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Neuroleptic malignant syndrome and clozapine monotherapy
R Chatterton1, S Cardy, T M Schramm
1Wolston Park Hospital, Wacol, Queensland, Australia.
Objective:
This report identifies neuroleptic malignant syndrome (NMS) occurring on a steady state dosage of clozapine monotherapy.
Clinical Picture:
An outpatient presented with a recent history of stiffness and soreness of his legs, dizziness, polydipsia, polyuria, abdominal and chest pains. After admission to a general hospital, further symptomatology was identified including: pallor, diaphoresis, nausea, confusion, agitation, decrease in normal reflexes, minimally reactive pupils and rigid limbs.
Treatment:
Intravenous (I/V) diazepam was administered but failed to decrease the agitation and confusion. He was sedated with the administered of I/V droperadol, intubated and placed on a ventilator with circulatory supports for 4 days.
Outcome:
On day five he was extubated and transfered to a medical ward. All laboratory values had returned to normal values by this time. The patient was subsequently discharged.
Conclusions:
Neuroleptic malignant syndrome can occur at any stage of clozapine treatment, and the patient can be rechallenged after such an episode. This person was rechallenged and after 6 months of treatment has suffered no further recurrence of NMS.