Neuroleptic malignant syndrome associated with olanzapine

Area of Science:

• Psychiatry
• Pharmacology
• Neurology

Background:

• Neuroleptic Malignant Syndrome (NMS) is a rare but life-threatening condition associated with antipsychotic medications.
• Olanzapine is an atypical antipsychotic commonly used for bipolar disorder and schizophrenia.
• The association between olanzapine and NMS has been infrequently reported.

Observation:

• A 67-year-old male with bipolar disorder developed symptoms of NMS, including hyperthermia, rigidity, and altered mental status, while on olanzapine and divalproex sodium.
• The patient presented with confusion, delirium, and mania, progressing to classic NMS signs such as high fever, obtundation, tremor, diaphoresis, and elevated creatine kinase.
• Olanzapine was administered for 6 of the first 7 hospital days before being discontinued.

Findings:

• The patient exhibited all major manifestations of NMS, with no other plausible cause identified.
• Discontinuation of olanzapine led to the resolution of NMS symptoms within 5 days.
• This case represents the first documented instance of NMS associated with olanzapine use.

Implications:

• Clinicians should be vigilant for NMS symptoms in patients treated with olanzapine, particularly those with risk factors.
• Early recognition and discontinuation of the offending agent are crucial for managing NMS.
• This case adds to the understanding of the potential adverse effects of atypical antipsychotics.