Related Experiment Video
Updated: Jul 11, 2026
Handwriting Analysis Indicates Spontaneous Dyskinesias in Neuroleptic Naïve Adolescents at High Risk for Psychosis
Published on: November 21, 2013
[Malignant neuroleptic syndrome associated with amisulpride]
C Harter1, C Obier, K-F Druschky
1Klinik für Psychiatrie und Psychotherapeutische Medizin, Städtisches Klinikum Karlsruhe, Kaiserallee 10, 76133, Karlsruhe. Christian.harter@klinikum-karlsruhe.com
Abstract:
Malignant neuroleptic syndrome (MNS) is a rare side effect of antipsychotic medications but means a serious and life-threatening complication. The risk of MNS seems to be lower for second generation antipsychotics (SGA). We report the 9-month history of a 42-year-old female patient whose antipsychotic medication was switched to 800 mg per day of amisulpride. Two weeks after discharge she suffered muscular pain, stiffness, weakness of the legs, rigor, and fever. After attending our outpatient department and being diagnosed, she was transferred to the neurological intensive unit, where the creatine kinase (CK) level was measured at 160,000 U/l. Furthermore extensive rhabdomyolysis accompanied by a compartment syndrome was seen. Surgical intervention was necessary for the latter. The patient was then retransferred to the psychiatric department after treatment with lorazepam and withdrawal of antipsychotic medications. In addition a therapy with valproate sodium was conducted. Long-term high levels of CK and abnormalities in the electromyogram led to the hypothesis of myopathy as a possible risk factor, but a final diagnostic classification was not feasible. This report describes the appearance of a MNS as a consequence of SGA therapy, discusses risk factors and therapy options, and shows the 9-month course.
Insights
Malignant neuroleptic syndrome (MNS), a rare but life-threatening complication of antipsychotics, occurred in a patient on second-generation antipsychotics (SGA). This case highlights potential risks and management strategies for MNS during SGA therapy.
Area of Science:
- Neuroscience
- Pharmacology
- Clinical Medicine
Background:
- Malignant neuroleptic syndrome (MNS) is a rare, severe, and potentially fatal adverse reaction to antipsychotic medications.
- Second-generation antipsychotics (SGAs) are generally associated with a lower risk of MNS compared to first-generation agents.
Observation:
- A 42-year-old female developed MNS symptoms including muscle rigidity, fever, and elevated creatine kinase (CK) levels (160,000 U/l) two weeks after initiating amisulpride (an SGA).
- The patient experienced severe rhabdomyolysis and compartment syndrome, necessitating surgical intervention.
- She was treated with lorazepam, antipsychotic withdrawal, and valproate sodium, with a complex 9-month clinical course.
Findings:
- This case demonstrates MNS can occur even with SGA use, challenging the assumption of significantly reduced risk.
- Persistent high CK levels and electromyogram abnormalities suggested a possible underlying myopathy, though a definitive diagnosis was not established.
Implications:
- Clinicians should maintain a high index of suspicion for MNS in patients on SGAs, particularly those with risk factors.
- Prompt diagnosis, medication withdrawal, supportive care, and potential adjunctive therapies are crucial for managing MNS.
- Further research into risk factors, including potential myopathy, may refine MNS prevention and treatment strategies.
Related Concept Videos
01:23Antidepressant Drugs: MAOIs and Other Agents
01:21Antipsychotic Drugs: Typical and Atypical Agents
01:28Psychosis and Antipsychotic Drugs: Overview
01:24Mania and Antimanic Drugs: Overview
01:28Drug Therapy
Antianxiety Medications
01:21Antipsychotic Drugs: Therapeutic Uses and Side Effects
Despite these side effects, antipsychotics are used therapeutically for various purposes, including managing schizophrenia, preventing nausea and vomiting, curbing...