What are the signs and symptoms of neuroleptic malignant syndrome?
Symptoms of neuroleptic malignant syndrome usually include very high fever (102 to 104 degrees F), irregular pulse, accelerated heartbeat (tachycardia), increased rate of respiration (tachypnea), muscle rigidity, altered mental status, autonomic nervous system dysfunction resulting in high or low blood pressure.
What are the complications of neuroleptic malignant syndrome?
Complications of neuroleptic malignant syndrome include dehydration from poor oral intake, acute renal failure from rhabdomyolysis, and deep venous thrombosis and pulmonary embolism from rigidity and immobilization. Avoiding antipsychotics can cause complications related to uncontrolled psychosis.
Which drug causes neuroleptic malignant syndrome?
The primary trigger of NMS is dopamine receptor blockade and the standard causative agent is an antipsychotic. Potent typical neuroleptics such as haloperidol, fluphenazine, chlorpromazine, trifluoperazine, and prochlorperazine have been most frequently associated with NMS and thought to confer the greatest risk.
Can antidepressants cause neuroleptic malignant syndrome?
Like NMS, SS often occurs when beginning a new drug or increasing the dosage of a current drug. Many drugs can cause the condition, but it’s most often associated with antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs).
How do you manage a patient who develops neuroleptic malignant syndrome while on an atypical antipsychotic?
Treatment of patients with neuroleptic malignant syndrome may include the following:
- Benzodiazepines for restraint may be useful.
- Stop all neuroleptics.
- Correct volume depletion and hypotension with intravenous fluids.
- Reduce hyperthermia.
How do you test for neuroleptic malignant syndrome?
No laboratory test result is diagnostic for neuroleptic malignant syndrome (NMS)….Approach Considerations
- Complete blood count (CBC)
- Blood cultures.
- Liver function tests (LFTs)
- Blood urea nitrogen (BUN) and creatinine levels.
- Calcium and phosphate levels.
- Creatine kinase (CK) level.
- Serum iron level.
- Urine myoglobin level.
Can SSRI cause NMS?
SSRIs may cause NMS by their facilitative action on neurotransmitter serotonin along with central dopaminergic blockade. Addition of SSRI to second-generation antipsychotic is also reported to increase the risk of NMS by inhibiting dopamine release by SSRIs.
Is SSRI a neuroleptic?
Neuroleptic (NL) or antipsychotic drugs and selective serotonin reuptake inhibitors (SSRIs) are frequently used to treat neuropsychiatric disorders.
How can you tell the difference between serotonin syndrome and neuroleptic malignant syndrome?
NMS and serotonin syndrome are rare, but potentially life-threatening, medicine-induced disorders. Features of these syndromes may overlap making diagnosis difficult. However, NMS is characterised by ‘lead-pipe’ rigidity, whilst serotonin syndrome is characterised by hyperreflexia and clonus.