Neuroleptic Malignant Syndrome, a Sequalae of Multiple Administration of Antipsychotics: A Case Report

Nervana Abdelfattah Hafez Elbakary; Mohamed Adil Shah Khoodoruth

doi:doi:10.11648/j.ajpn.20190704.12

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Neuroleptic Malignant Syndrome, a Sequalae of Multiple Administration of Antipsychotics: A Case Report

Nervana Abdelfattah Hafez Elbakary, Mohamed Adil Shah Khoodoruth

Published in American Journal of Psychiatry and Neuroscience (Volume 7, Issue 4)

Received: 21 September 2019 Accepted: 9 October 2019 Published: 5 November 2019

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Abstract

Neuroleptic malignant syndrome (NMS) is a lethal adverse drug reaction (ADR) that is often attributed to the administration of dopamine blockers, antiemetic agents as well as anti-parkinsonism medication withdrawal. We describe a challenging case of NMS, with malignant catatonia as a differential diagnosis, who was difficult to respond to treatment. The patient developed severe complications following her exposure to rapid titration using high doses of olanzapine, which was abruptly converted to chlorpromazine due to lack of efficacy, in addition to administering multiple as needed (PRN) medications for agitation. Hyperthermia, muscle rigidity, dysautonomia, mental status changes, catatonia, and some laboratory derangement were reported in this case. It is possible that factors such as naïve patients, high doses of neuroleptics, a switch from one agent to another, rapid escalation, and the increased use of parenteral therapy for managing of agitation acted collectively or individually as risk factors for developing NMS. Health care professionals should be cautious about the cumulative dose of antipsychotics used per day, including PRN medications. The delay in recognizing the early symptoms of NMS could put patients at higher risk of mortality. Lastly, it is pivotal to exclude other infectious or autoimmune etiologies before treating as NMS case.

Published in	American Journal of Psychiatry and Neuroscience (Volume 7, Issue 4)
DOI	10.11648/j.ajpn.20190704.12
Page(s)	83-87
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2019. Published by Science Publishing Group

Keywords

Malignant, Adverse Drug Reaction (ADR), Dopamine Blockers, Hyperthermia, Catatonia, Neuroleptics

References

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Nervana Abdelfattah Hafez Elbakary, Mohamed Adil Shah Khoodoruth. (2019). Neuroleptic Malignant Syndrome, a Sequalae of Multiple Administration of Antipsychotics: A Case Report. American Journal of Psychiatry and Neuroscience, 7(4), 83-87. https://doi.org/10.11648/j.ajpn.20190704.12

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ACS Style

Nervana Abdelfattah Hafez Elbakary; Mohamed Adil Shah Khoodoruth. Neuroleptic Malignant Syndrome, a Sequalae of Multiple Administration of Antipsychotics: A Case Report. Am. J. Psychiatry Neurosci. 2019, 7(4), 83-87. doi: 10.11648/j.ajpn.20190704.12

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AMA Style

Nervana Abdelfattah Hafez Elbakary, Mohamed Adil Shah Khoodoruth. Neuroleptic Malignant Syndrome, a Sequalae of Multiple Administration of Antipsychotics: A Case Report. Am J Psychiatry Neurosci. 2019;7(4):83-87. doi: 10.11648/j.ajpn.20190704.12

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@article{10.11648/j.ajpn.20190704.12,
  author = {Nervana Abdelfattah Hafez Elbakary and Mohamed Adil Shah Khoodoruth},
  title = {Neuroleptic Malignant Syndrome, a Sequalae of Multiple Administration of Antipsychotics: A Case Report},
  journal = {American Journal of Psychiatry and Neuroscience},
  volume = {7},
  number = {4},
  pages = {83-87},
  doi = {10.11648/j.ajpn.20190704.12},
  url = {https://doi.org/10.11648/j.ajpn.20190704.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajpn.20190704.12},
  abstract = {Neuroleptic malignant syndrome (NMS) is a lethal adverse drug reaction (ADR) that is often attributed to the administration of dopamine blockers, antiemetic agents as well as anti-parkinsonism medication withdrawal. We describe a challenging case of NMS, with malignant catatonia as a differential diagnosis, who was difficult to respond to treatment. The patient developed severe complications following her exposure to rapid titration using high doses of olanzapine, which was abruptly converted to chlorpromazine due to lack of efficacy, in addition to administering multiple as needed (PRN) medications for agitation. Hyperthermia, muscle rigidity, dysautonomia, mental status changes, catatonia, and some laboratory derangement were reported in this case. It is possible that factors such as naïve patients, high doses of neuroleptics, a switch from one agent to another, rapid escalation, and the increased use of parenteral therapy for managing of agitation acted collectively or individually as risk factors for developing NMS. Health care professionals should be cautious about the cumulative dose of antipsychotics used per day, including PRN medications. The delay in recognizing the early symptoms of NMS could put patients at higher risk of mortality. Lastly, it is pivotal to exclude other infectious or autoimmune etiologies before treating as NMS case.},
 year = {2019}
}

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TY  - JOUR
T1  - Neuroleptic Malignant Syndrome, a Sequalae of Multiple Administration of Antipsychotics: A Case Report
AU  - Nervana Abdelfattah Hafez Elbakary
AU  - Mohamed Adil Shah Khoodoruth
Y1  - 2019/11/05
PY  - 2019
N1  - https://doi.org/10.11648/j.ajpn.20190704.12
DO  - 10.11648/j.ajpn.20190704.12
T2  - American Journal of Psychiatry and Neuroscience
JF  - American Journal of Psychiatry and Neuroscience
JO  - American Journal of Psychiatry and Neuroscience
SP  - 83
EP  - 87
PB  - Science Publishing Group
SN  - 2330-426X
UR  - https://doi.org/10.11648/j.ajpn.20190704.12
AB  - Neuroleptic malignant syndrome (NMS) is a lethal adverse drug reaction (ADR) that is often attributed to the administration of dopamine blockers, antiemetic agents as well as anti-parkinsonism medication withdrawal. We describe a challenging case of NMS, with malignant catatonia as a differential diagnosis, who was difficult to respond to treatment. The patient developed severe complications following her exposure to rapid titration using high doses of olanzapine, which was abruptly converted to chlorpromazine due to lack of efficacy, in addition to administering multiple as needed (PRN) medications for agitation. Hyperthermia, muscle rigidity, dysautonomia, mental status changes, catatonia, and some laboratory derangement were reported in this case. It is possible that factors such as naïve patients, high doses of neuroleptics, a switch from one agent to another, rapid escalation, and the increased use of parenteral therapy for managing of agitation acted collectively or individually as risk factors for developing NMS. Health care professionals should be cautious about the cumulative dose of antipsychotics used per day, including PRN medications. The delay in recognizing the early symptoms of NMS could put patients at higher risk of mortality. Lastly, it is pivotal to exclude other infectious or autoimmune etiologies before treating as NMS case.
VL  - 7
IS  - 4
ER  -

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Author Information

Nervana Abdelfattah Hafez Elbakary

Mental Health Hospital, Hamad Medical Corporation, Doha, Qatar
Mohamed Adil Shah Khoodoruth

Mental Health Hospital, Hamad Medical Corporation, Doha, Qatar

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APA Style

Nervana Abdelfattah Hafez Elbakary, Mohamed Adil Shah Khoodoruth. (2019). Neuroleptic Malignant Syndrome, a Sequalae of Multiple Administration of Antipsychotics: A Case Report. American Journal of Psychiatry and Neuroscience, 7(4), 83-87. https://doi.org/10.11648/j.ajpn.20190704.12

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ACS Style

Nervana Abdelfattah Hafez Elbakary; Mohamed Adil Shah Khoodoruth. Neuroleptic Malignant Syndrome, a Sequalae of Multiple Administration of Antipsychotics: A Case Report. Am. J. Psychiatry Neurosci. 2019, 7(4), 83-87. doi: 10.11648/j.ajpn.20190704.12

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AMA Style

Nervana Abdelfattah Hafez Elbakary, Mohamed Adil Shah Khoodoruth. Neuroleptic Malignant Syndrome, a Sequalae of Multiple Administration of Antipsychotics: A Case Report. Am J Psychiatry Neurosci. 2019;7(4):83-87. doi: 10.11648/j.ajpn.20190704.12

Copy | Download

@article{10.11648/j.ajpn.20190704.12,
  author = {Nervana Abdelfattah Hafez Elbakary and Mohamed Adil Shah Khoodoruth},
  title = {Neuroleptic Malignant Syndrome, a Sequalae of Multiple Administration of Antipsychotics: A Case Report},
  journal = {American Journal of Psychiatry and Neuroscience},
  volume = {7},
  number = {4},
  pages = {83-87},
  doi = {10.11648/j.ajpn.20190704.12},
  url = {https://doi.org/10.11648/j.ajpn.20190704.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajpn.20190704.12},
  abstract = {Neuroleptic malignant syndrome (NMS) is a lethal adverse drug reaction (ADR) that is often attributed to the administration of dopamine blockers, antiemetic agents as well as anti-parkinsonism medication withdrawal. We describe a challenging case of NMS, with malignant catatonia as a differential diagnosis, who was difficult to respond to treatment. The patient developed severe complications following her exposure to rapid titration using high doses of olanzapine, which was abruptly converted to chlorpromazine due to lack of efficacy, in addition to administering multiple as needed (PRN) medications for agitation. Hyperthermia, muscle rigidity, dysautonomia, mental status changes, catatonia, and some laboratory derangement were reported in this case. It is possible that factors such as naïve patients, high doses of neuroleptics, a switch from one agent to another, rapid escalation, and the increased use of parenteral therapy for managing of agitation acted collectively or individually as risk factors for developing NMS. Health care professionals should be cautious about the cumulative dose of antipsychotics used per day, including PRN medications. The delay in recognizing the early symptoms of NMS could put patients at higher risk of mortality. Lastly, it is pivotal to exclude other infectious or autoimmune etiologies before treating as NMS case.},
 year = {2019}
}

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TY  - JOUR
T1  - Neuroleptic Malignant Syndrome, a Sequalae of Multiple Administration of Antipsychotics: A Case Report
AU  - Nervana Abdelfattah Hafez Elbakary
AU  - Mohamed Adil Shah Khoodoruth
Y1  - 2019/11/05
PY  - 2019
N1  - https://doi.org/10.11648/j.ajpn.20190704.12
DO  - 10.11648/j.ajpn.20190704.12
T2  - American Journal of Psychiatry and Neuroscience
JF  - American Journal of Psychiatry and Neuroscience
JO  - American Journal of Psychiatry and Neuroscience
SP  - 83
EP  - 87
PB  - Science Publishing Group
SN  - 2330-426X
UR  - https://doi.org/10.11648/j.ajpn.20190704.12
AB  - Neuroleptic malignant syndrome (NMS) is a lethal adverse drug reaction (ADR) that is often attributed to the administration of dopamine blockers, antiemetic agents as well as anti-parkinsonism medication withdrawal. We describe a challenging case of NMS, with malignant catatonia as a differential diagnosis, who was difficult to respond to treatment. The patient developed severe complications following her exposure to rapid titration using high doses of olanzapine, which was abruptly converted to chlorpromazine due to lack of efficacy, in addition to administering multiple as needed (PRN) medications for agitation. Hyperthermia, muscle rigidity, dysautonomia, mental status changes, catatonia, and some laboratory derangement were reported in this case. It is possible that factors such as naïve patients, high doses of neuroleptics, a switch from one agent to another, rapid escalation, and the increased use of parenteral therapy for managing of agitation acted collectively or individually as risk factors for developing NMS. Health care professionals should be cautious about the cumulative dose of antipsychotics used per day, including PRN medications. The delay in recognizing the early symptoms of NMS could put patients at higher risk of mortality. Lastly, it is pivotal to exclude other infectious or autoimmune etiologies before treating as NMS case.
VL  - 7
IS  - 4
ER  -

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