1/17. Neuroleptic-induced acute respiratory distress syndrome.CONTEXT: A case of neuroleptic malignant syndrome and acute respiratory distress syndrome is presented and discussed with emphasis on the role of muscle relaxation, creatine kinase, and respiratory function tests. CASE REPORT: A 41-year-old man presented right otalgia and peripheral facial paralysis. A computed tomography scan of the skull showed a hyperdense area, 2 cm in diameter, in the pathway of the anterior intercommunicating cerebral artery. Preoperative examination revealed: pH 7.4, PaCO2 40 torr, PaO2 80 torr (room air), Hb 13.8 g/dl, blood urea nitrogen 3.2 mmol/l, and creatinine 90 mmol/l. The chest x-ray was normal. The patient had not eaten during the 12-hour period prior to anesthesia induction. Intravenous halothane, fentanyl 0.5 mg and droperidol 25 mg were used for anesthesia. After the first six hours, the PaO2 was 65 torr (normal PaCO2) with FiO2 50% (PaO2/FiO2 130), and remained at this level until the end of the operation 4 hours later, maintaining PaCO2 at 35 torr. A thrombosed aneurysm was detected and resected, and the ends of the artery were closed with clips. No vasospasm was present. This case illustrates that neuroleptic drugs can cause neuroleptic malignant syndrome associated with acute respiratory distress syndrome. neuroleptic malignant syndrome is a disease that is difficult to diagnose. Acute respiratory distress syndrome is another manifestation of neuroleptic malignant syndrome that has not been recognized in previous reports: it may be produced by neuroleptic drugs independent of the manifestation of neuroleptic malignant syndrome. Some considerations regarding the cause and effect relationship between acute respiratory distress syndrome and neuroleptic drugs are discussed. intensive care unit physicians should consider the possibility that patients receiving neuroleptic drugs could develop respiratory failure in the absence of other factors that might explain the syndrome.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/17. neuroleptic malignant syndrome: case report and discussion.We report a case involving an 81-tear-old man with schizoaffective disorder who presented with neuroleptic malignant syndrome (NMS) after an increase in his neuroleptic dose. NMS, a rare but potentially fatal complication of neuroleptic medications (e.g., antipsychotics, sedatives and antinauseants), is characterized by hyperthermia, muscle rigidity, an elevated creatine kinase level and autonomic instability. The syndrome often develops after a sudden increase in dosage of the neuroleptic medication or in states of dehydration. Treatment is mainly supportive and includes withdrawal of the neuroleptic medication and, possibly, administration of drugs such as dantrolene and bromocriptine. Complications of NMS include acute renal failure and acute respiratory failure. Given the widespread prescription of neuroleptics by physicians in a variety of fields, all physicians need to be able to recognize and appropriately manage NMS.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
3/17. neuroleptic malignant syndrome associated with ziprasidone in an adolescent.BACKGROUND: neuroleptic malignant syndrome (NMS) is a rare but potentially fatal disorder characterized by fever, muscular rigidity, delirium, and autonomic instability. Although the classic presentation of NMS has been most commonly associated with the typical neuroleptic medications, sporadic cases in association with atypical neuroleptic medications have been reported. OBJECTIVE: We describe a case report of a pediatric patient with NMS associated with the use of the atypical antipsychotic medication ziprasidone hydrochloride. methods: After a medline search of relevant literature (key terms: atypical antipsychotic, ziprasidone, neuroleptic malignant syndrome, and NMS; years: 1995-2004), no reports of NMS in association with ziprasidone in the pediatric population were identified. RESULTS: The patient was a 15-year-old male adolescent with a history of schizoaffective disorder treated with ziprasidone capsules, 80 mg QD for 8 weeks prior to presentation. He was brought to the emergency department because the family noted that the child had a tactile fever; was rigid, diaphoretic, tremulous, and difficult to arouse; and had persistent urinary incontinence. The patient was admitted to the pediatric intensive care unit, where he remained rigid and unresponsive except for incoherent speech. He was treated for a presumptive diagnosis of NMS with IV dantrolene sodium (2 mg/kg q6h) to reduce the sequele of NMS; urinary alkalinization with sodium bicarbonate to maintain a urinary pH of 6.5 to 7.0; cardiac, pulse oximetry, and vital sign monitoring; and supportive care, including IV saline hydration. CONCLUSION: We present this case to alert physicians of the possibility of NMS in adolescent patients treated with ziprasidone.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/17. neuroleptic malignant syndrome.neuroleptic malignant syndrome is a relatively uncommon life-threatening disorder. The widespread use of the neuroleptic and psychotropic medications, however, makes it important for the primary care physician to understand the clinical presentation, differential diagnosis, and management of neuroleptic malignant syndrome. Early recognition should be possible. Rapid diagnosis followed by aggressive supportive care and specific pharmacologic therapy can be life saving.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/17. neuroleptic malignant syndrome: life-threatening complication of neuroleptic treatment in adolescents with affective disorder.neuroleptic malignant syndrome (NMS) is an uncommon, potentially fatal side effect of neuroleptic treatment characterized by hyperthermia, rigidity, rhabdomyolysis, and delirium. In recent clinical studies of adults it was suggested that affective disorder is a risk factor for the development of neuroleptic malignant syndrome. The cases of two adolescents with neuroleptic malignant syndrome who were treated with neuroleptic therapy because of psychotic symptoms in association with primary affective disorders are reported. The occurrence of these cases, as well as the observations in adults, suggests that attention to the primary psychiatric diagnosis is important in neuroleptic usage and that physicians should be vigilant to the occurrence of neuroleptic malignant syndrome in the pediatric population.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/17. neuroleptic malignant syndrome in Parkinson's disease after withdrawal or alteration of dopaminergic therapy.neuroleptic malignant syndrome is characterized by altered consciousness, fever, extrapyramidal signs, autonomic instability, elevated creatine kinase level, and leukocytosis. Although originally described in patients receiving neuroleptic drugs, this syndrome may also occur in patients with Parkinson's disease during withdrawal or reduction of levodopa therapy or other dopaminergic drug therapy. We have encountered three cases of neuroleptic malignant syndrome related to withdrawal of levodopa therapy. These cases illustrate the variety of circumstances in which alteration of therapy with dopaminergic drugs can cause this syndrome and the relative unfamiliarity of the neuroleptic malignant syndrome-levodopa relationship among physicians who do not treat large numbers of patients with Parkinson's disease. An understanding of the role of brain dopamine in the pathogenesis of neuroleptic malignant syndrome and an appreciation of the great variety of drugs whose manipulation can result in this potentially fatal syndrome will aid its proper and timely recognition, especially when the offending pharmacologic manipulation does not involve neuroleptic drugs.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/17. A case report of neuroleptic malignant syndrome without fever in a patient given aripiprazole.neuroleptic malignant syndrome (NMS) is a rare disorder seen most often in patients exposed to antipsychotic medications. This syndrome is generally manifested by hyperthermia, muscle rigidity, autonomic instability, altered mental status, tremors, elevated serum creatinine phosphokinase and leucocytosis. It was first described by Delay during the 1960s. It is considered a medical emergency and is fatal if not promptly addressed. It is clinically relevant not only to psychiatrists but all clinicians since patients taking neuroleptics are seen by physicians from virtually every specialty. Relevant studies report a mortality rate of 10-20%. Conditions that share some features of NMS but have different treatment regimens include serotonergic syndrome, lethal catatonia, malignant hyperthermia, infections and various heat disorders. The importance of recognition and prompt intervention can not be overemphasized. fever is a predominant symptom in NMS. The authors present an unusual case of NMS in a schizophrenic patient without fever who had been on aripiprazole. To date, there are only three possible reported cases of NMS related to aripiprazole. This case report serves to remind clinicians of the essential features in the diagnosis and management of NMS.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/17. A hazardous side effect of neuroleptics: diagnosis and treatment.neuroleptic malignant syndrome (NMS) is a potentially fatal disease process characterized by hyperthermia, altered mental status, muscular rigidity, and autonomic instability. This syndrome is most often seen in patients who are taking neuroleptics and other psychoactive medications. Primary care physicians are often the first providers to see patients with this syndrome and must be alert to its potential diagnosis. Treatment should be immediate and consists of discontinuing the neuroleptic medication; supporting pulmonary, cardiovascular, and renal functions, and using bromocriptine and/or dantrolene.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/17. neuroleptic malignant syndrome associated with clozapine use.clozapine, an atypical antipsychotic drug, is indicated for severely ill schizophrenic patients refractory to treatment with conventional neuroleptics. One advertised advantage of clozapine is the absence of associated neuroleptic malignant syndrome (NMS). On the basis of a clinical case, the authors question this claim. They are concerned that this potentially fatal condition may be misdiagnosed if physicians are not aware of possible NMS associated with the use of clozapine.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/17. neuroleptic malignant syndrome: recognizing an unrecognized killer.NMS has been with us for years as an often unrecognized entity. nurses ask why there are "more of these cases" when what might be happening is that NMS is being discovered for what it is. There have been cases where the authors are convinced that the "pneumonia" or "urinary tract infection" was in fact a mild case of NMS that cleared. Probably some of the "sudden deaths" that have been reported in the past with neuroleptics are the results of undiagnosed NMS. Any patient with a fever, fluctuating vital signs, and signs of difficulty with moving should be considered as a possible case of NMS. All nurses and physicians need to be aware of the possibility, but those who work with psychiatric patients must not forget this potentially life-threatening problem.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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