[Malignant neuroleptic syndrome after haloperidol administration]
M U Gerbershagen1, W D Ito, F Wappler
1Klinik für Anästhesiologie, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg. gerbershagen@uke.uni-hamburg.de
Abstract:
The neuroleptic malignant syndrome (NMS) is a rare complication of antipsychotic therapy. We report on a 65-year-old patient who was treated with haloperidol, diazepam and mirtazapin because of a severe depressive episode with psychotic symptoms. He exhibited most of the signs and symptoms characteristic of NMS, e.g.: hyperthermia, rigidity, elevated creatine phosphokinase, leukocytosis, elevated liver enzymes, reduced consciousness and autonomic nervous system disturbances. A secondary pneumonia was diagnosed 2 days after the onset of the NMS, which might have been due to chest wall rigidity. Intensive care treatment consisted of immediate discontinuation of the offending agent, supportive therapy with rehydratation and catecholamines as well as application of dantrolen. After 23 days of intensive therapy all pathological parameters were normalised and the patient was transferred to an internal ward. Three main theories on the pathogenesis of NMS exist: 1. blockade of central receptors, 2. a skeletal muscle target model and 3. sympathoadrenal hyperactivity. The differential diagnosis includes among others malignant hyperthermia and serotonin syndrome.
Insights
Neuroleptic Malignant Syndrome (NMS) is a rare antipsychotic complication. This case highlights NMS symptoms, intensive care, and recovery, emphasizing differential diagnosis for patient safety.
Area of Science:
- Neuroscience
- Pharmacology
- Critical Care Medicine
Background:
- Neuroleptic Malignant Syndrome (NMS) is a rare but life-threatening complication associated with antipsychotic medications.
- Early recognition and prompt management are crucial for patient outcomes.
Observation:
- A 65-year-old patient developed NMS during treatment for a severe depressive episode with psychotic symptoms, exhibiting hyperthermia, rigidity, elevated creatine phosphokinase, leukocytosis, liver enzymes, reduced consciousness, and autonomic disturbances.
- The patient also developed secondary pneumonia, potentially linked to chest wall rigidity.
Findings:
- Intensive care involved immediate discontinuation of the causative agent, supportive therapy (rehydration, catecholamines), and dantrolene administration.
- The patient recovered fully after 23 days of intensive treatment, with normalization of all pathological parameters.
Implications:
- This case underscores the importance of recognizing NMS symptoms and initiating prompt, intensive care.
- Understanding NMS pathogenesis theories and differential diagnoses, including malignant hyperthermia and serotonin syndrome, is vital for effective clinical management.
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