INTRODUCTION Neuroleptic malignant syndrome (NMS) is a life-threatening neurologic emergency associated with the use of antipsychotic (neuroleptic) agents and characterized by a distinctive clinical syndrome of mental status change, rigidity, fever, and dysautonomia.
How is neuroleptic malignant diagnosed?
The diagnosis is confirmed by the presence of recent treatment with neuroleptics (within the past 1-4 weeks), hyperthermia (temperature above 38°C), and muscular rigidity, along with at least five of the following features: Change in mental status Tachycardia. Hypertension or hypotension. Diaphoresis or sialorrhea.
How can you prevent neuroleptic malignant syndrome?
The most important aspect of treatment is prevention. This includes reducing risk factors (e.g. dehydration, agitation and exhaustion), early recognition of suspected cases and prompt discontinuation of the offending agent.
How do you manage neuroleptic syndrome?
Nonpharmacologic management centers on aggressive supportive care including vigilant nursing, physical therapy, cooling, rehydration, anticoagulation. Pharmacologic interventions include immediate discontinuation of antipsychotics, judicious use of anticholinergics, and adjunctive benzodiazepines.
How common is neuroleptic malignant syndrome?
NMS is very rare. Only about 1 to 2 out of every 10,000 people who take antipsychotic drugs get it.
How long does neuroleptic malignant syndrome last?
In patients who develop neuroleptic malignant syndrome after taking an oral agent, the syndrome may last 7-10 days after discontinuation of the drug. In those who have received depot neuroleptics (eg, fluphenazine), the syndrome may last up to a month.
Why is NMS a medical emergency?
Neuroleptic malignant syndrome (NMS) is a lethal medical emergency associated with the use of neuroleptic agents and antiemetics that is characterized by a typical clinical syndrome of hyperthermia, rigidity, mental status alteration, and dysautonomia.
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.
What is the difference between neuroleptic malignant syndrome and malignant hyperthermia?
Malignant hyperthermia is extremely rare in the postoperative setting, and serotonin syndrome has a faster onset and neuromuscular hyperactivity while neuroleptic malignant syndrome has a slower onset and neuromuscular hypoactivity.
How do antipsychotics cause tardive dyskinesia?
Tardive dyskinesia is often a side effect of antipsychotic drugs. These drugs work to block dopamine, which is a chemical in the brain that helps control muscle movement. Most of the time, tardive dyskinesia only occurs if a person has taken these medications for a long time.
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.
What is a serious side effect of neuroleptic medication?
Side effects of antipsychotics can include the following.
- Uncontrollable movements of the jaw, lips and tongue. This is known as tardive dyskinesia. …
- Uncomfortable restlessness, known as akathisia.
- Sexual problems due to hormonal changes.
- Sedation. …
- Weight gain.
- A higher risk of getting diabetes.
- Constipation.
- Dry mouth.
What can be mistaken for malignant hyperthermia?
In addition to the conditions listed in the differential diagnosis, there are a number of other conditions and circumstances that may mimic malignant hyperthermia (MH), including the following: Contrast dye. Diabetic coma. Drug toxicity.
How is serotonin syndrome different from 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.
What are the symptoms of serotonin syndrome?
Symptoms
- Agitation or restlessness.
- Confusion.
- Rapid heart rate and high blood pressure.
- Dilated pupils.
- Loss of muscle coordination or twitching muscles.
- Muscle rigidity.
- Heavy sweating.
- Diarrhea.
When should I restart antipsychotic after NMS?
Approximately 2 weeks after resolution of NMS, treatment with a low-potency atypical antipsychotic should be initiated at a low dose and slowly titrated in a monitored setting with careful assessment for signs of recurrent NMS.
Which of the following increases the risk for neuroleptic malignant syndrome NMS )?
One of the clearest risk factors in the development of NMS is the course of drug therapy chosen to treat a condition. Use of high-potency neuroleptics, a rapid increase in the dosage of neuroleptics, and use of long-acting forms of neuroleptics are all known to increase the risk of developing NMS.
Can Abilify cause neuroleptic malignant syndrome?
A recent systematic review indicated that aripiprazole-induced neuroleptic malignant syndrome occurs after treatment with a mean dose of 18.9 mg and has a symptom duration of approximately 7.5 days.
What does dantrolene treat?
Dantrolene is used to treat spasticity (muscle stiffness and tightness) or muscle spasms associated with spinal cord injuries, stroke, multiple sclerosis, or cerebral palsy.
Is neuroleptic malignant syndrome a extrapyramidal symptoms?
Antipsychotic medications commonly produce extrapyramidal symptoms as side effects. The extrapyramidal symptoms include acute dyskinesias and dystonic reactions, tardive dyskinesia, Parkinsonism, akinesia, akathisia, and neuroleptic malignant syndrome.
What is the mechanism of action of dantrolene?
Dantrolene depresses excitation-contraction coupling in skeletal muscle by binding to the ryanodine receptor 1, and decreasing intracellular calcium concentration. Ryanodine receptors mediate the release of calcium from the sarcoplasmic reticulum, an essential step in muscle contraction.
Which symptoms does a nurse expect to find in a patient that develops neuroleptic malignant syndrome after being administered antipsychotic drugs?
Neuroleptic malignant syndrome is a rare, life threatening adverse effect of antipsychotics which occurs in <1% of patients. Symptoms include confusion, fever, extreme muscle stiffness, and sweating. If any of these symptoms occur, contact your healthcare provider immediately.
What does tardive dyskinesia look like?
Tardive dyskinesia is characterized by involuntary and abnormal movements of the jaw, lips and tongue. Typical symptoms include facial grimacing, sticking out the tongue, sucking or fish-like movements of the mouth.