZChenGQPhillipsMR.Neuroleptic malignant syndrome in 12 of 9,792 chinese inpatients exposed to neuroleptics: a prospective study. Am J Psychiatry1990;147: 91149–1155.
36.
KeckPEPopeHGCohenBMRisk factors for neuroleptic malignant syndrome. Arch Gen Psychiatry1989;46: 914–918.
37.
GelenbergAJBellinghausenBWojcikJDA prospective survey of neuroleptic malignant syndrome in a short-term psychiatric hospital. Am J Psychiatry1988;145: 517–518.
38.
LevittAJMidhaRCravenJL.Neuroleptic malignant syndrome with intravenous haloperidol (letter). Can J Psychiatry1990; 35:789.
39.
PatelPBristowG.Postoperative neuroleptic malignant syndrome: a case report. Can J Anaesth1987;34: 515–518.
40.
RosebushPIStewartTDGelenbergAJ.Twenty neuroleptic rechallenges after neuroleptic malignant syndrome in 15 patients. J Clin Psychiatry1989;50: 295–298.
41.
SusmanVLAddonizioG.Recurrence of neuroleptic malignant syndrome. J Nerv Ment Dis1988;176: 234–241.
42.
NisijimaKIshiguroT.Does dantrolene influence central dopamine and serotonin metabolism in the neuroleptic malignant syndrome? A retrospective 'study. Biol Psychiatry1993;33: 45–48.
43.
GoekeJEHaganDSGoelzerSLCoursinDB.Lethal catatonia complicated by the development of neuroleptic malignant syndrome in a middle-aged female. Crit Care Med1991; 19:1445–1448.
44.
RosebushPIStewartTD.A prospective analysis of 24 episodes of neuroleptic malignant syndrome. Am J Psychiatry1989; 146:717–725.
45.
RosebushPIStewartTDMazurekMF.The treatment of neuroleptic malignant syndrome: are dantrolene and bromo-criptine useful adjuncts to supportive care?Br J Psychiatry1991;159: 709–712.
46.
SakkasPDavisJMHuaJWangZPharmacotherapy of neuroleptic malignant syndrome. Psychiatr Ann1991;21: 157–164.
47.
ShaderRIGreenblattDJ.A possible new approach to the treatment of neuroleptic malignant syndrome (editorial). Psychopharmacology1992;12:155.