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Neuroleptic malignant syndrome among acute psychiatric admissions in Barbados
G A Mansoor1, D O Corbin, C N Edwards
1Department of Medicine, Queen Elizabeth Hospital, Barbados.
Abstract:
The main features of the Neuroleptic Malignant Syndrome (NMS), a complication of neuroleptic therapy, are fever, muscle rigidity, autonomic dysfunction, and an alteration in consciousness level. We describe five cases of NMS comprising 0.6% of acute neuroleptically-treated admissions to a psychiatric hospital over a one-year period. All patients, four females aged 26 to 63 years, and one male, aged 65 years, were of African origin and received multiple neuroleptic drugs, at least one of which was a depot preparation. Four were being treated for functional psychiatric disorders while one had dementia. All patients had fever and depressed consciousness level while four had rigidity and autonomic dysfunction. Serum creatine phosphokinase was elevated in 4 cases, and there was indirect evidence of myoglobinuria in 3 cases suggested by a positive urine dipstick test for blood despite the absence of red cells on microscopy. Rhabdomyolysis was associated with renal failure in one case. Both bromocriptine mesylate and dantrolene sodium were given in two cases. Three patients died in hospital, one with persistent rigidity and progressive decubitus ulceration, one from peritonitis following peritoneal dialysis, and another suddenly. Early recognition of NMS is important; it should be considered in any patient on neuroleptic therapy who develops fever, rigidity or alteration in consciousness level.
Insights
Neuroleptic Malignant Syndrome (NMS) is a severe reaction to neuroleptic medications, characterized by fever and altered consciousness. Early recognition and intervention are crucial for managing this potentially fatal condition.
Area of Science:
- Neuroscience
- Pharmacology
- Clinical Medicine
Background:
- Neuroleptic Malignant Syndrome (NMS) is a rare but serious complication associated with neuroleptic drug therapy.
- It is characterized by a distinct clinical presentation including hyperthermia, muscle rigidity, autonomic instability, and altered mental status.
Observation:
- This study reports five cases of NMS (0.6% of admissions) in patients receiving neuroleptic treatment.
- The affected patients, predominantly female and of African origin, received multiple neuroleptic agents, including depot preparations.
- Common symptoms observed were fever, depressed consciousness, rigidity, and autonomic dysfunction.
Findings:
- Elevated serum creatine phosphokinase and evidence of myoglobinuria were noted in most cases.
- Rhabdomyolysis and subsequent renal failure occurred in one patient.
- Treatment involved bromocriptine mesylate and dantrolene sodium, with three patients unfortunately succumbing to the condition.
Implications:
- The findings underscore the importance of prompt recognition of NMS in patients on neuroleptic therapy presenting with fever, rigidity, or altered consciousness.
- Awareness of NMS risk factors and clinical signs is vital for timely diagnosis and management to improve patient outcomes.
- Further research into NMS pathophysiology and optimal treatment strategies is warranted.